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Research ArticleOriginal Research

Importance of Nebulizer Drying for Patients With Cystic Fibrosis

John E Moore, Rachel E Moore, Jane Bell and B Cherie Millar
Respiratory Care October 2020, 65 (10) 1443-1450; DOI: https://doi.org/10.4187/respcare.07362
John E Moore
Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, Northern Ireland, United Kingdom.
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  • For correspondence: [email protected]
Rachel E Moore
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Jane Bell
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B Cherie Millar
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Abstract

BACKGROUND: Nebulizer therapy is an important treatment component for patients with cystic fibrosis (CF). Nebulizer manufacturers’ guidelines advocate thorough nebulizer drying after washing. The aim of this study, therefore, was to examine the microbiology associated with nebulizer drying, particularly related to Pseudomonas control, and to examine microbiologically non-adherence to the recommended drying procedures.

METHODS: Four aspects of nebulizer drying were examined in 3 common nebulizers, including examination of the drying profile, improvement to the drying profile of assembled nebulizers, survival of Pseudomonas aeruginosa in tap water and in tap water plus 0.5% (v/v) dishwashing detergent, and the effect of drying of P. aeruginosa in tap water and tap water plus residual sputum (1%v/v, 10%v/v). Microbiologic examination was performed by using P. aeruginosa (5 clinical CF strains plus 1 National Collection of Type Cultures Reference strain).

RESULTS: There were differences in the time to complete dryness between disassembled and fully assembled nebulizers. Vigorous repeated shaking was unable to drive off all residual water on assembled nebulizers. P. aeruginosa counts did not decrease significantly in either tap water or in tap water plus detergent after 24 h storage at ambient temperature. In contrast, all Pseudomonas organisms were killed when nebulizers were dried for 24 h, even when contaminated with 1% and 10% sputum. Dishwashing detergent did not demonstrate any antibacterial activity.

CONCLUSIONS: This study demonstrated that nebulizer drying, if applied properly, had the ability to reduce counts of P. aeruginosa to non-detectable levels. Equally, this study showed that, if the device was not dried thoroughly and moisture remained, then the device was able to support the survival of P. aeruginosa at high numbers, which constituted an infection risk to the patient with CF. This information may help educate and inform the patient with CF about the importance of proper nebulizer drying for Pseudomonas control to improve patient awareness and safety.

  • nebulizer
  • Pseudomonas aeruginosa
  • drying
  • cleaning
  • disinfection
  • contamination

Footnotes

  • Correspondence: John E Moore PhD, Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Lisburn Rd, Belfast BT9 7AD, Northern Ireland, UK. E-mail: jemoore{at}niphl.dnet.co.uk
  • This study was supported by the Northern Ireland Working Group on Nebuliser Care & Hygiene in Cystic Fibrosis, which has received educational grants from Vertex Pharmaceuticals and Chiesi (UK).

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (10)
Respiratory Care
Vol. 65, Issue 10
1 Oct 2020
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Importance of Nebulizer Drying for Patients With Cystic Fibrosis
John E Moore, Rachel E Moore, Jane Bell, B Cherie Millar
Respiratory Care Oct 2020, 65 (10) 1443-1450; DOI: 10.4187/respcare.07362

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Importance of Nebulizer Drying for Patients With Cystic Fibrosis
John E Moore, Rachel E Moore, Jane Bell, B Cherie Millar
Respiratory Care Oct 2020, 65 (10) 1443-1450; DOI: 10.4187/respcare.07362
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Keywords

  • nebulizer
  • Pseudomonas aeruginosa
  • drying
  • cleaning
  • disinfection
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