Expert advice on this patient concern
I was recently admitted to hospital with an exacerbation of my asthma and required nebulised drugs. I was somewhat surprised that during my hospital stay my nebuliser was constantly used for a week and during this time it was not washed and cleaned out.
I took my mask and pipe to the bathroom to wash it and was challenged by the nurse who said that she had never heard of washing masks. When I put my argument to her about cross-contamination she understood where I was coming from but said that it wasn’t the policy of the hospital and it had not been addressed in any training.
I would like to ask if this is safe practice. Are there guidelines?
It is important that nebuliser chambers are clean and dry before use.
Medication is delivered directly to the lungs and could, if contaminated, be a source of infection. To ensure appropriate hygiene nebulisers are either single use, denoted by the symbol, and disposed of after each administration, or single-patient use, enabling nebulisers to be washed with warm soapy water and air dried in between treatments, or at least daily.
It is important that single-use devices are not re-used as the durability of the product often diminishes after one use, resulting in poor performance (and therefore potentially poor drug delivery).
Cost consideration is an issue: single-use nebulisers, although often cheaper per item, can be more costly per inpatient episode.
In A&E it may be cheaper to use single-use equipment, whereas in ward areas single-patient nebulisers may be a more cost-effective choice.
Nebulisers in this category often can be re-used for up to three months providing cleaning and storage instructions are explicitly followed.
Nursing staff time can be an additional resource consideration if regular washing is needed. However, if patients are expected to continue nebulised therapy after discharge their stay in hospital can be an ideal opportunity to teach them correct use, and delegating responsibility for cleaning to them supports self-management and independence.
Carol Kelly is a senior lecturer at Edge Hill University, Lancashire.