Cleaning Equipment 101 CF Education Day 2009

1. Cleaning Equipment 101CF Education Day 2009 Kristin Shelton, CPFT, RRT Cystic Fibrosis Center Lucille Packard Children’s Hospital at Stanford

2. Cleaning Your Respiratory Equipment • Germs can get on respiratory equipment and cause lung infections. • It is important to clean and disinfect equipment that has been in contact with mucous membranes, or secretions. • Clean and disinfectall equipment used for inhaled medicines or airway clearance using the manufacturer’s instructions.

3. To clean and disinfect your nebulizer, follow these steps: Clean your hands. 1

4. Disassembled nebulizer

5. Disassembled nebulizer

6. Disassembled nebulizer

7. 2 Clean and rinse the nebulizer parts.

8. 3 Disinfect nebulizer parts using one of these options: Boiling for 5 minutes

9. Dishwasher, if the water is hotter than 158° F for 30 minutes

10. The CFF has approved the electric Avent iQ24 steam sterilizer as an option for disinfection.

11. Soaking in a solution of 1 part household bleach and 50 parts water for 3 minutes 1 Part 50 Parts +

12. 4. Rinse the nebulizer parts. If you disinfect using bleach, rinse all parts thoroughly using sterile water. You can make water sterile by boiling it for 5 minutes. 5. Air-dry the nebulizer parts. Drain the parts on a clean surface covered with new paper towels. Remember, germs will grow on anything that stays wet, so store the dry nebulizer in a clean, dry bag in a clean, dry place.

13. Maintaining your compressor Remember to change your filter every 6 months

14. Which nebulizer for which drug? • Pari LC Plus: • Tobi • Colistin (Colistimethate, Colymycin) • Albuterol • Hypertonic Saline (Hyper-sal) • Pulmozyme (Dornase Alpha) • Mucomyst (Acetylcystine) • PulmocortRespules (Budesonide)

15. Which Nebulizer for which drug • Pari Sprint: • Use with Albuterol • Hypertonic Saline • Mucomyst (Acetylcystine) • Pulmozyme (Dornase Alfa) • PulmicortRespules *Replace every six months

16. Which nebulizer for which drug? • Pari LC Star • Colistin (Colistimethate, Colymycin)

17. Which nebulizer for which drug? Side Stream nebulizer: Use with Pulmozyme (Dornase Alfa) or Albuterol Replace once a year

18. Which nebulizer for which drug? E-flow nebulizer: Use with Colistin (Colistimethate sodium), Hypertonic saline Replace aerosol head every ninety days

19. Which nebulizer for which drug? Disposable nebulizer: use if you have no other nebulizer available. Replace each month

20. Nebulizing for a child The bubble’s the fish mask will melt if boiled.

21. Nebulizing for an infant

22. Recommended order of nebulized medications • Bronchodilators: (Albuterol, Xopenex, Atrovent, Combivent) to open the airways. • Mucomyst: (10%) (20%) to break up mucous. • Hypertonic Saline: (7%) (available now in premixed vial manufactured by Pari called Hypersal) to mobilize mucus and improve airway clearance. • Pulmozyme: (Dornase Alfa) to thin mucus. • Airway Clearance • Antibiotics: (TOBI, Colistin) the previous therapies open and clear the airways thereby improving the distribution and effect of these antibiotics. • Steroids: (Flovent, Pulmicort, QVAR, Symbicort, Advair) to relieve inflammation.

23. Special Considerations • Do not mix medications in the same nebulizer unless proven to be compatible. • Use a mouthpiece whenever possible (moving the mask just 2 cm away from the face may reduce the delivery of nebulized drug by up to 85%; in addition, nasal deposition further reduces airway deposition). • Learn how each medication should be stored (e.g., refrigerator, room temperature, travel considerations) and any special mixing concerns. • Be aware of possible side effects for each medication (e.g., bronchospasm, hoarseness/voice changes, increased cough and/or secretions, sore throat, loss of taste or hearing).