1. < MAC & Bronchiectasis

Practical questions about nebulizer, shower head filters & gargling

Posted by terryb1 @128128terry11t, Dec 20, 2017

This forum is so helpful and I thank all for their contributions. I have three questions:
1. Do we have to rinse the aerobika or nebulizer in distilled water after we soak in plain sudsy water or can we just rinse in regular water for our daily cleaning? I ask because lugging distilled water can be cumbersome and I would love to skip the use of distilled water if it is unnecessary.
2. For those who have put a filter(s) on their shower head so that showering can be the equivalent of bathing, please let us know specifically what filter or filters you installed and any other information that would be helpful for us to know.
3. Was anyone advised to gargle after using inhaled amikacin? If so, was any particular mouthwash recommended?
As always, thank you and wishing all a Merry Christmas and a Happy and Healthier New Year. Terry

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

Mentor
Terri Martin, Volunteer Mentor | @windwalker | Dec 28, 2017
In reply to @128128terry11t "Thank you to those who have responded to my questions. I look forward to other responses...." + (show)
@128128terry11t

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

Jump to this post

@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.

REPLY
Mentor
Terri Martin, Volunteer Mentor | @windwalker | Dec 28, 2017

@123123terry11t, Terry, you had asked about why vinegar was suggested as a cleaning solution.....it was recommended by the doctors at the conference last spring. They said the acid in vinegar kills bacteria and the bugs have not become resistant to it yet. They suggested wiping countertops and kitchen handles with it as well. Some species of the MAC have become resistant to chlorine now, so they recommend vinegar. Restaurants have been using vinegar to wipe the tables and counters for years for it's antibacterial properties. Some say to use industrial strength, I just use regular vinegar. I keep a gallon of it in the house. It lasts a long time as I am not super diligent about using it like I should be.

REPLY
heathert | @heathert | Dec 28, 2017
In reply to @128128terry11t "Thank you to those who have responded to my questions. I look forward to other responses...." + (show)
@128128terry11t

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

Jump to this post

Hi @128128terry11t and welcome the vinegar should be 10% strength to kill the MAC,.

REPLY
terryb1 | @128128terry11t | Dec 28, 2017

@windwaker, Thanks for the tip. Do you use distilled white vinegar? I am a little (well, maybe a lot) confused about how a gallon lasts a long time. Don't you have to put quite a bit of the vinegar in a bowl in order to adequately soak? If someone does this daily, I would imagine that a gallon would go fairly quickly unless it is diluted with some boiled water?? .... and if you use an aerobika with nebulizer, even faster. When you stated that you were not super diligent, did you mean that sometimes you clean/rinse in boiled water? By the way, what is a "spacer"? Your knowledge and advice is much appreciated.

REPLY
2 replies
Mentor
Terri Martin, Volunteer Mentor | @windwalker | Dec 29, 2017
In reply to @128128terry11t "@windwaker, Thanks for the tip. Do you use distilled white vinegar? I am a little (well,..." + (show)
@128128terry11t

@windwaker, Thanks for the tip. Do you use distilled white vinegar? I am a little (well, maybe a lot) confused about how a gallon lasts a long time. Don't you have to put quite a bit of the vinegar in a bowl in order to adequately soak? If someone does this daily, I would imagine that a gallon would go fairly quickly unless it is diluted with some boiled water?? .... and if you use an aerobika with nebulizer, even faster. When you stated that you were not super diligent, did you mean that sometimes you clean/rinse in boiled water? By the way, what is a "spacer"? Your knowledge and advice is much appreciated.

Jump to this post

@128128terry11t, I just use whatever vinegar is in the house. I could be wrong, but I believe the acid is probably strong enough in any of the vinegars to kill bacteria. Some people like to buy the industrial strength just to make sure. I think you can buy it at places like Lowe's. I suggest you start with one gallon first to gage how much you use in a week's time. It will depend on how diligent you are with cleaning your equipment. Mine lasts a long time because I am not so diligent as I should be. I soak my nebulizer cups and mouthpieces about once a week . Some reports say that every three days is fine.

REPLY
Mentor
Terri Martin, Volunteer Mentor | @windwalker | Dec 29, 2017
In reply to @128128terry11t "Thank you to those who have responded to my questions. I look forward to other responses...." + (show)
@128128terry11t

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

Jump to this post

@heathert, thank you Heather for posting that it needs to be 10% strength. Is that 10% meaning the other 80% is water?

REPLY
terryb1 | @128128terry11t | Dec 29, 2017

Oh! I think I misunderstood and thought that you used the vinegar for daily cleaning. It sounds like you use the vinegar when you clean before you sterilize which can certainly be only once a week. Am I now finally correct?? Also, do you dilute the vinegar with equal part boiled water? Looking forward to answer from another member of the forum as to what 10% strength of vinegar means. Thanks again.

REPLY
pattywatty | @pattywatty | Dec 29, 2017
In reply to @128128terry11t "@windwaker, Thanks for the tip. Do you use distilled white vinegar? I am a little (well,..." + (show)
@128128terry11t

@windwaker, Thanks for the tip. Do you use distilled white vinegar? I am a little (well, maybe a lot) confused about how a gallon lasts a long time. Don't you have to put quite a bit of the vinegar in a bowl in order to adequately soak? If someone does this daily, I would imagine that a gallon would go fairly quickly unless it is diluted with some boiled water?? .... and if you use an aerobika with nebulizer, even faster. When you stated that you were not super diligent, did you mean that sometimes you clean/rinse in boiled water? By the way, what is a "spacer"? Your knowledge and advice is much appreciated.

Jump to this post

I read that 6% vinegar kills mac
wal mart sells this in their cooking section next to 5% vinegar. it will say the percentage of acid on the bottle.

REPLY
heathert | @heathert | Dec 29, 2017

@128128terry11t . I bought 80% food grade acteic acid and then dilute it was water down to 10%, I bought it from an eccochem business. I had read on a reputable site that we need 10%, I dont know if that has changed or not now.

REPLY
heathert | @heathert | Dec 29, 2017
In reply to @128128terry11t "Thank you to those who have responded to my questions. I look forward to other responses...." + (show)
@128128terry11t

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

Jump to this post

@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.

REPLY
View MoreView Less
Please sign in or register to post a reply.