Inhalation Equipment Hygiene: A Belgian National Survey

Abstract

The Belgian CF Association sent this questionnaire to all Belgian CF patients. Of the 903 questionnaires distributed, 379 (42%) were returned. Fifty-two, 40 and 8% of patients used a vibrating-mesh nebulizer, jet nebulizer, or ultrasonic device, respectively. Ninety-eight percent of patients cleaned their material and soap was used by 35% of patients. Disinfection was performed by 91% of the patients and was daily performed by 57% of patients. Thermal disinfection (boiling water or sterilizer), a hypochlorite-based solution, or acetic acid solution was used by 44, 29, and 25% of patients, respectively, to disinfect their nebulizers. Thermal disinfection was used by 37 and 53% of patients using a classical or vibrating-mesh nebulizer, respectively. After cleaning or disinfection, 91% of the material was dried. The high percentage of Belgian CF patients disinfecting their nebulizer proves that they seem aware of the hygiene problem. The lack of unanimous guidelines in Belgium at the time of the study perhaps explains the variety of methods used. The arrival of vibrating-mesh nebulizers has led to a change in disinfection methods.

Nebuliser cleaning and disinfection practice in the home among patients with cystic fibrosis

“…This baseline measure of current practice revealed that a high proportion of adult CF patients (50%) and 20% of paediatric carers never disinfect their nebuliser, with none of the adults disinfecting it daily and only 42% of parents of children with CF doing so. These findings concur with a national study in Belgium, which reported that although the majority of patients cleaned their nebulisers on a daily basis, only 57% performed disinfection daily (Reychler et al, 2009).…”

Baby bottle steam sterilizers disinfect home nebulizers inoculated with bacterial respiratory pathogens

“…More importantly, in CF decreased adherence has been shown to correlate with poorer lung health, therefore a fast reliable method of cleaning is extremely important to this patient cohort [15]. A Belgian study found that only 57% of patients cleaned home inhalation devices daily as recommended [16]. A rapid and easy disinfection method would potentially improve adherence to daily disinfection and be consistent with other proposed strategies to reduce the treatment burden [17].…”

Nebuliser hygiene in cystic fibrosis: evidence-based recommendations

“…It has been reported that although patients are familiar with the importance of nebuliser care, often, the mesh component is never cleaned nor is an appropriate method of disinfection chosen, which in turn will have damaging effects on the mesh [ 5 , 7 ]. Decreased nebuliser output, increased nebulisation duration and nebulisers prematurely switching off have been reported in a number of studies examining e-Flow Rapid nebuliser evaluation delivering tobramycin over a 6-month period [ 7 , 8 ].…”

“…It has been reported that although patients are familiar with the importance of nebuliser care, often, the mesh component is never cleaned nor is an appropriate method of disinfection chosen, which in turn will have damaging effects on the mesh [ 5 , 7 ]. Decreased nebuliser output, increased nebulisation duration and nebulisers prematurely switching off have been reported in a number of studies examining e-Flow Rapid nebuliser evaluation delivering tobramycin over a 6-month period [ 7 , 8 ]. Due to the fact that the manufacturer's MeshCare system, which involves a reverse rinse of the nebuliser mesh with isotonic saline (5 mL for 20 min) by means of a bespoke small shower head significantly improves nebuliser performance, it is advised to use this system on a monthly basis and particularly when the duration of nebulisation time is increased [ 8 ].…”

“…There have been numerous reports of nebuliser hygienic practices in the home that have highlighted that each individual has their own ideas about how to clean and disinfect their nebuliser in terms of frequency of cleaning, washing, drying, disinfection and storage of nebulisers [ 7 , 14 , 15 , 24 ]. One of the earliest studies concluded that respiratory therapists should immediately address and improve their nebuliser cleaning methods and replacement practices with more focus on teaching patients these practices [ 25 ].…”