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[Problems in the use, cleaning and maintenance of nebulization equipment in the home situation]
V H Struycken1, H A Tiddens, E T van den Broek
1Afd. Kindergeneeskunde, Academisch Ziekenhuis Rotterdam-Sophia Kinderziekenhuis.
Insights
Home jet nebulizers for pediatric asthma treatment are often used suboptimally. Many devices are contaminated, poorly maintained, and fail to deliver medication effectively, necessitating improved user education and regular technical checks.
Area of Science:
- Pediatric Pulmonology
- Respiratory Device Technology
- Infectious Disease Control
Context:
- Home-based nebulizer therapy is common for childhood asthma.
- Suboptimal use and maintenance of jet nebulizers can impact treatment efficacy.
- Bacterial contamination and device malfunction are significant concerns in pediatric respiratory care.
Purpose:
- To assess the optimal usage of home jet nebulizers in children with asthma.
- To identify deficiencies in user instructions and technical maintenance of jet nebulizers.
- To evaluate the microbial contamination and aerodynamic performance of frequently used nebulizers.
Summary:
- A descriptive study involving 39 children with asthma found significant issues with home jet nebulizer use.
- Fifty percent of nebulizers showed bacterial contamination, and over half operated below required pressure.
- Device age correlated with increased particle size, potentially reducing therapeutic effectiveness.
Impact:
- Highlights the need for improved patient education on nebulizer cleaning and maintenance.
- Recommends periodic technical assessments of jet nebulizers to ensure optimal function and safety.
- Findings underscore the importance of quality control for home respiratory care devices in pediatric asthma management.
Objective:
To determine whether jet nebulizers used at home for the treatment of children with asthma are used optimally.
Design:
Descriptive.
Setting:
Outpatient clinic for child pulmonary diseases of the Academic Hospital/Sophia Children's Hospital Rotterdam and outpatient clinic for child diseases of the Baronie Hospital Breda, the Netherlands.
Method:
Thirty-nine children aged 0-13 years and their parents were interviewed at home, and medication cup, saline and aerosol were cultured for bacterial analysis. The pressures of the compressor and nebulizer were measured with a manometer, and the particle size of the aerosol of 10 jet nebulizers was measured by laser technique.
Results:
The suppliers of the nebulizer did not provide clear instructions on user-related aspects and technical maintenance of the jet nebulizer. Many patients used damaged and poorly functioning, contaminated jet nebulizers. Contamination by potentially pathogenic micro-organisms was present in 50% of the saline, medication cups and aerosols (Klebsiella, Enterobacter, Pseudomonas, Serratia, Escherichia coli). The operating pressure of compressor and nebulizer was below the requirements in more than 50% of the jet nebulizers. In addition, we found that the aerodynamic mass median diameter increased considerably as the nebulizer became older. In 6/10 nebulizers the particle size was below 5 microns.
Conclusion:
A periodical checkup of user-related aspects and technical quality of jet nebulizers is necessary. The quality of the instruction to users about the procedure for cleaning and maintenance of the jet nebulizer should be improved.