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Hygiene with oxygen

Question
My question deals with the humidifiying of oxygen. On the one hand there are the Perlan-humidifier, which have to be filled with boiled water or the destilled water (Respiflo).
Which is more sensible with an increased incidence of infections?
And can the destilled water be reused after standing still for some days?
Many thanks for a quick answer.
Answer
Dear questioner,
concerning your question first of all a comment: in case I interpret it correctly, you want to know, which approach bears the lowest risk of infection from the hygienic point of view.
In case of the Respiflo it deals with a destilled that means demineralized water. The destillation has the aim of getting rid of impurities and salts, e.g. to avoid cristallization of salts at the nebulizers and tubes (most clean water). Respiflo however is via the process of production also a germ-free water (sterile water).
Concering the risk of an infection via the usage of Respiflo this is the relevant parameter. Therefore there could not be a direct danger of infection from Respiflo, unless the water would be contaminated after the opening subsequently. The risk of a secundary contamination of Respiflo differs according to the inidividual hygienic behaviour and the way of usage. In case Respiflo is used in a close system, means that there is no contact to the outside, e.g. directly to the breathing mask, its usage over 5 days is (according to the company) without risk. As this is a medical product, the company is forced to give detailed information on this (please see also the product information).

Boiled tap water can therefore of course not fulfill this requirements and is therefore more risky. Via boiling one can kill in general all relevant humid germs like e.g. P. aeruginosa, the grade of cleanness which can be achieved via destillation is however not realizable in any case. Calcification of salt on the devices can via certain circumstances favour a bacterial colonization, this is because a most clean water is more suitable. Moreover self-boiled water is more prone to recontamination than a commercially produced and quality-controlled product like Respiflo. This is similarly true for the oxygen-humidifier bottles, which have to be cleaned, refilled and reused.
Even in case of the usage of this systems with boiled water there is for sure not an extensively high risk of infection and these are of course not to be refused ín general, however a pure sterile water is more secure and therefore advisable form the microbiologic-hygienic point of view. Especiallly in patients with CF where different humid-germs play a role (Burkholderia sp., Achromobacter sp., etc), this should be taken into account more than in other groups of patients (e.g. asthma).
Yours sincerely,
Dr. Michael Hogardt
10.11.2009