Bacterial Contamination of Spacer Devices Used by Asthmatic Children

Purpose of the Study. To investigate bacterial contamination in spacer devices used by asthmatic children and the device-maintenance procedures practiced by parents. Study Population. The study group consisted of 62 consecutive children (aged 2–5 years) attending a clinic. All were enrolled in the study during an acute asthma attack. Methods. Spacer devices used by 62 asthmatic children were examined. Swabs taken from the inner surface of the reservoirs and face masks were cultured. Parents were interviewed regarding their spacer-cleaning and -disinfection routines. Results. Bacterial contamination was noted in 22 reservoirs (35.5%) and 16 masks (25.8%). Pseudomonas aeruginosa was isolated from 21.0% of the reservoirs and 14.5% of the face masks, Klebsiella pneumoniae from 6.5% and 4.8%, and Staphylococcus aureus from 9.7% and 8.1%, respectively. Only 34 parents (54.8%) reported that they received cleaning and maintenance instructions from the medical staff at initiation of spacer use by their child, and only 38 (61.8%) cleaned the device after each use. Conclusions. Bacterial contamination is common in spacer devices. This study demonstrates that contamination rates are significantly lower when parents clean and actually dry (preferably with an air blower) spacer devices after each use. Spacer device maintenance should be emphasized in education programs for managing asthma. Reviewer Comments. This study underscores the need for pediatricians and families to be educated about the proper care of spacer devices and the potential risks associated with improper cleaning. In particular, simple cleansing techniques can lessen or eliminate the number of nosocomial infections introduced by poor care of these devices. The benefit of metered-dose inhalers used with spacers and a face mask is high, and it is worthwhile to ensure that patients and health care workers use these devices properly and to their best advantage.