Current practice in decontamination of nebulisers in ventilated patients, Johannesburg, South Africa
Date
2011-02-10
Authors
Ellis, Amy Jean
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Abstract
Background:
Jet nebulisers are one of the primary devices used in the nebulisation of ventilated patients. It has
been observed that due to cost restraints devices marked as “single use” are inadvertently being
used as “single-patient-use” devices. This has both ethical and medico legal implications for the
ICU. Ventilator-associated pneumonia (VAP) in limited-resource countries carries a large burden of
increased mortality, morbidity and cost. Ineffective or absent nebuliser decontamination in
ventilated patients can increase the risk of the development of VAP as well as the risk of antibiotic
resistance.
Objectives:
The aim of this study was to examine the current practice of nebuliser decontamination and the
incidence of contamination of nebulisers after use within a ventilator circuit, in ICUs in
Johannesburg, South Africa. The secondary objectives of the study were to assess the presence of
and adherence to a decontamination protocol in intensive care units (ICU) in Johannesburg and to
identify which practices were associated with lower or no bacterial growth.
Methods:
A cross-sectional study design was used which included an interview with the unit manager and an
audit of current nebuliser practice in the ICU. Nebulisers that were identified in the interview were
then swabbed and streaked on blood agar plates (BAPs). Blood agar plates were then incubated
and assessed for bacterial colonisation, number of colony forming units (CFUs) and number of
different species of CFUs that were formed.
Results:
Single-use jet nebulisers represented 93% of nebulisers used within a ventilator circuit. All of the
single-use jet nebulisers were being re-used (n=42). None of the hospitals studied had a nebuliser
decontamination protocol. The contamination rate for jet nebulisers that had been re-used within
the ventilator circuit was 52%. In the group of nebulisers that had bacterial colonisation, the
nebulisers that were stored in a sterile drape had a significantly higher concentration of bacterial
growth, than those that were not stored in a sterile drape (p=0.03). Nebulisers are often used in the
administration of bronchodilators in ICUs in Johannesburg, South Africa. Colonised nebulisers can
create bacterial aerosol when used within a ventilator circuit. A change to single-patient-use
devices, such as vibrating mesh nebulisers, may assist in reducing the problem of colonisation of
jet nebulisers.
Conclusion:
The rate of colonisation of jet nebulisers that have been re-used is unacceptably high. ICUs need
to develop nebuliser decontamination protocols. Physiotherapists should assist with creating
awareness and driving the creation of these protocols. ICUs should be encouraged to change
single-use devices to single-patient-use devices. Nebulisers should not be stored in sterile drapes
after use in a ventilator circuit.
Description
MSc, Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand
Keywords
nebulisers, decontamination, contamination