Bacterial contamination of inhalers

Letters to the Editor

321

References Endoscopy 1. British Society of Gastroenterology Committee Cleaning and disinfection of equipment for gastrointestinal endoscopy. Report of a Working Party of the British Society of gasGut 1998; troenterology Endoscopy Committee. 42: 585-593. A, Umasankar 2. Cooke RPD, Whymant-Morris RS, Goddard S V Bacteria-free water for automatic washer-disinfectors: an impossible dream?

r Hosp Infect (1998) 39: 63-65. water quality for automatic 3 Curtis B. Testing washer-disinfectors J Hosp Infect (1999) 42: 74-75. G, McEwan H, McKay I, Crowe G, 4 Philips McBeath J. Black pigmented fungi in the water pipe-work supplying endoscope washer disinfectors J Hosp Irzfect (1999) 40: 250. fungi in water 5 Newsom SWB. Black pigmented

Journal of Hospital Infection (1999) 41: 254. H. Lee JV. Water quality for 6 Humphreys endoscopy washer-disinfectors J Hosp Infect (1999) 42: 76-78.

Bacterial

contamination

of inhalers

Sir, I would like to report the findings of a pilot study we performed which your readers may find of interest. Whilst the bacterial contamination of ventilator and nebulizer equipment has been well described, it is not yet clear whether hand-held inhalers are also important reservoirs of infective agents. We examined the inhalers of 20 consecutive patients (aged 60-93 years) admitted to the elderly care department with an exacerbation of chronic airways disease. Swabs were taken from the inside of the mouthpiece of each inhaler and from the portal where the aerosol emerges. These were then cultured on blood and chocolate agar for three days. We tested 31 devices, of which 28 were metered dose inhalers, two were ‘easibreathe’ devices and one was a ‘turbohaler’. These devices, which were made by several manufacturers, contained salbutamol (13), beclomethasone (eight), duovent (four),

combivent, budesonide, and ipratropium (two of each). Only one patient had cleaned their inhaler in the week before admission, and only four claimed to have cleaned their devices at any time. This was either because they did not appreciate that cleaning it was necessary or they were unable to remove the canister from the sleeve of the device. There

were

no organisms

in 18 of the

cul-

tures. Upper respiratory tract flora were grown in seven, coagulase-negative staphylococci in six, and Staphylococcus aureus in one. All cultures but one (URT flora) yielded only scanty growths or needed enrichment media to be identified. These preliminary data suggest that common respiratory tract pathogens do not coloof inhalers, probably nize the mouthpieces because these organisms do not survive we!1 in the dry conditions between use. Some staphylococci however were able to survive for prolonged periods on inhalers. There may be implications for those patients who are carriers of methicillin-resistant S. aureus, as attempts at eradicating them may be potentially thwarted by re-inoculation from their inhalers. Larger studies are now needed to confirm that failure to clean an inhaler does not result in any harmful bacteria entering the lungs. Whether dust and dirt impair drug delivery also needs to be determined. K. J. Harkins

Department

of Care for the Elderly, St rames’s University Hospital, Leeds, LS9 7TF

Pseudobacteraemia

due to Pseudomoncrs fl uorescens

Sir, A recent report in TheJournal’ details 12 paediatric patients with pseudobacteraemia due to contamination of lithium heparin bottles with Pseudomonas jluorescens. We recently have had

0 I999 The Hospital

Infection

Society