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Vol. 14. Issue 4.
Pages 380-384 (July - August 2010)
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Vol. 14. Issue 4.
Pages 380-384 (July - August 2010)
Review article
Open Access
Recommendations for hygiene of masks and circuits in mechanically home ventilated patients
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Michel Toussaint1,
Corresponding author
michel.toussaint@inkendaal.be

Correspondence to: Centre for Neuromuscular Disease, and Centre for Home Mechanical Ventilation UZ-VUB-Inkendaal; Rehabilitation Hospital Inkendaal, Inkendaalstraat, 1; 1602 – Vlezenbeek – Belgium. Tel.: +32-2-5315111; fax: +32-2-5315301
, Gregory Reychler2
1 Centre for Neuromuscular Disease, and Centre for Home Mechanical Ventilation UZ-VUB-Inkendaal; Rehabilitation Hospital Inkendaal, Vlezenbeek, Belgium
2 Department of Physical Medicine and Rehabilitation, and Centre for Cystic Fibrosis, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Abstract

Home mechanical ventilation requires equipment, consisting of a generator of pressure, a tubing and an interface to deliver air to the patient. Instructions for equipment maintenance are generally not based on scientific evidence. Studies however have reported that tubing and masks used at home are the most commonly found as very dirty and contaminated. Dirtiness and contamination of equipment potentially expose patients to a higher risk of airway colonization, which, in turn, should cause respiratory infections. For this reason, published hygiene instructions include the use of disinfectant solution. Nevertheless, they generally fail to explain how basic maintenance may be achieved by simple cleaning with soap and water. The instructions for post-cleaning disinfection will depend upon the relative sensitivity of patients to respiratory tract infections and the related risks for bacterial colonization of the airways. Restrictive and obstructive disease patients are not equally sensitive to infections and, as a consequence, should not require similarly elaborate disinfection level. According with the restrictive or obstructive origin of respiratory insufficiency, the current educational review suggests simple and adequate rules for hygiene of tubing and masks in the home setting. Written instructions on how to clean the equipment for home ventilation are useful and sufficient in restrictive patients. In obstructive patients, cleaning always precedes disinfection. After cleaning, rinsing and drying are important. An effective weekly 20-minute disinfection may be achieved by using an hypochlorite solution of soaking in a concentration of 0.5%.

Keywords:
contamination
colonization
disinfection
home mechanical ventilation
hygiene
maintenance
non-invasive ventilation
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References
[1.]
C. Dohna-Schwake, P. Podiewski, T. Voit, U. Mellies.
Non-invasive ventilation reduces respiratory tract infections in children with neuromuscular disorders.
Pediatric Pulmonology, 43 (2008), pp. 67-71
[2.]
R. Farre, S.J. Lloyd-Owen, N. Ambrosino, et al.
Quality control of equipment in home mechanical ventilation: a European survey.
Eur Respir J, 26 (2005), pp. 86-94
[3.]
J.M. Rodriguez Gonzalez-Moro, G. Andrade Vivero, J. de Miguel Diez, et al.
Bacterial colonization and home mechanical ventilation: prevalence and risk factors.
Arch Bronchoneumol, 40 (2004), pp. 392-396
[4.]
M. Toussaint, M. Steens, A. Van Zeebroeck, P. Soudon.
Is disinfection of mechanical ventilation needed at home?.
Int J Hyg Environ Health, 209 (2006), pp. 183-190
[5.]
W. Ebner, A. Eitel, M. Scherrer, F.D. Daschner.
Can household dishwashers be used to disinfect medical equipment?.
J Hosp Infect, 45 (2000), pp. 155-159
[6.]
M. Antonelli, G. Conti, M. Rocco, et al.
A comparison of non-invasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure.
N Engl J Med, 339 (1998), pp. 429-435
[7.]
L. Brochard, D. Isabey, A. Harf, F. Lemaire.
Non-invasive ventilation in acute respiratory insufficiency in chronic obstructive bronchopneumopathy.
Rev Mal Respir, 1 (1995), pp. 111-117
[8.]
C. Guerin, R. Girard, C. Chemorin, R. De Varax, G. Fournier.
Facial mask non-invasive mechanical ventilation reduces the incidence of nosocomial pneumonia. A prospective epidemiological survey from a single ICU.
Intensive Care Med, 23 (1997), pp. 1024-1032
[9.]
K. Nourdine, P. Combes, M.J. Carton, et al.
Does non-invasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey.
Intensive Care Med, 25 (1999), pp. 567-573
[10.]
G.R. Hutchinson, S. Parker, J.A. Pryor, et al.
Home-use nebulizers: a potential primary source of Burkholderia cepacia and other colistin-resistant. Gram-negative bacteria in patients with cystic fibrosis.
J Clin Microbiol, 34 (1996), pp. 584-587
[11.]
B.M. Jakobsson, A.B. Onnered, L. Hjelte, B. Nystrom.
Low bacterial contamination of nebulizers in home treatment of cystic fibrosis patients.
J Hosp Infect, 36 (1997), pp. 201-207
[12.]
K.C. Pitchford, M. Corey, A.K. Highsmith, et al.
Pseudomonas species contamination of cystic fibrosis patients home inhalation equipment.
J Pediatr, 111 (1987), pp. 212-216
[13.]
S. Vassal, R. Taamma, N. Marty, et al.
A. Microbiologic contamination study of nebulizers after aerosol therapy in patients with cystic fibrosis.
Am J Infect Control, 28 (2000), pp. 347-351
[14.]
T.D. Mastro, B.S. Fields, R.F. Breiman, et al.
Nosocomial Legionnaires disease and use of medication nebulizers.
J Infect Dis, 163 (1991), pp. 667-671
[15.]
K. Merritt, V.M. Hitchins, S.A. Brown.
Safety and cleaning of medical materials and devices.
J Biomed Mater Res, 53 (2000), pp. 131-136
[16.]
S. Oie, D. Makieda, S. Ishida, Y. Okano, A. Kamiya.
Microbial contamination of nebulization solution and its measures.
Biol Pharm Bull, 29 (2006), pp. 503-507
[17.]
M. Denton, A. Rajgopal, L. Mooney, et al.
Stenotrophomonas maltophilia contamination of nebulizers used to deliver aerosolized therapy to inpatients with cystic fibrosis.
J Hosp Infect, 55 (2003), pp. 180-183
[18.]
M. Karapinar, S.A. Gonul.
Effects of sodium bicarbonate, vinegar, acetic and citric acids on growth and survival of Yersinia enterocolitica.
Int J Food Microbiol, 16 (1992), pp. 343-347
[19.]
G. Reychler, K. Aarab, C. Van Ossel, et al.
In vitro evaluation of efficacy of five methods of disinfection on mouthpieces and facemasks contaminated by strains of cystic fibrosis patients.
J Cyst Fibros, 4 (2005), pp. 183-187
[20.]
W.A. Rutala, S.L. Barbee, N.C. Aguiar, M.D. Sonsey, D.J. Weber.
Antimicrobial activity of home disinfectants and natural products against potential human pathogens.
Infect Control Hosp Epidemiol, 21 (2000), pp. 33-38
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