Placebo respiratory devices, such as inhalers, large volume spacers and peak flow meters provide reli able methods of teaching patients effective drug able methods of teaching patients effective drug delivery techniques and monitoring compliance and treatment progress. Concern has been raised that using such demonstration devices on more than one person may expose patients to the risk of cross-infection with pathogenic organisms. The lack of regulation and guidance on the use and decontamination of placebo devices prompted us to complete a risk assessment, examining the likelihood and consequence of acquisition of pathogens and resultant illness in our respiratory patient group.
Asthma UK (2006) Asthma Charter. www.asthma.org.uk
2.
Black J. (2005) Microbiology: principles and explorations (6th edn). John Wiley and Sons Inc: New York.
3.
Blau H. , Mussaffi H. , Mei Zahav M. , Prais D. , Livne M. , Czitron BM , Cohen HA (2006) Microbial contamination of nebulizers in the home treatment of cystic fibrosis. Child: Care , Health and Development33(4): 491-5.
4.
Boe J. (1987) Micro-organisms in inhalation equipment used for domiciliary treatment with nebulized beta-2-agonists . Advances in Therapy4(4): 179-85.
5.
British Thoracic Society Standards of Care Committee. (2005) The use of placebo inhaler devices, peak flow meters and inspiratory flow meters in clinical practice. www.brit-thoracic.org.uk
6.
British Thoracic Society, Scottish Intercollegiate Guidelines Network.2007) British guideline on the management of asthma. A national clinical guideline. www.brit-thoracic.org.uk
7.
Brooks G , Carroll K , Butel J , Morse S (eds). (2007) Jawetz, Melnick and Adelberg's Medical Microbiology (24th edn). McGraw-Hill Lange: Europe.
8.
Clancy K. (2003) Cross-infection and the use and decontamination of placebo inhalers . British Journal of Nursing12(13): 778-83.
9.
Coia JE , Duckworth GJ , Edwards DI , Farrington M. , Fry C. , Humphreys H. , Mallaghan C. , Tucker DR (2006) Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) n healthcare facilities . Journal of Hospital Infection635: S1-S44.
10.
Department of Health. (1999a) Health Service Circular 1999/123: Governance in the new NHS controls assurance statements 1999/2000 risk management and organisational controls. NHS Executive . NHS Executive: London.
11.
Department of Health. (1999b) Health Service Circular 1999/178. variant Creutzfeldt-Jakob disease (vCJD): minimising the risk of transmission. NHS Executive: London.
12.
Department of Health. (1999c) Health Service Circular 1999/179. Controls assurance in infection control: decontamination of medical devices. NHS Executive: London.
13.
Department of Health. (2004) Standards for better health . www.dh.gov.ukHarkins KJ (1999) Bacterial contamination of inhalers . Journal of Hospital Infection43(4): 321 .
14.
Hawker J. , Begg N. , Blair I. , Reintjes R. , Weinberg J. (2006) Communicable disease control handbook(2nd edn). Blackwell: Oxford.
15.
Hutchinson G. , Parker S. , Pryor J. , Duncan-Skingle F. , Hoffman P. , Hodson M. , Kaufman M. , Pitt T. ( 1996) Home-use nebulizers: a potential primary source of Burkholderia cepacia and other colistin-resistant, gram-negative bacteria in patients with cystic fibrosis . Journal of Clinical Microbiology34: 584-7.
16.
Jones AM , Webb AK ( 2003) Recent advances in cross-infection in cystic fibrosis: Burkholderia cepacia complex, Pseudonmonas aeruginosa, MRSA and Pandoraea s pp. Journal of the Royal Society of Medicine43(96): 66-72.
17.
Kendrick AH , Johns DP , Leeming JP (2003) Infection control of lung function equipment: a practical approach . Respiratory Medicine97: 1163-79.
18.
Lee G. , Bishop P. (2006) Microbiology and infection control for health professionals (3rd edn). Pearson: London.
19.
Levesque KA , Johnson CE (1984) Bacterial contamination of pressurized inhalers . Drug Intelligence and Clinical Pharmacy18(9): 735-7.
20.
Medicines and Healthcare products Regulation Agency. (2006) Single-use medical devices: implications and consequences of reuse . MHRADB2006(04). http://www.mhra.gov.uk/Publications/Safetyguidance/DeviceBulletins/CON2024995
21.
National Institute for Clinical Excellence. ( 2002) Inhaler devices for routine treatment of chronic asthma in older children (aged 5-15 years). Technology Appraisal No 38, NICE: London.
22.
National Institute for Clinical Excellence. ( 2003) Infection control. Prevention of healthcare-associated infection in primary and community care. Clinical guideline 2. NICE: London.
23.
Taylor CJ , McGaw J. , Howden R. , Duerden BI , Baxter PS (1990) Bacterial reservoirs in cystic fibrosis . Archives of Disease in Childhood65(2): 1468-2044.
24.
UK Cystic Fibrosis Trust Infection Control Group. (2004) The Burkholderia cepacia complex: suggestions for prevention and infection control (2nd edn). Cystic Fibrosis Trust: Bromley.
25.
UK Cystic Fibrosis Trust Infection Control Group. (2008) Methicillin resistant Staphylococcus aureus (MRSA) (2nd edn). Cystic Fibrosis Trust : Bromley.
26.
Weller T. , Levy M. ( 2002) Are peak flow meters a potential hazard in the health care setting ? Primary Care Respiratory Journal11(3): 90-1.
27.
Weller T. (2005) Placebo inhaler devices and infection risks . Nursing Times101(42): 50 .
