70 Dry powder inhalation devices are a safe alternative to nebulizers regarding contamination with CF specific pathogenic germs

Abstract

Objectives To assess the contamination risk with CF-relevant pathogens of the Tobi Podhaler dry powder inhaler (DPI) device compared to established nebulizers and to obtain real-world data from nebulizers of patients with chronic colonization of the lung with Gram-negative bacteria in the patient's usual inhalation setting, to learn more about patient's cleaning and inhalation habits. Methods Microbiological samples from the mouthpiece and medication reservoir were collected using an eSwab® from a device that was prepared in the patient's personal way before next inhalation. Results Microbiological analysis showed that the samples of 8/26 dry powder devices were sterile while the other 16 samples were contaminated with non-pathogenic bacteria of the human respiratory flora. Only 1/20 nebulizer devices were sterile. In 4 devices Staphylococcus aureus was detected. The other nebulizers were contaminated with a variety of bacterial species belonging to the human respiratory tract flora and bacteria typically found in humid sources (e.g. Pseudomonas fluorescens, Acinetobacter ursingii, Mycobacterium fortuitum ), indicating the potential transmission risk of CF-relevant species such as P. aeruginosa . Conclusion Tobi Podhaler is used 7 days twice daily. For cleaning it is supposed to be wiped with a dry and clean cloth. The cleaning procedure of a nebulizer is more time consuming and challenging. Under real-world conditions we found that the typical cleaning procedure of a nebulizer is failing to sterilize the device completely. Using a DPI with almost zero cleaning effort seems to be a satisfactory alternative regarding the hygienic requirements of an inhalation device.