2002 OPEN FORUM Abstracts
AMBIENT CONTAMINATION AND CAREGIVER PROTECTION DURING AEROSOL ANTIBIOTIC ADMINISTRATION.
Andrew R. Schwartz, RRT, CPFT; Robert M. Kacmarek, PhD, RRT, FAARC; Dean R. Hess, PhD, RRT, FAARC. Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Background: Administration of aerosol antibiotics has increased in recent years, which has raised concerns related to caregiver exposure. To our knowledge, there are no published standards related to caregiver protection during aerosol antibiotic administration. The results of an informal survey revealed a variety of practices in hospitals around the United States.
Hypothesis: A measurable amount of particulate is present in the room during aerosol antibiotic therapy, but actions can be used to minimize caregiver exposure.
Methods: A Puritan-Bennett 840 ventilator (Tyco, Carlsbad, CA) was attached to one chamber of a dual-chambered test lung (Michigan Instruments, Grand Rapids, MI). Ventilator settings were VT 0.5 L, rate 16/min, I:E 1:2. A lift bar placed between the chambers simulated spontaneous breathing of the second chamber, which was connected to a filter (Hospitak, Farmingdale, NY) that was in turn connected to a Pari nebulizer (Pari LC D, Monterey, CA). One vial (5 mL, 300 mg) of Tobi (tobramycin solution for inhalation, Chiron, Emeryville, CA) was placed into the nebulizer. The nebulizer was operated with a flow of 8 L/min until no further aerosol was produced. The amount of particulate in the room was sampled using an 8-stage cascade impactor (Andersen Mark II, Symra, GA). Particulate was collected on glass fiber media substrates and the amount of particulate deposited on each stage was determined gravimetrically (Mettler PB 153-S balance). The cascade impactor was placed 5 ft from the site of aerosol generation. The following conditions were tested in a patient room: 1) a baseline 1 hr sample with no aerosol generated during the sample period, 2) 1 hr sample with a simulated Tobi treatment at the beginning of the sample period, 3) a simulated Tobi treatment with a 1 hr sample initiated 30 min after the completion of a simulated Tobi treatment, 4) 1 hr sample with a simulated Tobi treatment during at the beginning of the sample period, with a respirator mask (3M 1860 Health Care Particulate Respirator) fitted over the inlet to the cascade impactor, 5) 1 hr sample with a simulated Tobi treatment during at the beginning of the sample period and the room configured for positive pressure.
Results: During the baseline measurement with no aerosol delivered into the room, no particulate was detected. During Tobi administration during, 9 mg of particulate was sampled and these particles were in the respirable range (MMAD 2.6 microns). When sampling was initiated 30 min after the completion of the Tobi aerosol, 4 mg of particulate was sampled with a MMAD of 1.1 microns. No particulate was sampled when the respirator mask was used and when the room was configured for positive pressure.
Conclusions: Although a measurable amount of respirable particulates were sampled during Tobi administration in a standard patient room, caregiver exposure was eliminated by use of a respirator mask or a positive pressure room. Further work is needed to assess other aerosolized antibiotics (e.g., colistin, amphotericin) and additional room configurations (e.g., negative pressure).