Importance of Nebulizer Drying for Patients With Cystic Fibrosis.

BACKGROUND

Nebulizer therapy is an important treatment component for patients with cystic fibrosis (CF). Nebulizer manufacturers' guidelines advocate thorough nebulizer drying after washing. The aim of this study, therefore, was to examine the microbiology associated with nebulizer drying, particularly related to control, and to examine microbiologically non-adherence to the recommended drying procedures.

METHODS

Four aspects of nebulizer drying were examined in 3 common nebulizers, including examination of the drying profile, improvement to the drying profile of assembled nebulizers, survival of in tap water and in tap water plus 0.5% (v/v) dishwashing detergent, and the effect of drying of in tap water and tap water plus residual sputum (1%v/v, 10%v/v). Microbiologic examination was performed by using (5 clinical CF strains plus 1 National Collection of Type Cultures Reference strain).

RESULTS

There were differences in the time to complete dryness between disassembled and fully assembled nebulizers. Vigorous repeated shaking was unable to drive off all residual water on assembled nebulizers. counts did not decrease significantly in either tap water or in tap water plus detergent after 24 h storage at ambient temperature. In contrast, all organisms were killed when nebulizers were dried for 24 h, even when contaminated with 1% and 10% sputum. Dishwashing detergent did not demonstrate any antibacterial activity.

CONCLUSIONS

This study demonstrated that nebulizer drying, if applied properly, had the ability to reduce counts of to non-detectable levels. Equally, this study showed that, if the device was not dried thoroughly and moisture remained, then the device was able to support the survival of at high numbers, which constituted an infection risk to the patient with CF. This information may help educate and inform the patient with CF about the importance of proper nebulizer drying for control to improve patient awareness and safety.