Cleaning + disinfecting nebulizer and aerobica

Gee Sara, I apologize - I thought I answered you yesterday but my reply disappeared into the ether, I guess.

I buy my nebulizer parts from on-line home health suppliers, not loyal to any particular one, just whoever has the best price plus shipping and is in stock when I need it. I buy Pari neb cups, and each comes with replacement tubing. I am not aware of any parts on the Aerobika that need to be replaced.

The silicon "waffle mat" is a hot pad that happens to fit in the bottom of my sauce pan. It works great for this purpose, or for protecting a tabletop, but is lousy for picking up hot things because it is springy feeling.

When I boil things, I just used my filtered tap water - I can't see the need for distilled or spring water as the boiling kills any NTM in the water, along with on the parts. I can't say that about baby bottle or microwave sterilizers - don't use those
Sue

Thanks so much Sue. Is a prescription required to buy the parts? And does Medicare pay for the saline or neb parts/Aerobica? If not then I will just shop for best price. Some places seem to require the prescription.

No prescription is required to buy nebulizer parts. You can call most places and they will process your order if you explain it is for your already existing neb.) Basic Medicare Part B does not pay for the parts. Depending on any supplemental plan(s) you may have, a nebulizer may be covered as durable medical equipment, but my plan only covers a very basic, corded machine - nothing portable or battery operated, and no replacement parts. Another tip - I buy several at once, to get to the minimum so I don't pay shipping. I used to share them with my friend, who has since passed away. Now I share with my daughter.
On my Blue Cross plan through my former employer, which happens to be my Medicare supplement, my nebulizer solutions are covered under Medicare B because they are used in medical equipment. Medicare Part D does not cover them. (I have this "discussion" every 3 months with my mail order pharmacy or Walgreens, depending where I order - they submit to Part D, get rejected, call me, I tell them to resubmit under Part B...)
My saline costs about $10 for a months supply, or $20 for 3 months through mail order pharmacy with a prescription. Lots cheaper than on-line.
Sue

Thank you very much. I have these discussions with Walmart every time they charge me differently for the saline and they cannot tell me if it is covered by Medicare. You have been so helpful.

All the studies I find don't seem to include mycobacteria. Most baby bottle sterilizers don't meet the 10 minute boiling threshold. I think that is why Dr Falkenham is doing the tests in his lab.
Can you cite any studies that show these sterilizers are good against Mycobacteria?
Sue

The best study / meta-study is this one from June 2020: "Nebuliser hygiene in cystic fibrosis: evidence-based recommendations," in Breathe (Sheff). 2020 Jun; 16(2): 190328.

There is a LOT in this piece but here's a relevant snippet:

"Steam disinfection with the aid of “baby bottle steam sterilisers” is an effective method for disinfection of nebuliser devices, as detailed (table 4). Whilst commercially termed a “steriliser” by the CF community and patients, this method is a disinfection method rather than a sterilisation method. This difference in terminology has important microbiological significance as to the anticipated outcome."

Table 4 indicates its effectiveness at killing of a wide range of bacterial pathogens, including:

Mycobacterium abscessus abscessus
Mycobacterium abscessus bolletii
Mycobacterium abscessus massiliense
Mycobacterium abscessus/chelonae
Mycobacterium avium intracellulare
Mycobacterium chelonae

-- and also notes:

"P. aeruginosa (mucoid, nonmucoid) and nontuberculous mycobacteria were not detected in either wet or dry fully assembled nebulisers following steam disinfection even in the presence of sputa"

They tested using the Wabi baby unit, but note that "Different brands of steam disinfectors performed effectively." They also note that these devices are pretty cheap, far more convenient than other cleaning protocols, and operate in such a way that pathogens cannot "enter during prior stages (tap water, residual sputum, detergent, handling, etc.)" -- and that you can store your items in it for up to 24 hours w/out fear of contamination by storing in plastic containers, baggies, other surfaces.

The article concludes with the strong, evidence-based recommendation to use a bottle sterilizing units for home cleaning of nebulizers (and other equipment, one can extrapolate). Figure 1 (attached) is a nice graphic of the cleaning protocol they recommend. The audience for the article are CF patients, but there is no reason it wouldn't apply to our group as well 🙂

I did a deep dive into cleaning methods when I got my MAC diagnosis on top of Bronchiectasis, and decided to go with a baby-bottle sterilizer (microwave looked good for me too, but would have meant traveling downstairs every time I wanted to clean). I then did product research and purchased this unit (there were other good ones out there but I liked this because of it's relatively low profile) : Philips AVENT Premium Baby Bottle Sterilizer with Dryer.

I usually swish stuff around in a soapy-water tub and rinse before I put it in the unit. The full steam-to-dry cycle takes a full 40 minutes, with 10 minutes of sterilizing and 30 minutes of drying. I imagine it does meet the 10 minute boiling threshold...?

Thank you, this is very helpful for those using nebulizer with compatible parts like my Pari LC. Too bad it isn't rigt6for my InnoSpire Go, which has metal mesh - instructions specifically say no microwave, autoclave or baby bottle sterilizer.
Sue

Ah, but you CAN put Innospire Go in the baby bottle sterilizer! I actually called the company last year because I was confused about this. I could not find anything in their instructions that indicated whether or not one could put the mouthpiece in a steamer -- all they said was "Do not autoclave the mouthpiece" and "Do not put any part of the device in a microwave." The only thing I could find in the instructions regarding steam clean was about the HANDSET: "Do not immerse the handset in liquid or steam clean." Please tell me if you have different instructions on hand in which Philips specifically says not to steam clean the mouthpiece? Either way, I have been doing so for about six months now with no change in the function of my Innospire. Note that the article I sent you says this in Table 4, under advantages of steam-cleaning: "Can be used with metal components (e.g. metal vibrating mesh)."

p.s. adding to my comment this confirming info from Philips Innospire Go online FAQ:
'"Q. Can the mouthpiece assembly be disinfected? If so, How?
A. Yes. There are three ways you can disinfect the mouthpiece assembly which are boiling, steaming and immersion in a Korsolex® disinfectant solution.

Thanks for this info. How do you clean the tube? I use the nebulizer for the albuteral and wash the plastic components but was told not the tube. I would think it would be hard.
Miriam

Nebulizer tubing should not need to be cleaned. It is only the conduit for air from the compressor to the mouthpiece, and should never get any mucus or saliva in it. If you see moisture in the tubing at the end of a session, it is condensation. Disconnect the mouthpiece and let the compressor run for 5-10. The dry air from the compressor will dry the tubing.

Tubing should be replaced as often as you replace your nebulizer assembly - docs varyingly recommend 3-6 months. With my Pari, if using daily, I replace it at 3 months. When I order the nebulizer (cup and mouthpiece) it is a kit, which includes new tubing, so it is replaced at the same time. This has been the practice in our house for over 30 years.

Sue