Precautionary Practices of Respiratory Therapists and Other Health-Care Practitioners Who Administer Aerosolized Medications

Abstract

Introduction Respiratory therapists and other healthcare workers are potentially exposed to a variety of aerosolized medications. The NIOSH Health and Safety Practices Survey of Healthcare Workers describes current exposure control practices and barriers to using personal protective equipment during administration of selected aerosolized medications. Methods An anonymous, multi-module, web-based survey was conducted among members of healthcare professional practice organizations representing respiratory therapists, nurses and other healthcare practitioners. A module on aerosolized medications included submodules for antibiotics (amikacin, colistin, tobramycin), pentamidine and ribavirin. Results The submodules on antibiotics, pentamidine and ribavirin were completed by 321, 227 and 50 respondents, respectively, who were mostly respiratory therapists. The relatively low number of ribavirin respondents precluded meaningful interpretation of these data and may represent the rare use of this drug. Consequently, analysis focused on pentamidine, classified by NIOSH as a hazardous drug, and antibiotics amikacin, colistin, and tobramycin which currently lack authoritative safe handling guidelines. Respondents who administered pentamidine were more likely to adhere to good work practices compared to those who administered these antibiotics. Examples included: training received on safe handling procedures (75% vs 52%), availability of employer standard procedures (82% vs 55%), use of aerosol delivery devices equipped with an expiratory filter (96% vs 53%) or negative pressure rooms (61% vs 20%), and always using respiratory protection (51% vs 13%). Conclusions Despite the availability of safe handling guidelines for pentamidine, implementation was not universal, placing workers, co-workers, and even family members at risk of exposure. Although the antibiotics included in this study lack authoritative safe handling guidelines, prudence dictates that appropriate exposure controls are used to minimize exposure to the antibiotics as well as other aerosolized medications. Employers and employees share responsibility for ensuring that precautionary measures are taken to keep exposures to all aerosolized medications as low as practicable.

An in vitro investigation into the release of fugitive medical aerosols into the environment during manual ventilation

“…Due to the nature of their work, respiratory therapists can be exposed to an array of different compounds. Previous studies have reported healthcare workers (HCWs) experiencing side effects and airway irritation after the treatment of patients with aerosolized pentamidine, liposomal cisplatin, S&R isomers of Albuterol and ribavirin [12,14,15]. In certain circumstances, respiratory therapists can be also be exposed to experimental therapeutics used in the treatment of rare diseases or during global pandemics, the potential long-term side effects of which are unknown.…”

Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis

“…The ratio of nasal cannula outer diameter to nostril inner diameter determines the leak of oxygen, and consequently aerosol from the system also. This ratio also plays a part in the delivered aerosol dose, as well as the levels of fugitive emissions to the local environment, which is a key, but often forgotten consideration for healthcare professionals or bystanders during aerosol therapy [ 46 , 47 , 48 , 49 ]. A recent review of aerosol delivery during HFNT by Li and colleagues provides additional insight into the factors at play [ 50 ].…”

Fugitive Aerosol Therapy Emissions during Mechanical Ventilation: In Vitro Assessment of the Effect of Tidal Volume and Use of Protective Filters

“…Chughtai et al (2013) showed that airborne medical aerosols are an occupational hazard to HCWs and homecare workers. Tsai et al (2015) highlighted the lack of knowledge among respiratory therapists with…”