title: Nebulizers in cystic fibrosis: a source of bacterial contamination in cystic fibrosis patients?
abstract: OBJECTIVE
  To determine whether nebulizers are a source of microbial contamination in patients with cystic fibrosis, as well as whether the technique and frequency of disinfection of these devices is appropriate.
  
  
  METHODS
  This was a cross-sectional, uncontrolled observational study. Samples were collected from 28 patients with cystic fibrosis. Samples were collected at the homes of the patients, who were not previously informed of the purpose of the visit. Three samples were collected from each patient: one from the nebulizer chamber, one from the mask/mouthpiece, and one from the patient (oropharyngeal swab /sputum). The samples were properly stored and taken for analyses. The patients, their parents, or their legal guardians completed a questionnaire regarding nebulizer cleaning and disinfecting methods.
  
  
  RESULTS
  We collected 84 samples from the 28 patients. Of those 28 patients, 15 (53.5%) were male. The median age of the patients was 11 years (range, 1-27 years). Of the 28 patients, 15 presented with positive oropharyngeal swab /sputum sample cultures. The most common bacterial isolates were Staphylococcus aureus (in 8 patients) and Pseudomonas aeruginosa (in 4 patients). Although the samples obtained from the nebulizers presented with various pathogens in culture, no specific species predominated. In 27 cases (96.7%), there were no associations between the samples obtained from the nebulizers and those obtained from the patients in terms of the results of the cultures. Cleaning and disinfection of nebulizers were inappropriate in 22 cases (78.6%).
  
  
  CONCLUSIONS
  In this sample of patients, despite the inappropriate disinfection techniques, nebulizers were not found to be a source of microbial contamination.
authors.affiliation: Pequeno Príncipe Hospital, Curitiba, Brazil. lobrzezinski@gmail.com
authors.forename: Lorena Xavier Costa
authors.initials: LX
authors.lastname: Brzezinski
authors.forename: Carlos Antônio
authors.initials: CA
authors.lastname: Riedi
authors.forename: Paulo
authors.initials: P
authors.lastname: Kussek
authors.forename: Helena Homem de Melo de
authors.initials: HH
authors.lastname: Souza
authors.forename: Nelson
authors.initials: N
authors.lastname: Rosário
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000382:microbiology*; D004203:Disinfection / Q000592:standards* / Q000706:statistics & numerical data; D004866:Equipment Contamination / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008397:Masks / Q000382:microbiology*; D009330:Nebulizers and Vaporizers / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013183:Sputum / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D055815:Young Adult