The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

BACTERIA GROWTH IN HIGH-EFFICIENCY NEBULIZERS FOR SINGLE PATIENT USE

Betsy Robertson, RRT, Thomas Kallstrom, RRT Fairview Hospital Cleveland Clinic Health System, Cleveland, Ohio


Background:
Is it necessary to change aerosol nebulizers every twenty-four hours for patients on regularly scheduled treatments? This is the recommendation according to the AARC Clinical Practice Guidelines, subtitled Delivery of Aerosols to the Upper Airways. This guideline states that "nebulizers should be changed or sterilized at the conclusion of a procedure that is not to be repeated; or every twenty-four hours with repeated or continuous administration or more often when visibly soiled."

Introduction:
Fairview Hospital Cleveland Clinic Health System is a 500 bed acute care full service health care facility located on the western border of Cleveland, Ohio. Changing nebulizers every twenty-four hours for patients on scheduled or continuous treatments, as recommended by the AARC guidelines, has not been the standard of care. Although patient length of stay has lessened considerably, it is not uncommon for a patient to use the same nebulizer from admission to discharge. To the best of our knowledge there has been no evidence of subsequent infection resulting from this practice. However, it did prompt us to conduct a study to alter our standard of care if necessary.

Method:
A total of twenty-five adult spontaneously breathing patients were randomly identified for this study. The study group consisted of thirteen female and twelve male patients with an average age of 67.8 years. All patients were selected without regard to diagnosis and had a variety of medical and surgical diagnoses. All patients were admitted to a variety of medical and surgical units throughout the hospital, including the skilled nursing unit. One person was a long term tracheostomy patient. One person was in isolation for MRSA. The minimum length of stay was four days. At the beginning of the study each patient was supplied with a new single patient use airlife sidestream high-efficiency nebulizer with a seven foot oxygen tube, T adapter, mouthpiece or mask. The nebulizer was put into a new plastic set-up bag and placed at the patient's bedside. Every twenty-four hours, for the next seventy-two hours, the nebulizer medicine chamber and mouthpiece were cultured for bacteria with a S/P Brand Culture Swab Collection and Transport System. The nebulizers were cultured as they were found at the bedside. The respiratory care practitioners had no prior knowledge of the study being conducted. Each culture swab was numbered and transported to the microbiology lab where they were transferred to an agar plate and incubated for four days. 

RESULTS:
After studying the cultures, we found a common oral flora identified as Staphylococcus coagulase negative bacteria, which requires no treatment, in only three of the twenty-five nebulizers studied. This finding indicates that the positive culture was likely due to self-contamination.

Discussion: Since swabbing the nebulizer medicine chamber and mouthpiece of twenty-five random patients resulted in finding only a rare occurrence of a common oral flora in three nebulizers, we discovered that our current standard of practice of not replacing or sterilizing aerosol nebulizers every twenty-four hours, as recommended by the AARC Clinical Practice Guidelines mentioned above, does not have a negative effect on respiratory patients.

CONCLUSION:
According to our study of twenty five patient nebulizers, we conclude that we can responsibly continue our current standard of practice without jeopardizing patient care. Unless visibly soiled, a single patient use nebulizer can be safely used repeatedly by a patient for a maximum of four days. However, other institutions, where nebulizers are changed more frequently, should conduct their own studies on a larger patient population to validate these findings. If validated, our current standard of practice could significantly reduce equipment cost.

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