Bowdoin College, Brunswick, Maine.
Charlotte Hungerford Hospital, Department of Respiratory Care, Torrington, Connecticut.
Respir Care. 2024 Nov 18;69(12):1543-1547. doi: 10.4187/respcare.11760.
Despite advancements in cystic fibrosis (CF) therapeutics, the persistence of chronic infections necessitates continued use of nebulized therapies. Though the Cystic Fibrosis Foundation recommends well-defined cleaning and disinfection of nebulizers to mitigate pathogen exposure risks, discrepancies between Cystic Fibrosis Foundation guidelines, manufacturers' instructions, and variability in center recommendations contribute to confusion and non-standardized practices.
A digital survey was distributed to directors, associate directors, and care coordinators of CF centers across the United States to investigate the methods, frequency, and educational practices surrounding nebulizer care they provide patients. Responses were analyzed using descriptive techniques and chi-square analyses.
Of 855 distributed surveys, 129 respondents provided insights into nebulizer care recommendations. Discrepancies in disinfection frequency were notable, with 18% of respondents recommending disinfecting nebulizers less than daily. Approximately 20% of respondents were unsure if their recommendations aligned with Cystic Fibrosis Foundation guidelines while 73% reported that their recommendations strictly adhered to the published guidelines. Of this 73%, all recommended at least daily cleaning, with 69% specifying cleaning before reuse; and 88% recommended disinfection at least daily, with 36% specifying disinfection before reuse. Only 10% recommended both cleaning and disinfection after every use. Disinfection less than daily was recommended by 11% of the respondents who felt they were strictly following the guidelines. We also highlight respondents who cited barriers to strict adhesion to the published guidelines.
The highlighted variations in CF centers' recommendations for nebulizer care with deviations from Cystic Fibrosis Foundation guidelines underscore the necessity for developing clear and practical guidelines that consider both efficacy and the realities of patient adherence. Collaboration among CF care centers, patients, guideline committees, and other stakeholders is essential to develop recommendations that effectively address the challenges faced by the CF community, ensuring the safe and effective nebulizer use.
尽管囊性纤维化 (CF) 的治疗方法有所进步，但慢性感染的持续存在仍需要持续使用雾化治疗。虽然囊性纤维化基金会建议对雾化器进行明确的清洁和消毒，以降低病原体暴露风险，但囊性纤维化基金会指南、制造商说明以及各中心建议之间的差异导致了混淆和非标准化实践。
我们向美国各地 CF 中心的主任、副主任和护理协调员分发了一份数字调查，以调查他们为患者提供的雾化器护理方法、频率和教育实践。使用描述性技术和卡方分析对回复进行分析。
在分发的 855 份调查中，有 129 名受访者就雾化器护理建议提供了见解。在消毒频率方面存在明显差异，18%的受访者建议每天少于一次对雾化器进行消毒。大约 20%的受访者不确定他们的建议是否符合囊性纤维化基金会的指南，而 73%的受访者报告说他们的建议严格遵循了已发表的指南。在这 73%的受访者中，所有人都建议每天至少进行一次清洁，其中 69%规定在重复使用前进行清洁；88%建议每天至少进行一次消毒，其中 36%规定在重复使用前进行消毒。只有 10%的受访者建议每次使用后都进行清洁和消毒。有 11%严格遵循指南的受访者建议每天少于一次消毒。我们还强调了一些受访者提到的遵守已发表指南的障碍。
CF 中心对雾化器护理的建议存在差异，与囊性纤维化基金会的指南存在偏差，这突出表明需要制定明确和实用的指南，既要考虑疗效，又要考虑患者依从性的现实情况。CF 护理中心、患者、指南委员会和其他利益相关者之间的合作对于制定建议至关重要，这些建议需要有效应对 CF 社区面临的挑战，确保安全有效的雾化器使用。
