title: Microbial contamination of nebulizers in the home treatment of cystic fibrosis.
abstract: BACKGROUND
  Home nebulizers are in widespread use in cystic fibrosis (CF) and other chronic pulmonary diseases. Bacterial contamination may be a source of respiratory tract colonization.
  
  
  OBJECTIVE
  To investigate microbial contamination of home nebulizers in CF patients, compare with sputum cultures and relate to cleaning practices.
  
  
  METHODS
  A total of 29 home nebulizers of CF patients were cultured. Families were interviewed regarding cleaning routines and patients had sputum cultures for bacteria and fungi.
  
  
  RESULTS
  In total, 19/29 (65%) nebulizers were contaminated: 18 reservoir cups, 14 mouthpieces and five filters. Pseudomonas spp. were isolated from 10 nebulizers (35%) and all 10 had Pseudomonas aeruginosa airway infection although without genetic typing we could not be sure this was the same bacteria as that from their nebulizer unit. An additional 7/29 had Pseudomonas aeruginosa airway infection without a contaminated nebulizer (P=0.001). No nebulizers were contaminated with Aspergillus. Only 4/19 contaminated nebulizers (22%) had been cleaned after every use, compared with seven of the 10 (70%) uncontaminated nebulizers (P=0.017). Only 7/19 patients with contaminated nebulizers (37%) and 5/10 with clean nebulizers (50%) recalled receiving cleaning instructions (not significant).
  
  
  CONCLUSIONS
  Home nebulizers are frequently contaminated, particularly when cleaning instructions are inadequate, and may be a source of airway infection or reinfection especially following contamination from a patient chronically colonized with P. aeruginosa. Simple oral and written cleaning instructions should be offered.
authors.affiliation: Kathy and Lee Graub Cystic Fibrosis Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. hblau@post.tau.ac.il
authors.forename: H
authors.initials: H
authors.lastname: Blau
authors.forename: H
authors.initials: H
authors.lastname: Mussaffi
authors.forename: M
authors.initials: M
authors.lastname: Mei Zahav
authors.forename: D
authors.initials: D
authors.lastname: Prais
authors.forename: M
authors.initials: M
authors.lastname: Livne
authors.forename: B M
authors.initials: BM
authors.lastname: Czitron
authors.forename: H A
authors.initials: HA
authors.lastname: Cohen
mesh_terms: D003550:Cystic Fibrosis / Q000382:microbiology*; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D009330:Nebulizers and Vaporizers / Q000382:microbiology*; D010353:Patient Education as Topic; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*