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Practical questions about nebulizer, shower head filters & gargling
MAC & Bronchiectasis | Last Active: Jul 26, 2018 | Replies (54)Comment receiving replies
Thank you to those who have responded to my questions. I look forward to other responses. I emailed Dr. Falkinham (well known and respected microbiologist who lectures on NTMs) and asked him the questions about using distilled water to rinse the equipment, cleaning aerobika/nebulizer just once a day, and recommendations for shower head. The following is his response:
Dear Terry:
Here are a few answers.
Question 1. Yes, it is important to ensure that the water added to a nebulizer after disinfection is as sterile as possible. Rather than buying sterile water, simply boil the necessary volume of water on the stove, let it cool before adding it to the instrument. Use that water for rinsing and final filling. Rinsing with regular tap water will likely "inoculate" the nebulizer with NTM. Remember, regular drinking water has NTM. Also, distilled water is not sterile.
Question 2. If the instrument has been filled initially with sterile water it is probably all right to not clean/disinfect before the next use. However, remember, that it is possible to "inoculate" the nebulizer with your own sputum.
Question 3. Shower heads can be unscrewed and cleaned by scrubbing the inside as best you can and then submerging the shower head in Chlorox for 30 min. Alternatively, you can filter the water before it enters the shower head. Pall Medical makes 0.2 micrometer pore size filters and those prevent passage of NTM (we've confirmed). However, the 0.2 micrometer pore size filters clog easily, so we recommend adding a 5 micrometer pore size filter before the water passes to the 0.2 micro meter filter. The Pall filters are expensive and good for 30 or 60 days, so if possible, I would simply scrub out a standard shower head and disinfect in Chlorix for 30 minutes monthly.
Further, some shower heads have a fine spray and generate a great deal of mist that stays in the air of the bathroom. That is not so good as the NTM are in the aerosol. Look around for a shower head with large holes that generates streams (usually 1-2 mm diameter holes). That will not generate the mist that can enter the farthest reaches of your lungs. Big drops are better.
Let me know if you have further questions.
Merry Christmas and Happy New Year,
Joe
Replies to "Thank you to those who have responded to my questions. I look forward to other responses...."
I am confused and need some clarification. Terri, you mentioned that you soak "mine" in a bowl of vinegar for half an hour and then rinse in water that has been boiled and allowed to cool. Are you referring to nebulizer used for inhaled amikacin and if so, do you soak it in plain distilled white vinegar (not diluted with water) for 1/2 hr. followed by the rinse each time that you use it? Do you do that for all your equipment such as aerobika and regular nebulizers daily? I have just been soaking in sudsy water followed by rinse in plain water. I just started to use water that I boil the night before and it sits on my stove until the next day when I use it for cleaning and rinsing. I do it the day before because I am unsure just how long it would take to cool a large amount of boiled water. This is the first time that I am hearing a recommendation to soak in vinegar. Thank you very much. Terry
Hi Terri,
I can't remember if I replied. Thanks for the suggestion of what you do w/ your nebulizer cup. I've been putting mine in boiling water every third time I use it and nothing happened; i.e. it didn't melt. However, now I'll be more careful. The instructions say it's OK to boil and to change the cup every 6 months. I'll have to re-read the instructions. But this is what I recall.
I sterilize mine once a week in a baby bottle sterilizer gizmo. When do you soak it in vinegar? Daily, instead of sudsy water? I am finding it difficult to get some suds going now that I use the sterile water!!! Happy holidays. Terry
@123123terry11t, Hi Terry. The equipment I clean is my nebulizer cups, mouthpiece, and spacer. I use straight vinegar because it kills all bacteria, including mac. Use boiled water for the rinse; as straight tap water may have the mac in it.
Hi @128128terry11t and welcome the vinegar should be 10% strength to kill the MAC,.
@heathert, thank you Heather for posting that it needs to be 10% strength. Is that 10% meaning the other 80% is water?
@windwalker yes, I bought 80% food grade acetic acid and dilute it, I sent Kathryn the site but dont know it I will still be able to find it on the web ,will have a look, it will be on this site somewhere. The % is very important or its no use.
My vinegar isnt 10% but I heat it in the microwave. Would that be equivalent?
@luvocean good thinking, it would increase the percent of acetic acid.
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@ronaf, Rona, I soak mine in a bowl of vinegar for a half hour, that kills the bugs, then rinse with boiled, then cooled water. Don't put your cups into the pan of boiling water or you can melt your equipment. (that happened to me).