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How to clean nebulizer supplies?
I do nebulizer treatments two times a day with 7% saline solution for pulmonary hygiene. I have bronchiectasis. I'm wondering how others clean their nebulizer supplies. I rinse
mine in water and let them air dry. I'm wondering if that's good enough?
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@kate2025
You commented: "I use boiled distilled water in my sterilizer to help eliminate mineral buildup on the plate."
Are you boiling the distilled water before putting it in the baby bottle sterilizer just as an extra precaution? If NTM is killed within about 3 minutes during the sterilization cycle, and distilled water may contain some amount of NTM before use, what is the benefit of boiling the water first? It seems the sterilizer itself would destroy any NTM present.
We all approach cleaning and sterilization of neb equipment in our individual ways, influenced by our status of disease and experiences. After a prolonged pneumonia, requiring two hospitalizations in April and May, complicated by sepsis, I am coming from a place of extra caution. Logic tells me to boil the equipment after EVERY use. Scientific evidence confirms that NTM are present in our tap water and store-bought distilled water. Soaking and rinsing makes sense, but why would I only boil ONCE a week, and leave it to CHANCE on the other six days (that I'm not being exposed to NTM)?
I've also wondered if we are ingesting NTM when we don't boil fruits and vegetables?
And the most frustrating question: If I already have MAC or NTM, why am I taking all these precautions to avoid it??
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3 ReactionsThank you Irene, Kate, Kamarla, and Ursala for responding to my post. To clarify, I have a Roscoe Rite-Neb5 nebulizer with individual 3% saline vials (not an Aerobika with neb cups??). After reading your posts, I'll try to articulate my specific questions that cause confusion for me:
1. As Kamarla asked: Why is a sterilizer needed if we boil for 5 minutes and let air dry?
2. Can someone provide a link to a baby bottle sterilizer that can be used to sterilize the nebulizer accessories?
3. If you use a baby bottle sterilizer, can you put regular water that has been boiled in it?
4. Can you boil the water in a microwave - instead of on the stovetop - to boil the water?
5. If you boil the water on the stovetop, are you putting the nebulizer accessories in the boiling water on the stovetop each time you use it? Do you need to boil for 5 or 10 minutes? Can the parts hold up to boiling water? 6. Do you boil the nebulizer parts BEFORE or AFTER each use?
7. Do you wash the nebulizer parts in regular water with Dawn detergent (as some suggested) AND then boil the parts in water too after each use?
8. My instruction booklet says to clean the compressor accessories with distilled water and then immerse them in 70/30 isopropyl alcohol for 30 minutes and then wash and rinse with warm distilled water - which is different from what everyone's posts have been saying (hence, part of my confusion).
9. When you nebulize, do you inhale through the nebulizer and then exhale into the air? How long is 1 treatment with a 3% individual vial?
10. I also have an Air Physio - would you clean the parts the same way you clean the nebulizer?
Thanks again for your thoughtful responses. Denise
@phoenixrises Sorry to say, I wrote a response yesterday, and "the computer ate it". Now I am tap-tap-tapping on a tablet, and long posts are a torture.
The neb parts supplied with your compressor are probably the "disposable" variety, and won't stand boiling, hence the alcohol bath.
If you buy Pari or similar reusable cups, widely available online, (they are interchangeable among machines) they can be boiled. Not the tubing - it should be discarded and replaced regularly. It is helpful to have 2 or more sets of nebulizer cups (only one tubing needed) -they cost about $15 each and are good for 3-6 months of daily use. When I was nebbing 3 times a day, I had as many as 6 cups at one point.
Here is a simple, time efficient method:
Boil a week supply of tap water and store in sanitized, covered container(s) - no need to refrigerate. Or get a 0.2 micron filter like LifeStraw or a filter at the tap. This is what you use for soaking and rinsing. See not below about microwave.
After each use, take apart the neb cup, agitate in hot soapy water and let soak. Repeat until you use them all.
Put all the parts in a saucepan with enough distilled water to cover, bring water to a boil, turn the heat to just boiling and set the timer for 10 minutes. Then turn off the stove and remove parts to a clean towel (we use a paper towel) to dry, it only takes minutes when they are hot. When dry store in a clean, covered container. We cover the pan, save and reuse the water several times, just topping off to cover the parts. Distilled water keeps the dissolved solids present in tap water from building up on the equipment. (Once I put my equipment into already boiling water, and it deformed. So now it goes into room temperature water and comes to a boil - not a problem.)
In my humble opinion, if you are boiling after each use, it is probably not necessary to use sterile water for the washing and rinsing.
Extended boiling of water in the microwave is not recommended by the oven manufacturers - you can get shattering, and once I had a Pyrex measuring cup explode when I was doing it - but don't ask me to explain why, or whether the problem has been solved in modern microwaves.
We use the saucepan method because it doesn't require another appliance, takes no space on the counter, doesn't require counting the number of uses (microwave steamer bags have that) and the equipment doesn't need separate drying operation.
When we (2 of us neb in our home) do not have an illness or exacerbation, we actually wash and rinse in filtered water after every use, but just boil once a week. And I have stayed MAC-free for 6 years after treatment, my partner has not gotten infected.
I don't know about the Air Physio. I use an Aerobika, which is also boilable.
We know that people at risk of lung infection, whether due to COPD, Cystic Fibrosis or Bronchiectasis, need to be careful about cleaning their equipment, but as you are learning, current recommendations and practices are all-over-the-map and very confusing. All of the methods people have been recommending here have been self-developed by patients with VERY limited testing to determine exactly what works and how many precautions are necessary.
The cleaning and sterilizing processes are currently undergoing scientific testing by Dr Jennifer Honda and Dr Joe Falkinham to determine exactly what is needed to be safe. We are all awaiting a definitive report.
It has taken me far longer to write this than it takes to do either the daily cleaning, or the boiling routine.
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4 Reactions@phoenixrises The most established ways as far as I can tell are baby bottle sterilizers and boiling for ten minutes, though recent experiments by Jennifer Honda, microbiologist, and performed throughout the country seem to suggest that three minutes of boiling suffices. I boil for ten minutes each time I use equipment but I tend to be ultra conservative and careful. I only nebulize once a day with .9 saline solution b/c I am so prone to hemoptysis with 3% and 7% saline so it’s not so onerous to sterilize once a day once you set up your equipment. People use microwaveable bags also but mostly for travel, I would say.
Nebulizing is one of the best self-defense tools we have for Bronchiectasis and NTM and I recommend you at least try it. It beats getting sicker and sicker. If it doesn’t work for you there are other air clearance techniques that don’t require a lot of equipment. You just have to find the best for you. Try to consult with a respiratory therapist if you can. Also, there is a great site online called Bronchiectasis Toolbox that goes through many air clearance techniques with videos. Well worth exploring. Wishing you all the best.
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2 ReactionsI'm currently in Paris (don't be jealous, it's close to 100 degrees) and am working with a local respiratory therapist. I explained that I hated boiling my nebulizer and aerobika and she told me that she uses a product made by Milton. They are sterilizing tablets that you put in water, leave for 15 minutes and it sterilizes the equipment. It claims to eliminate 99.9%. of germs, but I can't find out if that includes NTM. Milton is a UK company, but Amazon in the US does carry it. Does anyone have any experience using sterilizing tablets? Thanks!
@bklynprof
The Milton sterilizing tablets will reliably kill pseudomonas, but NTM not reliably. NTM contain a protective covering also known as a biofilm, which makes them resistant to many disinfectants. The only reliable way to kill NTM is through high heat.
Can you find any baby bottles sterilizers in France? If not, then a small Ramen boiler is a good alternative. They’re very quick and have a small footprint.
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1 ReactionThanks for that information. I am in an apartment so I can boil everything, which when it is cool is not a problem. It's just soooooo hot now that I was hoping to find an alternative. There are lots of bottle sterilizers here so I'll look into it although by the time that I buy one the heat wave will be over. Or so I hope 🙂
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1 Reaction@scoop
Pseudomonas (specifically Pseudomonas aeruginosa) is a textbook biofilm former. It forms protective, multi-layered communities encased in a self-produced extracellular matrix, making it notoriously resistant to antibiotics and the immune system.
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2 ReactionsI read that vinegar kills bacteria so I soak mine in a jar of vinegar for a few hours and then rinse.