The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

“Implementing Infection Control Guidelines in Cystic Fibrosis Patients: Nebulizer Management Protocol”

Edward Conway RRT, Leslie Phillips, RRT, Amy Moore, CRT, Gerry Pandzick, RN, Jeanne Weiland, RN, Beth Maggard, RN Cincinnati Children’s Hospital Medical Center, Cincinnati Ohio

Background Lung infections are one of the main causes of deterioration in health for people with cystic fibrosis and account for 95% of deaths. Pulmonary infections, particularly with bacteria like P.Aeruginosa, B.Cepacia and ORSA are primary reasons for hospital admissions and can lead to a decline in lung function. The use of nebulizers with a reservoir, common inpatient settings, can allow growth of hydrophilic bacteria that can be nebulized during the use of the device.

Parents on our Quality Improvement Initiative Team raised concerns around infection control practices, specifically use of nebulizers on inpatient units at Cincinnati Children’s Hospital. This promoted us to look at our practices of cleaning, storage, and replacement of nebulizers.

Method Review of the literature regarding current recommendations for small volume nebulizer management revealed the following:

Cystic Fibrosis Foundation Infection Control Consensus Guidelines: disinfect nebulizers, rinse with sterile water, and air dry after each use.

American Association Respiratory Care: change or sterilize nebulizes every 24 hours or more often when visibly soiled.

APIC: Sterilize, disinfect or rinse nebulizers with sterile water and air dry after each use.

Our committee comprised of a parent, Respiratory Therapist, Cystic Fibrosis Nurse Specialist, and an Infection Control Nurse reviewed the above recommendations and assessed current practices at our institution. Findings were that practices at Cincinnati Children’s were inconsistent and did not meet any of the above recommendations. The committee developed a new protocol for the small volume nebulizer management consistent with the recommendations by the CF Foundation and AARC that was considered practical for inpatient hospital setting. This protocol included:

Rinsing of all small volume nebulizers with sterile water after each use.

Air-drying of small volume nebulizers on a clean paper towel

Discarding of all small volume nebulizers and sterile water bottles after 24 hours of use

Responsibilities for these components of the protocol were delineated among each shift of the Respiratory Therapist. Respiratory Therapist were instructed on the new small volume nebulizer management protocols and informed of the rationale for change in practice.

Results In order to evaluate the success of this project, measures were identified. These included monitoring of daily dating and replacement of small volume nebulizer and of sterile water bottles. Additionally, the Respiratory Therapist from our committee collected observational data regarding appropriate rinsing practices. Results were shared monthly with unit staff.

Data collection began in April of 2003. Results for small volume nebulizer’s changes ranged from 70% to 100% of the time. Sterile water replacement ranged from 90% to 100%. Since January 2004 100% adherence to the management protocol has been sustained for both small volume nebulizers and sterile water replacement.

Successful implementation of infection control practices related to small volume nebulizer management can be achieved with interdisciplinary collaboration between parents, inpatient, respiratory Therapist, and the Cystic Fibrosis Team, and Infection Control Practitioner. Ongoing collection of data and feedback to health care providers and continual refinement are necessary for sustained reliability of the improvement at 100%

Conclusion Adherence to the small volume nebulizer protocol has allowed us to provide safe care to patients and to improve patient satisfaction.

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