Clinical study
Contaminated medication nebulizers in mechanical ventilator circuits: Source of bacterial aerosols

https://doi.org/10.1016/0002-9343(84)90520-5Get rights and content

Abstract

The contamination rates of medication nebulizers inserted into mechanical ventilator circuits were studied. Semiquantitative techniques were used to sample the reservoir fluid from in-line nebulizers during the first 24 hours after a circuit change. In the initial survey, high levels of contamination (organism concentrations above 103/ml) were present in 13 (68 percent) of the 19 nebulizer reservoirs, and bacterial aerosols were produced by 10 (71 percent) of 14 nebulizers. Gram-negative bacilli were the predominant organisms isolated. Nebulizer contamination originated primarily from reflux of contaminated condensate in the ventilator circuit. When nebulizers were cleaned after each treatment, a reduced rate of contamination was found. Small bacterial aerosols (less than 3 microns in size) were produced in vitro after inoculation of nebulizers with gram-negative bacilli in concentrations isolated from in-use nebulizers. Contaminated in-line medication nebulizers generate small-particle bacterial aerosols that may increase the risk of ventilator-associated pneumonia and therefore should be cleaned or disinfected after each treatment rather than every 24 hours.

References (21)

  • AM Lerner

    The gram-negative bacillary pneumonias

    DM

    (1980)
  • PA Gross et al.

    Deaths for nosocomial infections; experience in a university hospital and a community hospital

    Am J Med

    (1980)
  • JA Reinarz et al.

    The potential role of inhalation therapy equipment in nosocomial pulmonary infection

    J Clin Invest

    (1965)
  • T Schulze et al.

    Studies of a new humidifying device as a potential source of bacterial aerosols

    Am Rev Respir Dis

    (1965)
  • JJ Mertz et al.

    A hospital outbreak of Klebsiella pneumonia from inhalation therapy with contaminated aerosol solution

    Am Rev Respir Dis

    (1967)
  • I Phillips

    Pseudomonas aeruginosa respiratory tract infections in patients receiving mechanical ventilation

    J Hyg (Camb)

    (1967)
  • RE Ringrose et al.

    A hospital outbreak of Serratia marcescens associated with ultrasonic nebulizers

    Ann Intern Med

    (1968)
  • EB Edmondson et al.

    Nebulization equipment: a potential source of infection in gram-negative pneumonias

    Am J Dis Child

    (1966)
  • AK Pierce et al.

    Long-term evaluation of decontamination of inhalation-therapy equipment and the occurrence of necrotizing pneumonia

    N Engl J Med

    (1970)
  • Centers for Disease Control

    Guidelines for prevention of nosocomial pneumonia

    Infect Control

    (1982)
There are more references available in the full text version of this article.

Cited by (139)

  • Ventilator circuit leak alarm–think of unusual cause

    2019, Trends in Anaesthesia and Critical Care
  • Clinical outcome associated with the use of different inhalation method with and without humidification in asthmatic mechanically ventilated patients

    2017, Pulmonary Pharmacology and Therapeutics
    Citation Excerpt :

    When used with optimal technique, MDIs and nebulizers were found to be equally effective in the management of mechanically ventilated patients with different obstructive lung disease [48]. For routine bronchodilator therapy, MDIs may be preferred because of their convenience, more consistent dosing, and, similar to VMN, potential reduced risk of bacterial contamination when compared to JN [49,50]. In one survey of neonatal ICUs, MDI use was reported to have increased significantly over a period of approximately 20 years [51].

  • Fill volume, humidification and heat effects on aerosol delivery and fugitive emissions during noninvasive ventilation

    2017, Journal of Drug Delivery Science and Technology
    Citation Excerpt :

    In our model the use of humidification (HN) increased residual volume in the JN medication reservoir compared to NN (p = 0.048). This might be due to the location of the JN medication reservoir below the T-piece in the circuit which encourages return of aerosol droplets condensate to the reservoir allowing it to be either re-nebulized or left in the reservoir, which could lead to contaminated aerosol delivery to the patient [2,4,16,22]. However, there was no effect at all by the humidification or heat on the amount of salbutamol left in the medication reservoir of VMN.

View all citing articles on Scopus

This work was supported by a Program Project Grant, Blue Cross-Blue Shield, Massachusetts Hospital Association, Boston, Massachusetts, and was presented in part at the 23rd Interscience Conference on Antimicrobial Agents in Chemotherapy, October 21, 1983, Las Vegas, Nevada, and the 10th Annual Meeting of the Association for Practitioners in Infection Control, May 14, 1983, San Diego, California.

1

From the Divisions of Infectious Diseases and Pulmonary Medicine, Department of Medicine, Boston University School of Medicine, Boston City Hospital, Boston, Massachusetts.

View full text