The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Susan Rinaldo-Gallo, Ricky Bowen; Respiratory Care Services, Duke University Health System, Durham, NC

Background The emergence and spread of 2009 pandemic influenza A (H1N1) virus resulted in substantial influenza activity in the United States throughout the summer and fall months of 2009, with activity peaking in late October. Providing respiratory care is associated increased risk to RCPS. In particular administering medicated aerosol treatments exposes therapists to exhaled airborne particles that can carry H1N1 virus. We put practices in place that would reduce environmental exposure to aerosol particles from both symptomatic and non symptomatic patients. Methods We made two program changes: 1. Reinforced our delivery device selection protocol for Albuterol and Ipratropium orders. Patients who could perform MDI maneuver were automatically switched to MDI with a spacer/holding chamber. MDI treatments emit fewer particles than Small Volume Nebulizer treatments. 2. In addition to MDIs, we selected other equipment that would decrease the quantity of exhaled aerosol particles. Patients unable to perform MDI were placed on Breath Activated Nebulizers (BAN). If patients were unable to perform the BAN maneuvers, they were given treatments with a SVN and a mouthpiece using a filter on the exhalation port. If patients were unable to perform treatments with a mouth piece, the treatment was administered with a SVN nebulizer using a mask that had filters over the exhalation ports. Results Six months prior to implementation of this program the average Albuterol and Ipratropium treatments administered via MDI was 41.0%. After implementation the per cent increased to 55.1%. We could not quantify if these precautions actually decreased the transmission of H1N1 to our employees. There were too many variables such as H1H1 exposure outside of work and culturing employees was not feasible. Conclusion Transmission of respiratory infections such as H1N1 is possible through aerosol particles. Infection control precautions should be taken with symptomatic and non- symptomatic patients during a pandemic. The above describes the extra precautions taken at Duke Hospital by the Respiratory Care department. Sponsored Research - None

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