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.