Recommendations for Nebulization in ICU Setting
DO perform Nebulization in an Airborne Infection Isolation Room (AIIR) commonly called as Negative Pressure Room whenever feasible or in a portable anteroom.
DON’T follow continuous nebulization. Intermittent Nebulization (only during inspiration) is more efficient and safe as it minimizes aerosol loss during exhalation.
DO protect ventilators and other mechanical devices (for example cough assist machines) with a high-efficiency viral-bacterial filter.
DON’T allow multiple HCWs inside the Intensive Care Unit when Nebulization is being undertaken, unless they are wearing full PPE kit. Restrict entry and exit of HCWs into the ICU to a minimum.
DO standardize all the parameters in the use of nebulizer system. Place the nebulizer in the inspiratory line at least 30 cm from patient and ensure airflow of 6-8 L/ minute.
DON’T reuse the equipment & nebulizer accessories unless they have been washed up using liquid/hospital grade disinfectants like Isopropanol (70%) or Hydrogen Peroxide (3%).
DO wear appropriate PPE safety accessories like mask, hand gloves, face-shield and gown to avoid possible contamination through aerosol generation.
DON’T disconnect humidifier while placing nebulizer. Only remove the Heat and Moisture Exchanger, since it’s filter can act as a barrier to aerosol delivery.
DO leave the ICU vacant with the door closed for 30 minutes after the patient has vacated the room post-nebulization. Sanitize the room after nebulization before letting others to enter.
DON’T leave the ICU without cleaning and disinfecting high-touch surfaces (apart from the equipment) with an approved hospital disinfectant.
References:
- https://www.health.state.mn.us/communities/ep/surge/infectious/airbornenegative.pdf
- https://www.cdc.gov/coronavirus/2019-ncov/hcp/hand-hygiene.html
- Minnesota-CDC guidelines: www.health.state.mn.us, April 2020,
- Govt of Canada: Infection prevention and control for coronavirus disease(COVID-19),
- https://www.health.qld.gov.au/__data/assets/pdf_file/0038/939656/qh-covid-19-Infection-control-guidelines.pdf
- Guidance on infection prevention and control for COVID -https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control
- J Aerosol Med Pulm Drug Delivery 2012; 25:1-14
- Am J Respir Crit Care Med 1997; 156: 3-10
- Thorax 2008; 63(Suppl VI): vi1-vi68; Global Initiative for Asthma (GINA) 2015