Abstract
Background: The recommended infection control procedure in medicated aerosol therapy is to rinse the small volume nebulizer (SVN) reservoir with sterile distilled water after each treatment and allowing it to air dry, to prevent bacterial growth. Studies involving this topic have yielded conflicting results regarding which reagent and rinsing method is effective. If infection control guidelines are not being followed during the patient’s length of stay, (e.g. 3-5 days), there is the potential for bacterial growth inside the nebulizer, which may be inhaled by the patient, leading to nosocomial infection. The research question is: does rinsing the SVN reservoir with sterile distilled water and air drying reduce bacterial contamination in SVN reservoirs?
Methods: Following IRB approval, swab samples were collected from SVN reservoirs in clinical use, before and after the recommended sterile distilled water rinsing protocol was performed. Equipment belonging to patients in isolation was excluded. Nebulizers were chosen based on ordered frequency of bronchodilator therapy. A control group consisted of samples from reservoirs that had not been rinsed. The experimental samples came from the same reservoirs that had been rinsed with sterile distilled water and allowed to air-dry (the recommended protocol). All samples were plated on 5% sheep blood agar using serial dilution, incubated at 37°C for 18-24 hours, and evaluated for bacterial colony growth. Colony forming units (CFUs) were counted and compared between the two groups to determine if there was a difference in CFUs between the control and experimental groups. The data were analyzed using a paired T test (Excel, Microsoft Corp, Redmond, WA) to compare pre and post sample colony forming units (CFUs).
Results: Ten nebulizers in clinical use were chosen to be evaluated for this research. Each SVN had been used to nebulize bronchodilators at a frequency of every four hours for two days or more. There was a significantly lower number of CFUs in those nebulizers that had been rinsed (P= 0.01, 95% CI -11.69 to -0.3).
Conclusions: This study concludes that rinsing the SVN reservoir with sterile distilled water and allowing to air dry, reduces bacterial contamination in SVN reservoirs.
Nebulizer 7 control (pre rinse) and experimental (post rinse) cultures.
Footnotes
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