IPGUI06 Guidance for managing reuse of the salbutamol inhaler by Provide Community

Guidance for managing reuse of the salbutamol inhaler

Version: V1

Ratified by:

Infection Prevention and Control Group

Date ratified: 16/10/2024

Job Title of author: Head of Infection Prevention and Control

Reviewed by Committee or Expert Group

1. Introduction

This guidance is intended for use by the respiratory service when administering salbutamol inhalers. As part of cost-saving measures, some respiratory departments have adopted the practice of using a single metered dose inhaler (MDI) canister to deliver medication to multiple patients. Patient safety has been considered and risk assessed to ensure that this practice does not compromise care while providing the benefits of reduced costs and resource conservation.

This guidance focuses on the proper management of the reuse of MDI canisters and plastic actuators.

Managing the Reuse of Metered Dose Inhalers (MDIs)

• Previously, the management of MDIs has primarily focused on the mouthpiece (nozzle) and the spacer, which identified a reduction in infection risk by implementing the use of single-use mouthpieces and spacers.

• In practice, the MDI nozzle is disinfected with an appropriate disinfectant wipe before it is inserted into the patient’s aerosol cloud enhancer spacer, which is equipped with a one-way valve, allowing for the medication to be delivered effectively.

• The MDI remains with the respiratory therapist, who can administer subsequent doses to other patients requiring the same medication.

• Spacers, if reusable, are designated for individual patient use and are not shared between patients.

• Disposable spacers, (including the white end that serves as the mouthpiece), are used once and then properly disposed of. (Refer to Figure 1 in Section 4 for further details).

2. Purpose - Managing the reuse of a multi drug inhaler (MDI)

• The purpose of this guidance is to outline the procedures for managing the reuse of MDI canisters and plastic actuators across multiple patients, while maintaining safety, cost-effectiveness, and environmental responsibility.

• By cleaning and reusing the MDI canister and plastic actuator, the service aims to optimize resource use, improve staff efficiency, and reduce medical waste.

• Risks associated with reusing MDIs have been assessed, and this guidance provides clear instructions on the cleaning protocols that must be followed to minimise the likelihood of cross-contamination. Adherence to these guidelines is crucial for ensuring safe and effective patient care.

3. Infection Prevention and Control

Actions Transmission Risk reduction

Wash hands before and after handling equipment, in between patients

Use disposable gloves for handling used mouth pieces and potential contaminated surfaces.

4. Guidelines

Direct contact – With URTI, enteric infections, blood borne infections or from bleeding gums or mouth ulcers / sores

Indirect contact (aerosol droplet) – TB, viral infections, opportunistic infections, nosocomial pneumonia.

Do not test patients with known infections if possible.

Test potentially infectious patients at the end of a session,

Test vulnerable patients (e.g. immunocompromised) at the start of a session

For infection control in these patients, use disposable and valved mouthpieces with an antibacterial filter.

These guidelines are to support and advise staff on methods to reduce infection risks and offers the cleaning steps for managing the reuse of an inhaler Staff should familiarise themselves with themselves with the guidance in order to optimise patient safety.

There are different types of inhalers, spacers and mouth pieces, therefore the methods described relate to the differing types.

• Clean your hands before and after contact with the inhalers.

• Always read the manufacturers guidance to ensure managing the device appropriately

Method 1:

1. Remove the metal cannister from the plastic actuator (casing) and keep this away from water

2. Remove the cap of the inhaler.

3. Rinse the plastic casing of the inhaler by running warm water through the casing for 30 seconds.

4. Ensure any hardened medicine in the cover is removed using a q tip or toothpick and rinse again with warm water

5. Let the casing dry overnight if possible, making sure you have a spare inhaler if needed.

6. If you suspect the presence of any infection, consider using an antibacterial filter

7. The cleaning and reusing of the cannister and plastic actuator should only be carried out for 5 occasions and then disposed of.

Method 2:

1. Remove the metal cannister from the plastic actuator (casing) and keep this away from water

2. Remove the cap of the inhaler

3. Wipe the plastic casing of the inhaler with a disinfectant wipe ensuring the wipe goes through the entire inside of the casing.

4. Ensure any hardened medicine in the cover is removed using a q tip or toothpick and wipe over again with a disinfectant wipe

5. Let the casing dry before reusing.

6. The cleaning and reusing of the cannister and plastic actuator should only be carried out for 5 occasions and then disposed of.

As stated in MMSOP34 – An audit sheet should be kept logging the five occasions the canister is administered.

To manage Method 1:

There must be a decontamination area which allows for a hand wash sink and a separate sink for cleaning equipment and also, a clean wipeable surface to ensure reducing risk of contamination

To manage Method 2:

There will need to be hand wipes and disinfectant equipment wipes and a clean wipeable surface to ensure reducing risk of contamination

The Provide group use the spacer and mouthpiece as shown in this picture and will utilise method 2 to address reuse

5. Monitoring and Audit

The audit sheet should log each time salbutamol is administered and should be kept for ensuring the maximum uses are adhered to. (Five occasions of administration only)

The audit sheet, developed by the respiratory team, will be maintained and monitored, with any concerns or issues reported to Medicines Management and/or the Infection Prevention and Control team.

6. References

NHS England Spirometry -commissioning guidance spirometry-commissioning-guidance.pdf (england.nhs.uk)

Grissinger M (2013) Shared metered Dose Inhalers Among Multiple Patients -Can cross contamination be avoided? Journal of Pharmacy and Therapeutics Vol 38 No 8.

Shared Metered Dose Inhalers Among Multiple Patients - PMC (nih.gov)