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Disinfection
- Question
- Hello. My 14 years old son is currently treated in a research protocol with inhaled bromure tiotropium, 2 puffs each morning. It’s just like inhaled salbutamol. When I have asked about disinfection of the mouth piece of the pressurized metered-dose inhaler (pMDI), the CF Centre staff said that, like salbutamol pMDI, no disinfection of the mouth piece was required. I am surprised. Even if the bacteria are those of my son, they probably stay on the mouth piece with a possible risk of re-contamination (since September, he is treated each month with antibiotics for a Staphylococcus aureus. If this Staphylococcus is always present on the mouth piece, he will never get rid of it). For instance, if a disinfection of the flutter, only used by my son, is recommended, it’s surely to protect him against his bacteria. Thanks to give me the best way to do.
- Answer
- Hello and thanks very much for your question about disinfection of the pMDIs mouth pieces. Curiously, there are no published microbiological data concerning the pMDIs mouth pieces and no official disinfection recommendations (type and frequency), contrasting with what we know about other medical devices such as nebulizers or spacer devices. Despite this lack of data, the “good sense” recommends to do the same aswhat we do with the nebulizers mouth pieces, i.e. wash mouth pieces with water and soap, rinse them with tap water, and thermically (NUK for instance) or chemically (hypochlorite sodium) disinfect them at least once a week. Be sure before re-use of the pMDI’s that there is no humidity inside the mouth piece, particularly into the tiny hole from where the inhaled drug is ejected because this may considerably alter the quality of the drug aerosol. In some cases it is possible to prescribe to the patient several pMDIs of the same drug to alternate mouth pieces and to allow their disinfection. At last the use of a spacer device, usually proposed to facilitate the aerosol delivery, may also be useful.
Sincerely,
Pr Jean-Christophe Dubus - 02.02.2011
