Cross-infection and the use and decontamination of placebo inhalers

Abstract

Historically, inhaled placebos have been provided by pharmaceutical companies and have been widely used by nurses both in primary and secondary care to teach respiratory patients how to use prescribed inhaled therapy. Over recent years, the author of this article has had concerns about the potential risk of cross-infection as a result of reusing placebos with disposable mouthpieces. This concern has been heightened by the lack of verbal and written guidance from the pharmaceutical companies that provide these placebos. There are no recognized protocols or guidelines on the most effective cleaning methods that would minimize or prevent cross-infection. The cleaning of large volume spacers, which are used to enhance a patient's inhaler technique, are particularly problematic as it is not possible to use a disposable mouthpiece with this device. In response to this problem, a cross-sectional, multicentre, regional audit was designed to identify the decontamination process adopted by nurses working in the fields of respiratory care and infection control. The audit outcome confirmed that nurses were using a number of different cleaning methods, with no sound evidence base to support their chosen methods of decontamination. This is an issue that requires further investigation and clarification if nurses are to continue assessing patients' techniques with inhaled devices.

Reducing the risk: the use of placebo respiratory equipment in clinical practice

“…Clinicians are clearly engaged with the infection prevention agenda and collaborative working can produce positive results. Such dilemmas, however, expose clinicians to unpalatable choices, as many strongly advocate the need for placebo devices but feel uneasy about the potential for harm ( Clancy, 2003 ). The potential removal of a key resource from clinical practice and the diversion of fi nances into single-patient items, due to an, at present, unquantifed and theoretical risk is also controversial ( Kendrick et al, 2003 ) and may hinder clinicians' willingness to promote infection prevention strategies.…”

“…The variation in countrywide practice highlights the need for national guidance on the issue. Even after Clancy (2003) highlighted concerns, the majority of pharmaceutical companies have chosen only to make placebo items single-patient use, rather than invest in research and development into the problem ( Weller, 2005 ). If demonstration of technique remains a central tenet of training and assessing patients, national interest groups and pharmaceutical companies should promote safe placebo technology or alternatives.…”

“…A range of devices are available for diagnosis, monitoring and treatment of respiratory diseases such as asthma and cystic fi brosis (CF). For years, healthcare professionals in primary and secondary care have used and re-used the same placebo inhalers, large volume spacer devices (spacers) and peak fl ow meters to teach correct technique and monitor compliance ( Clancy, 2003 ). Concerns have been raised, however, regarding the lack of guidance concerning the re-use of these devices, the wide variation in decontamination practice across the country and the risk of cross-infection ( Weller and Levy, 2002 ;Clancy, 2003 ).…”

Establishing a Quality Control Program: Ensuring Safety from Contamination for Recycled Metered-Dose Inhalers

“…It is difficult to find solid evidence to support a single methodology. 11 The Centers for Disease Control and Prevention (CDC) endorses categorizing medical devices as critical, semicritical, or noncritical as determined by the risk of infection involved with their use. 12,13 A noncritical item, one that can come in contact with intact skin but not mucous membranes, is associated with the least amount of risk for infection.…”

The role of disposable inhalers in pulmonary drug delivery

“…Also, the daily frequency of drug administration and number of different drugs to be inhaled vary between diseases. These different treatment regimens may require different, and more particularly new inhaler technologies to become therapeutically or cost effective [17], or to eliminate the risks of microbial contamination of the device and infection of patients with pathogens [18,19]. By using disposable instead of reusable inhalers, some of the requirements for these new treatment regimens may be met best.…”