Implementation of a Breath-Actuated Nebulizer Regimen May Reduce Nosocomial Influenza Acquired by Exposure to Fugitive Droplet Emissions From Continuous Nebulizers Whose Droplets Produced During Exhalation Are Vented to the Environment

Abstract

Background: Most nebulizers generate aerosol continuously, resulting in the expulsion of droplets to the environment during each exhalation. Influenza virus particles attached to such droplets is a potential cause of infection for hospital staff. The influenza virus can survive up to 2–3 hours following droplet attachment. Transfer from continuous to breath-actuated nebulizer-based therapy might be beneficial in terms of reducing staff-acquired infections. The present study examined comparative costs associated with the care of patients in the Emergency Department of a mid-sized hospital on either continuous or BAN-based therapy.

Methods: Attendance records were examined for staff associated with the care of patients known to be carrying influenza virus and therefore isolated from the general population undergoing care in the ED. The following conditions were evaluated: (Group 1) Nov 2016—Mar 2017 for level 1 surgical procedure face mask for only the patients undergoing continuous nebulizer-based therapy (Airlife MistyMax-10 disposable nebulizer, CareFusion, San, Diego, CA); (Group 2) Nov 2017 — Dec 2017 for level 1 surgical procedure face mask for both staff and patients, the latter on continuous nebulizer therapy (as in (1) ) ; (Group 3) Jan 2018 — March 2018 for level 1 surgical procedure face mask for both staff and patients, the latter on BAN-based therapy (AeroEclipse-II, Monaghan Medical, Plattsburgh, NY).

Results: Table 1 summarizes the findings: While the use of facemasks by both staff and patients reduced the number of positive influenza tests, implementation of BAN-based therapy resulted in a further improvement protecting caregivers.

Conclusions: Implementation of BAN-based therapy has the potential to reduce costs associated with acquisition of nosocomial influenza in the ED.