[Meryl Jones]

Hi Giulietta,

I asked the same question but relating to a different setting (paediatric emergency department) a while back and received some useful advice from contributors.
Not all of our patients prescribed a salbutamol inhaler in the ED actually took one home with them, so we had the similar issue of single-use spacers but staff reusing inhalers in order to save costs.
I found the following article very useful although again, I acknowledge that it is written about patients admitted to hospital with an acute illness, rather than in the ambulatory/ outpatient setting so may not be relevant to your practice.
Larson, T., Gudavalli, R., Prater, D., & Sutton, S. (2015). Critical analysis of common canister programs: a review of cross-functional considerations and health system economics. Current Medical Research & Opinion, 31(4), 853-860.
http://informahealthcare.com/doi/pdf/10.1185/03007995.2015.1016604 Again, this

Following discussion between clinicians and pharmacists, we decided upon the following approach:

* It has been assumed that for our organisation, the chance of busy clinicians cleaning MDIs as per evidence-based guidelines is not reliable and the cost of cleaning outweighs the cost of throwing them away. Therefore, MDIs will be used as single-patient items: once issued, they will stay with children for the duration of their inpatient care.

* All MDIs will have labels attached to them in pharmacy to allow clinicians to add the appropriate information to them (i.e. patient name, dose) so that they can be taken home as discharge medications if required.

* Any MDI used during hospital stay but not required on discharge will be disposed of.

* Doctors will be advised to consider good stewardship when prescribing drugs to be taken via MDI to try and rationalise their use (e.g. not prescribing them on a “try it and see” basis to children who are probably too physiologically undeveloped to respond to salbutamol).

We decided that the cost of the salbutamol MDIs is small (approx. $3), but the risk of spreading infection (since many of our children who are prescribed drugs via MDI have respiratory viruses) is greater. Is your patient cohort relatively “bug-free”? I assume that they may not necessarily have respiratory viruses that cause acute illness, but are they a cohort who are susceptible to harbouring MROs in their sputum?

Kind regards,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au
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[cid:image005.png@01D0E95E.1D11D550]
Children’s Health Queensland acknowledges the Traditional Owners of the land, and pays respect to Elders past, present and future

Hi lung function units
Could I ask how other facilities with lung function test centre manage the use of multi dose ventolin inhalers where the patient only gets one single dose via spacer re-use inhalers for multiple patients. The spacers are single use but the ventolin is multi dose use.
I think the risk is low but the new disposable spaces do not have a large dead space and wonder if other think this could be a risk.
Many thanks for your support
Giulietta Pontivivo CICP RN/RM/MPH| CNC/NM Infection Prevention Management and Staff Health Services- St Vincent’s Hospital (Unit Level 6, DeLacy Building), 390 Victoria Street Darlinghurst NSW 2010
Contact Details: t: 61 2 8382 3284 | f: 61 2 8382 3892 |M-0457 533 452 e: Giulietta.Pontivivo@svha.org.au

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[Meryl Jones]

Thank you all for the interest shown in the original question posed. It is obviously an issue that we are not alone in experiencing and it has been very informative to hear how other health services have approached the problem. Given the level of interest this topic has generated I thought I’d feedback the approach we have decided upon.

I found the following article very useful and have shared it with other stakeholders within our organisation:
Larson, T., Gudavalli, R., Prater, D., & Sutton, S. (2015). Critical analysis of common canister programs: a review of cross-functional considerations and health system economics. Current Medical Research & Opinion, 31(4), 853-860.
http://informahealthcare.com/doi/pdf/10.1185/03007995.2015.1016604

Following discussion between clinicians and pharmacists, it has been decided that we will use the following approach:

* It has been assumed that for our organisation, the chance of busy clinicians cleaning MDIs as per evidence-based guidelines is not reliable and the cost of cleaning outweighs the cost of throwing them away. Therefore, MDIs will be used as single-patient items: once issued, they will stay with children for the duration of their inpatient care.

* All MDIs will have labels attached to them in pharmacy to allow clinicians to add the appropriate information to them (i.e. patient name, dose) so that they can be taken home as discharge medications.

* Any MDI used during hospital stay but not required on discharge will be disposed of.

* Doctors will be advised to consider good stewardship when prescribing drugs to be taken via MDI to try and rationalise their use (e.g. not prescribing them on a “try it and see” basis to children who are probably too physiologically undeveloped to respond to salbutamol).

We have decided that the cost of the MDIs is small, but the risk of spreading infection (since many of our children who are prescribed drugs via MDI have respiratory viruses) is greater.
Many thanks again for all your responses.

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

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[cid:image005.png@01D09172.12DA4CA0]

Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D08E34.09FD4060][cid:image002.png@01D08E34.09FD4060][cid:image003.png@01D08E34.09FD4060][cid:image004.png@01D08E34.09FD4060]
[cid:image005.png@01D08E34.09FD4060]

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Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.

Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.

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