Aboveallislove
Super Moderator
any comparator between optichamber and vortex?
spacer brand
- Thread starter Aboveallislove
- Start date
Hi Aboveall. We use an Optichamber. I haven't used Vortex but our CF RT gave us one of those electrostatic ones which turned rapidly to a lump of plastic when I even tried to clean it in a microwaveable steam bag! I knew it couldn't be sterilized, just washed, but I didn't care. If it can't survive at least a steam bag, I don't want it! So my recommendation is to check out the cleaning instructions!
Aboveallislove
Super Moderator
I would love to hear what folks use and how they clean. We had the old Opti Diamond which I dropped in the water that had been boiled 10 minutes and left 3 to "sterilize" but the OptiChamber when I did it wouldn't go back together again. I honestly don't get how they want us to use without at least 1x a week sterilizing. I mean the nebulizers can't just be washed and the used...they are suppose to be sterilized once a day. So why would the spacer be any different, especially if you are doing an attempt to erridcate where they have specific guidance on cleaning things when you have MRSA, etc. Yet I've yet to find one that says you can. The Vortex says its dishwasher safe so I'd think it would withstand boiled water better than the OptiDiamond. Thoughts?
S
stephen
Guest
The AeroChamber Plus / Z Stat is the only spacer I've used. They have a whistle that warns if you're inhaling too fast.
They do get washed every few weeks. However, I've never sterilized any of them.
There is a big difference between a nebulizer and a spacer. A spacer is NEVER supposed to be exhaled into; a nebulizer is. While the end of the spacer does touch my lips, I don't see how this is any different than drinking from a glass or using a spoon. My drinking glasses and silver ware utensils don't really get sterilized. Either does my toothbrush.
That's just my thoughts on the matter.
They do get washed every few weeks. However, I've never sterilized any of them.
There is a big difference between a nebulizer and a spacer. A spacer is NEVER supposed to be exhaled into; a nebulizer is. While the end of the spacer does touch my lips, I don't see how this is any different than drinking from a glass or using a spoon. My drinking glasses and silver ware utensils don't really get sterilized. Either does my toothbrush.
That's just my thoughts on the matter.
Sorry for such a short response earlier. I was in "kid mode" as I call it.
Questions about sterilizing or disinfecting all the accessories that come with our meds are persistent, aren't they. I suspect there are as many routines out there as there are people. There have been numerous threads about nebulizers, but few I think about the spacers that are used especially by children with their metered dose inhalers such as albuteral, xopenex, flovent, and Qvar to name just a few. Adults of course use spacers as well, I suspect because they are believed to be less likely to cause problems inside your mouth, and because they tend to make delivery easier and more complete. Your team can tell you more about why you might want to use a spacer if at all. But, I digress. . . .
First, there is indeed a difference between sterilization and disinfection although I tend to use the terms carelessly and interchangeably. As I understand it, disinfection eliminates the vast majority of organisms but does not eliminate a few - for example, the cff.org website materials indicate that disinfection will not eliminate bacterial spores. Sterilization, on the other hand, kills everything. (And for those of you who encounter the word "sanitize" on the back of your lysol or "disinfectant" sprays, that refers to simply reducing the number of critters, but not killing all of anything, I don't believe. So keep reading the back of that can and see what you need to do to "disinfect" with the same agent - its usually a matter of how long your target stays wet with the spray.)
The second concept involved here is the type of equipment you're targeting. The Guidelines for Infection Control distinguish between critical, semi-critical, and non-critical items. Critical items include things that basically invade your body - needles, surgical instruments, catheters, etc. Semi-critical items are things that come in contact with the mucous membranes (the lining of your nose, mouth, throat, lungs, etc) or broken skin - such as respiratory equipment. Non-critical items come in contact with your unbroken skin - such as your vest, clothing, linens, bedrails, etc. See www.cff.org/For-Caregivers/Clinical...Recommendations-for-Patients-With-CF-May-2003
To put it all together, generally speaking, you sterilize critical items and at a minimum disinfect semi-critical items. That's what the Guidelines say - "at a minimum." That sounds to me like we should be striving for sterilization of semi-critical items, but disinfecting is acceptable.
So a nebulizer is at least a semi-critical item. And as a reminder, here are the CFF's simplified version of the Guidelines for cleaning nebulizers:
"After each use, clean and disinfect the nebulizer by following the CF Foundation's recommended nebulizer care.
Heat Methods:
I would imagine that the spacer is in the same category as a nebulizer - a semi-critical item requiring high level disinfection, although the Guidelines indicate that another similar item - the face mask - has no recommendations made except to follow the manufacturer's instructions. That made me wonder about Stephen's thoughtful post. But the Aerochamber we have is meant for both inhaling and exhaling and has a little yellow bubble that moves with each breath so you can see when a child has taken the required number of breaths. But it doesn't sit inside your mouth the way the nebulizer does for 20 minutes or more, coming out covered in saliva. It's more akin to a "non-critical" piece than a "semi-critical" one. Although they obviously haven't seen what my little guy does with it - flip it with his teeth, stick his tongue inside it, etc. . . . ! I also wonder if the difference may be that the nebulizer allows much smaller particles to penetrate deeper into your lungs. I really don't know. It is an excellent question for the CF Team. I have asked it before, but have simply been told that it's ok to wash the spacers every few days.
Really, this reminds me of the problem with disposable nebulizers. You couldn't disinfect them without them falling apart or melting or becoming distorted to the point that they didn't fit together anymore. So the manufacturer's recommendation was to simply wash them every now and again and throw them out eventually. Of course nebulizers were determined to be an source of infection for CFers. The infection can come from our own mucous membranes, other parts of your body, such as your hand or clothes, or even the water used to rinse and clean them. So only reusable nebulizers are used (like the PariLCPlus for TOBI). The reusable nebulizers can at least be "disinfected." Whether you use baby bottle "sterilizers" or the dishwasher, or boiling water, you can disinfect them repeatedly without ruining them.
The Aerochamber (which is one of the ones we use) says that it can be ruined if sterilized, or boiled, or run in the dishwasher at higher than 158 degrees. The same is said of the OptiChamber (which we also have) and the Vortex. Vortex is made by Pari. All three have instructions to simply soak in mild detergent and lukewarm water for 15 minutes. Heck, I wash the vest (a "non-critical" device on the "sanitize" cycle and spray the thing down with Lysol periodically - that's more than they want you to do for the spacers that go over your mouth and shoot droplets into your lungs). So I persist. And frankly, I'm suspicious - no one seems to make a spacer that can withstand boiling or similar hot disinfection techniques. I'm not sure what would happen to the plastic under the chemical assault of the cold disinfection techniques either.
I will be honest - I just don't like the idea of not at least attempting to disinfect them at some level. So, after ruining many of them by boiling until they melted into a lump or distorted just enough to render them incapable of fitting together anymore, I now wash it with soap and water, and then use the microwaveable steam bags that you find in the baby section of your local WalMart or pharmacy. Both the Aerochamber and Optichamber come out just fine! Otherwise, I know of no real difference in them. I have had others, but I like the Aerochamber the best, because it has that bubble that lets me count his breaths so I know when all required breaths have been taken. That works well for the littler ones.
Questions about sterilizing or disinfecting all the accessories that come with our meds are persistent, aren't they. I suspect there are as many routines out there as there are people. There have been numerous threads about nebulizers, but few I think about the spacers that are used especially by children with their metered dose inhalers such as albuteral, xopenex, flovent, and Qvar to name just a few. Adults of course use spacers as well, I suspect because they are believed to be less likely to cause problems inside your mouth, and because they tend to make delivery easier and more complete. Your team can tell you more about why you might want to use a spacer if at all. But, I digress. . . .
First, there is indeed a difference between sterilization and disinfection although I tend to use the terms carelessly and interchangeably. As I understand it, disinfection eliminates the vast majority of organisms but does not eliminate a few - for example, the cff.org website materials indicate that disinfection will not eliminate bacterial spores. Sterilization, on the other hand, kills everything. (And for those of you who encounter the word "sanitize" on the back of your lysol or "disinfectant" sprays, that refers to simply reducing the number of critters, but not killing all of anything, I don't believe. So keep reading the back of that can and see what you need to do to "disinfect" with the same agent - its usually a matter of how long your target stays wet with the spray.)
The second concept involved here is the type of equipment you're targeting. The Guidelines for Infection Control distinguish between critical, semi-critical, and non-critical items. Critical items include things that basically invade your body - needles, surgical instruments, catheters, etc. Semi-critical items are things that come in contact with the mucous membranes (the lining of your nose, mouth, throat, lungs, etc) or broken skin - such as respiratory equipment. Non-critical items come in contact with your unbroken skin - such as your vest, clothing, linens, bedrails, etc. See www.cff.org/For-Caregivers/Clinical...Recommendations-for-Patients-With-CF-May-2003
To put it all together, generally speaking, you sterilize critical items and at a minimum disinfect semi-critical items. That's what the Guidelines say - "at a minimum." That sounds to me like we should be striving for sterilization of semi-critical items, but disinfecting is acceptable.
So a nebulizer is at least a semi-critical item. And as a reminder, here are the CFF's simplified version of the Guidelines for cleaning nebulizers:
"After each use, clean and disinfect the nebulizer by following the CF Foundation's recommended nebulizer care.
- Clean
- Disinfect
- Rinse
- Air dry
Heat Methods:
- Boil for 5 minutes
- Microwave for 5 minutes
- Dishwasher 158 degrees for 30 minutes
- Electric steam sterilizer
- 70% isopropyl alcohol for 5 minutes
- 3% hydrogen peroxide for 30 minutes”
I would imagine that the spacer is in the same category as a nebulizer - a semi-critical item requiring high level disinfection, although the Guidelines indicate that another similar item - the face mask - has no recommendations made except to follow the manufacturer's instructions. That made me wonder about Stephen's thoughtful post. But the Aerochamber we have is meant for both inhaling and exhaling and has a little yellow bubble that moves with each breath so you can see when a child has taken the required number of breaths. But it doesn't sit inside your mouth the way the nebulizer does for 20 minutes or more, coming out covered in saliva. It's more akin to a "non-critical" piece than a "semi-critical" one. Although they obviously haven't seen what my little guy does with it - flip it with his teeth, stick his tongue inside it, etc. . . . ! I also wonder if the difference may be that the nebulizer allows much smaller particles to penetrate deeper into your lungs. I really don't know. It is an excellent question for the CF Team. I have asked it before, but have simply been told that it's ok to wash the spacers every few days.
Really, this reminds me of the problem with disposable nebulizers. You couldn't disinfect them without them falling apart or melting or becoming distorted to the point that they didn't fit together anymore. So the manufacturer's recommendation was to simply wash them every now and again and throw them out eventually. Of course nebulizers were determined to be an source of infection for CFers. The infection can come from our own mucous membranes, other parts of your body, such as your hand or clothes, or even the water used to rinse and clean them. So only reusable nebulizers are used (like the PariLCPlus for TOBI). The reusable nebulizers can at least be "disinfected." Whether you use baby bottle "sterilizers" or the dishwasher, or boiling water, you can disinfect them repeatedly without ruining them.
The Aerochamber (which is one of the ones we use) says that it can be ruined if sterilized, or boiled, or run in the dishwasher at higher than 158 degrees. The same is said of the OptiChamber (which we also have) and the Vortex. Vortex is made by Pari. All three have instructions to simply soak in mild detergent and lukewarm water for 15 minutes. Heck, I wash the vest (a "non-critical" device on the "sanitize" cycle and spray the thing down with Lysol periodically - that's more than they want you to do for the spacers that go over your mouth and shoot droplets into your lungs). So I persist. And frankly, I'm suspicious - no one seems to make a spacer that can withstand boiling or similar hot disinfection techniques. I'm not sure what would happen to the plastic under the chemical assault of the cold disinfection techniques either.
I will be honest - I just don't like the idea of not at least attempting to disinfect them at some level. So, after ruining many of them by boiling until they melted into a lump or distorted just enough to render them incapable of fitting together anymore, I now wash it with soap and water, and then use the microwaveable steam bags that you find in the baby section of your local WalMart or pharmacy. Both the Aerochamber and Optichamber come out just fine! Otherwise, I know of no real difference in them. I have had others, but I like the Aerochamber the best, because it has that bubble that lets me count his breaths so I know when all required breaths have been taken. That works well for the littler ones.
Gammaw,
Your post is very informative. Thank you! I had something come up recently in regard to a mouthguard for soccer. How do I clean that? It can only be be boiled for a few seconds or it will melt. I am thinking wash with soap and water and soak in alcohol. When my son without CF had one I would just wash it with soap and water, but my daughter with CF does have resistant bacteria. I also remember my son putting his mouthguard after a game in his sneaker or shoe so it would not get lost. Ew.
Your post is very informative. Thank you! I had something come up recently in regard to a mouthguard for soccer. How do I clean that? It can only be be boiled for a few seconds or it will melt. I am thinking wash with soap and water and soak in alcohol. When my son without CF had one I would just wash it with soap and water, but my daughter with CF does have resistant bacteria. I also remember my son putting his mouthguard after a game in his sneaker or shoe so it would not get lost. Ew.
Aboveallislove
Super Moderator
Hey Stephen,
thanks so much for the thoughts. I do have a follow-up, though, as the way they taught us was that DS was to inhall and exhall 6 times and it all goes into the spacer. Maybe I misunderstood, but how do you inhall 6 times without exhaling or if you take it off your face, don't you loss some of the meds. Q
UOTE=stephen;1047820]The AeroChamber Plus / Z Stat is the only spacer I've used. They have a whistle that warns if you're inhaling too fast.
They do get washed every few weeks. However, I've never sterilized any of them.
There is a big difference between a nebulizer and a spacer. A spacer is NEVER supposed to be exhaled into; a nebulizer is. While the end of the spacer does touch my lips, I don't see how this is any different than drinking from a glass or using a spoon. My drinking glasses and silver ware utensils don't really get sterilized. Either does my toothbrush.
That's just my thoughts on the matter.[/QUOTE]
thanks so much for the thoughts. I do have a follow-up, though, as the way they taught us was that DS was to inhall and exhall 6 times and it all goes into the spacer. Maybe I misunderstood, but how do you inhall 6 times without exhaling or if you take it off your face, don't you loss some of the meds. Q
UOTE=stephen;1047820]The AeroChamber Plus / Z Stat is the only spacer I've used. They have a whistle that warns if you're inhaling too fast.
They do get washed every few weeks. However, I've never sterilized any of them.
There is a big difference between a nebulizer and a spacer. A spacer is NEVER supposed to be exhaled into; a nebulizer is. While the end of the spacer does touch my lips, I don't see how this is any different than drinking from a glass or using a spoon. My drinking glasses and silver ware utensils don't really get sterilized. Either does my toothbrush.
That's just my thoughts on the matter.[/QUOTE]
Aboveallislove
Super Moderator
Thanks so much for all the thoughts and I totally get the "mom mode."
I totally agree re trying at some level to disinfect or sterilizing. I thought I saw on the CFF recommendations (or maybe our Center's) that they don't recommend those bags. Now they are just discussing nebulizers and maybe it's just that other methods are better. And that would be better than nothing, unless there is a problem with the bags harboring bacteria if used more than once?? [
My other concern and I have it for the dip in boil water method I use too, is that it is suppose to have some sort of electro something that keeps the med from sticking so I worry how to do without ruining that. And I had thought well, when he's old enough to just inhall without the spacer that will be great, but Dot said in another thread that even adults should use because the meds get in better....so they should have a method of sterilizing the equipment, but our center told us to wash with soap and water and that's the directions too....augh. Re the alcohol, I'd also worry about that harming any protective coating. I don't see how they can't make one that can be sterlizing like the negs and unfortunately I haven't seen anything from anyone on this and the package directions don't give anything/nor the center.
Another thing I learned from the CFF guidelines was the term "asceptic" handling, which from my research looks like avoiding exposure to things and is how the nebs are suppose to be handled in the hospital setting, so ummm, like not dropping it on the floor and then using it.
I'm going to research more and see what they say at the next CF appointment and will update then.
QUOTE=Gammaw;1047822]Sorry for such a short response earlier. I was in "kid mode" as I call it.
Questions about sterilizing or disinfecting all the accessories that come with our meds are persistent, aren't they. I suspect there are as many routines out there as there are people. There have been numerous threads about nebulizers, but few I think about the spacers that are used especially by children with their metered dose inhalers such as albuteral, xopenex, flovent, and Qvar to name just a few. Adults of course use spacers as well, I suspect because they are believed to be less likely to cause problems inside your mouth, and because they tend to make delivery easier and more complete. Your team can tell you more about why you might want to use a spacer if at all. But, I digress. . . .
First, there is indeed a difference between sterilization and disinfection although I tend to use the terms carelessly and interchangeably. As I understand it, disinfection eliminates the vast majority of organisms but does not eliminate a few - for example, the cff.org website materials indicate that disinfection will not eliminate bacterial spores. Sterilization, on the other hand, kills everything. (And for those of you who encounter the word "sanitize" on the back of your lysol or "disinfectant" sprays, that refers to simply reducing the number of critters, but not killing all of anything, I don't believe. So keep reading the back of that can and see what you need to do to "disinfect" with the same agent - its usually a matter of how long your target stays wet with the spray.)
The second concept involved here is the type of equipment you're targeting. The Guidelines for Infection Control distinguish between critical, semi-critical, and non-critical items. Critical items include things that basically invade your body - needles, surgical instruments, catheters, etc. Semi-critical items are things that come in contact with the mucous membranes (the lining of your nose, mouth, throat, lungs, etc) or broken skin - such as respiratory equipment. Non-critical items come in contact with your unbroken skin - such as your vest, clothing, linens, bedrails, etc. See www.cff.org/For-Caregivers/Clinical-Care-Guidelines/Infection-Control-Recommendations-for-Patients-With-CF-May-2003
To put it all together, generally speaking, you sterilize critical items and at a minimum disinfect semi-critical items. That's what the Guidelines say - "at a minimum." That sounds to me like we should be striving for sterilization of semi-critical items, but disinfecting is acceptable.
So a nebulizer is at least a semi-critical item. And as a reminder, here are the CFF's simplified version of the Guidelines for cleaning nebulizers:
"After each use, clean and disinfect the nebulizer by following the CF Foundation's recommended nebulizer care.
Heat Methods:
I would imagine that the spacer is in the same category as a nebulizer - a semi-critical item requiring high level disinfection, although the Guidelines indicate that another similar item - the face mask - has no recommendations made except to follow the manufacturer's instructions. That made me wonder about Stephen's thoughtful post. But the Aerochamber we have is meant for both inhaling and exhaling and has a little yellow bubble that moves with each breath so you can see when a child has taken the required number of breaths. But it doesn't sit inside your mouth the way the nebulizer does for 20 minutes or more, coming out covered in saliva. It's more akin to a "non-critical" piece than a "semi-critical" one. Although they obviously haven't seen what my little guy does with it - flip it with his teeth, stick his tongue inside it, etc. . . . ! I also wonder if the difference may be that the nebulizer allows much smaller particles to penetrate deeper into your lungs. I really don't know. It is an excellent question for the CF Team. I have asked it before, but have simply been told that it's ok to wash the spacers every few days.
Really, this reminds me of the problem with disposable nebulizers. You couldn't disinfect them without them falling apart or melting or becoming distorted to the point that they didn't fit together anymore. So the manufacturer's recommendation was to simply wash them every now and again and throw them out eventually. Of course nebulizers were determined to be an source of infection for CFers. The infection can come from our own mucous membranes, other parts of your body, such as your hand or clothes, or even the water used to rinse and clean them. So only reusable nebulizers are used (like the PariLCPlus for TOBI). The reusable nebulizers can at least be "disinfected." Whether you use baby bottle "sterilizers" or the dishwasher, or boiling water, you can disinfect them repeatedly without ruining them.
The Aerochamber (which is one of the ones we use) says that it can be ruined if sterilized, or boiled, or run in the dishwasher at higher than 158 degrees. The same is said of the OptiChamber (which we also have) and the Vortex. Vortex is made by Pari. All three have instructions to simply soak in mild detergent and lukewarm water for 15 minutes. Heck, I wash the vest (a "non-critical" device on the "sanitize" cycle and spray the thing down with Lysol periodically - that's more than they want you to do for the spacers that go over your mouth and shoot droplets into your lungs). So I persist. And frankly, I'm suspicious - no one seems to make a spacer that can withstand boiling or similar hot disinfection techniques. I'm not sure what would happen to the plastic under the chemical assault of the cold disinfection techniques either.
I will be honest - I just don't like the idea of not at least attempting to disinfect them at some level. So, after ruining many of them by boiling until they melted into a lump or distorted just enough to render them incapable of fitting together anymore, I now wash it with soap and water, and then use the microwaveable steam bags that you find in the baby section of your local WalMart or pharmacy. Both the Aerochamber and Optichamber come out just fine! Otherwise, I know of no real difference in them. I have had others, but I like the Aerochamber the best, because it has that bubble that lets me count his breaths so I know when all required breaths have been taken. That works well for the littler ones.[/QUOTE]
I totally agree re trying at some level to disinfect or sterilizing. I thought I saw on the CFF recommendations (or maybe our Center's) that they don't recommend those bags. Now they are just discussing nebulizers and maybe it's just that other methods are better. And that would be better than nothing, unless there is a problem with the bags harboring bacteria if used more than once?? [
My other concern and I have it for the dip in boil water method I use too, is that it is suppose to have some sort of electro something that keeps the med from sticking so I worry how to do without ruining that. And I had thought well, when he's old enough to just inhall without the spacer that will be great, but Dot said in another thread that even adults should use because the meds get in better....so they should have a method of sterilizing the equipment, but our center told us to wash with soap and water and that's the directions too....augh. Re the alcohol, I'd also worry about that harming any protective coating. I don't see how they can't make one that can be sterlizing like the negs and unfortunately I haven't seen anything from anyone on this and the package directions don't give anything/nor the center.
Another thing I learned from the CFF guidelines was the term "asceptic" handling, which from my research looks like avoiding exposure to things and is how the nebs are suppose to be handled in the hospital setting, so ummm, like not dropping it on the floor and then using it.
I'm going to research more and see what they say at the next CF appointment and will update then.
QUOTE=Gammaw;1047822]Sorry for such a short response earlier. I was in "kid mode" as I call it.
Questions about sterilizing or disinfecting all the accessories that come with our meds are persistent, aren't they. I suspect there are as many routines out there as there are people. There have been numerous threads about nebulizers, but few I think about the spacers that are used especially by children with their metered dose inhalers such as albuteral, xopenex, flovent, and Qvar to name just a few. Adults of course use spacers as well, I suspect because they are believed to be less likely to cause problems inside your mouth, and because they tend to make delivery easier and more complete. Your team can tell you more about why you might want to use a spacer if at all. But, I digress. . . .
First, there is indeed a difference between sterilization and disinfection although I tend to use the terms carelessly and interchangeably. As I understand it, disinfection eliminates the vast majority of organisms but does not eliminate a few - for example, the cff.org website materials indicate that disinfection will not eliminate bacterial spores. Sterilization, on the other hand, kills everything. (And for those of you who encounter the word "sanitize" on the back of your lysol or "disinfectant" sprays, that refers to simply reducing the number of critters, but not killing all of anything, I don't believe. So keep reading the back of that can and see what you need to do to "disinfect" with the same agent - its usually a matter of how long your target stays wet with the spray.)
The second concept involved here is the type of equipment you're targeting. The Guidelines for Infection Control distinguish between critical, semi-critical, and non-critical items. Critical items include things that basically invade your body - needles, surgical instruments, catheters, etc. Semi-critical items are things that come in contact with the mucous membranes (the lining of your nose, mouth, throat, lungs, etc) or broken skin - such as respiratory equipment. Non-critical items come in contact with your unbroken skin - such as your vest, clothing, linens, bedrails, etc. See www.cff.org/For-Caregivers/Clinical-Care-Guidelines/Infection-Control-Recommendations-for-Patients-With-CF-May-2003
To put it all together, generally speaking, you sterilize critical items and at a minimum disinfect semi-critical items. That's what the Guidelines say - "at a minimum." That sounds to me like we should be striving for sterilization of semi-critical items, but disinfecting is acceptable.
So a nebulizer is at least a semi-critical item. And as a reminder, here are the CFF's simplified version of the Guidelines for cleaning nebulizers:
"After each use, clean and disinfect the nebulizer by following the CF Foundation's recommended nebulizer care.
- Clean
- Disinfect
- Rinse
- Air dry
Heat Methods:
- Boil for 5 minutes
- Microwave for 5 minutes
- Dishwasher 158 degrees for 30 minutes
- Electric steam sterilizer
- 70% isopropyl alcohol for 5 minutes
- 3% hydrogen peroxide for 30 minutes”
I would imagine that the spacer is in the same category as a nebulizer - a semi-critical item requiring high level disinfection, although the Guidelines indicate that another similar item - the face mask - has no recommendations made except to follow the manufacturer's instructions. That made me wonder about Stephen's thoughtful post. But the Aerochamber we have is meant for both inhaling and exhaling and has a little yellow bubble that moves with each breath so you can see when a child has taken the required number of breaths. But it doesn't sit inside your mouth the way the nebulizer does for 20 minutes or more, coming out covered in saliva. It's more akin to a "non-critical" piece than a "semi-critical" one. Although they obviously haven't seen what my little guy does with it - flip it with his teeth, stick his tongue inside it, etc. . . . ! I also wonder if the difference may be that the nebulizer allows much smaller particles to penetrate deeper into your lungs. I really don't know. It is an excellent question for the CF Team. I have asked it before, but have simply been told that it's ok to wash the spacers every few days.
Really, this reminds me of the problem with disposable nebulizers. You couldn't disinfect them without them falling apart or melting or becoming distorted to the point that they didn't fit together anymore. So the manufacturer's recommendation was to simply wash them every now and again and throw them out eventually. Of course nebulizers were determined to be an source of infection for CFers. The infection can come from our own mucous membranes, other parts of your body, such as your hand or clothes, or even the water used to rinse and clean them. So only reusable nebulizers are used (like the PariLCPlus for TOBI). The reusable nebulizers can at least be "disinfected." Whether you use baby bottle "sterilizers" or the dishwasher, or boiling water, you can disinfect them repeatedly without ruining them.
The Aerochamber (which is one of the ones we use) says that it can be ruined if sterilized, or boiled, or run in the dishwasher at higher than 158 degrees. The same is said of the OptiChamber (which we also have) and the Vortex. Vortex is made by Pari. All three have instructions to simply soak in mild detergent and lukewarm water for 15 minutes. Heck, I wash the vest (a "non-critical" device on the "sanitize" cycle and spray the thing down with Lysol periodically - that's more than they want you to do for the spacers that go over your mouth and shoot droplets into your lungs). So I persist. And frankly, I'm suspicious - no one seems to make a spacer that can withstand boiling or similar hot disinfection techniques. I'm not sure what would happen to the plastic under the chemical assault of the cold disinfection techniques either.
I will be honest - I just don't like the idea of not at least attempting to disinfect them at some level. So, after ruining many of them by boiling until they melted into a lump or distorted just enough to render them incapable of fitting together anymore, I now wash it with soap and water, and then use the microwaveable steam bags that you find in the baby section of your local WalMart or pharmacy. Both the Aerochamber and Optichamber come out just fine! Otherwise, I know of no real difference in them. I have had others, but I like the Aerochamber the best, because it has that bubble that lets me count his breaths so I know when all required breaths have been taken. That works well for the littler ones.[/QUOTE]
Aboveallislove
Super Moderator
Hey Rebjane,
What about washing with soap and water (soaking in anti-bacterial soap for 10 minutes) and then putting in water that you had used to boil the nebs (so the water has boiled and is sterile) and then just leaving in the water for 1-2 minutes? I'd think it is hot enough to kill stuff. Also, what about soaking in alcohol before washing??[
and ew.... on the shoes!
QUOTE=Rebjane;1047893]Gammaw,
Your post is very informative. Thank you! I had something come up recently in regard to a mouthguard for soccer. How do I clean that? It can only be be boiled for a few seconds or it will melt. I am thinking wash with soap and water and soak in alcohol. When my son without CF had one I would just wash it with soap and water, but my daughter with CF does have resistant bacteria. I also remember my son putting his mouthguard after a game in his sneaker or shoe so it would not get lost. Ew.[/QUOTE]
What about washing with soap and water (soaking in anti-bacterial soap for 10 minutes) and then putting in water that you had used to boil the nebs (so the water has boiled and is sterile) and then just leaving in the water for 1-2 minutes? I'd think it is hot enough to kill stuff. Also, what about soaking in alcohol before washing??[
and ew.... on the shoes!
QUOTE=Rebjane;1047893]Gammaw,
Your post is very informative. Thank you! I had something come up recently in regard to a mouthguard for soccer. How do I clean that? It can only be be boiled for a few seconds or it will melt. I am thinking wash with soap and water and soak in alcohol. When my son without CF had one I would just wash it with soap and water, but my daughter with CF does have resistant bacteria. I also remember my son putting his mouthguard after a game in his sneaker or shoe so it would not get lost. Ew.[/QUOTE]
Hi All,
We have used the Pari Vortex for years. It DOES hold up to heat sterilization. I have never boiled one in a pot, but we use a baby bottle sterilizer and they hold up beautifully. We use the Vortex because it is the only spacer that I know of that will hold up to heat sterilization. Are there any others out there? When it comes time for a new one I usually just google "Pari Vortex" and order online from which ever site has the best price at the time. The main part of the Vortex is made of metal, not plastic so it is a little bigger than some other spacers we have used. But we love that we can just throw it in the sterilizer with all the nebs.
Best,
Shay
We have used the Pari Vortex for years. It DOES hold up to heat sterilization. I have never boiled one in a pot, but we use a baby bottle sterilizer and they hold up beautifully. We use the Vortex because it is the only spacer that I know of that will hold up to heat sterilization. Are there any others out there? When it comes time for a new one I usually just google "Pari Vortex" and order online from which ever site has the best price at the time. The main part of the Vortex is made of metal, not plastic so it is a little bigger than some other spacers we have used. But we love that we can just throw it in the sterilizer with all the nebs.
Best,
Shay
T
The Dot
Guest
A high-quality spacer will have 2 one-way valves that direct air so that it never goes into the spacer when the patient exhales and only comes from inside the spacer when the patient inhales. So, technically, the inside of the spacer (if it has the one-way valves - I know our Aerochamber does) is "clean", but it does build up residue from the medication which can cause the one-way valves to malfunction. Cold sterilization with alcohol will not ruin most spacers, although it might shorten the life of your one-way valves. My take on that, "Better to shorten the life of the valve than the patient." Just sayin' 
S
stephen
Guest
Apparently there are different “models” of the AeroChamber Plus.
The "adult" model, which is the only one I was aware of, does not have any type of mouth covering. There is only a non-removable mouthpiece similar to what a nebulizer has.
To use it, I was instructed to take one long slow inhalation breath as the inhaler is depressed; then hold your breath for as long as it’s comfortable. As I've previously indicated, there is a whistle that sounds if the inhalation is too fast.
After using the AeroChamber for a while, a noticeable white power becomes deposited on the inner surface of the tube.
It was explained to me that a major reason to use the AeroChamber was to reduce the amount of this powder that’s inhaled. The powder is a byproduct of the propellant used in measured dose inhalers. A static charge on the AeroChamber's plastic tube attracts this powder and reduces the amount inhaled. That why I use it whenever I'm at home.
The "adult" model, which is the only one I was aware of, does not have any type of mouth covering. There is only a non-removable mouthpiece similar to what a nebulizer has.
To use it, I was instructed to take one long slow inhalation breath as the inhaler is depressed; then hold your breath for as long as it’s comfortable. As I've previously indicated, there is a whistle that sounds if the inhalation is too fast.
After using the AeroChamber for a while, a noticeable white power becomes deposited on the inner surface of the tube.
It was explained to me that a major reason to use the AeroChamber was to reduce the amount of this powder that’s inhaled. The powder is a byproduct of the propellant used in measured dose inhalers. A static charge on the AeroChamber's plastic tube attracts this powder and reduces the amount inhaled. That why I use it whenever I'm at home.
Hi all. I have spent several days now researching and reading on this issue. Thank you AboveAll for a great question that has rattled around in my brain but which I never really sought to resolve.
My conclusion, first of all, at this point is that I want a Pari Vortex. It can be disinfected.
What I've discovered is that the initial problem, which spacers (also known as valved holding chambers) were designed to resolve, was that most people, adults as well as children, do not use the metered dose inhalers, by themselves without spacers (MDI's) efficiently. Most of the medication wound up at the back of the throat or in the mouth, rather than in the lungs. Good timing and technique was a problem that the vast majority of people experienced, whether they were aware of it or not. It was too difficult to breathe in at the precise moment that the inhaler was depressed - so the medication hit the mouth or throat before a breath was taken, and little medication made it into the lungs.
Spacers allowed the sprayed medication to be held in a chamber until a breath was taken. So the medication finally made it into the lungs, rather than the mouth or throat. Unfortunately they then discovered that the inside of the chamber held an electrostatic charge which attracted the medication particles and adhered them to the walls of the spacer. So, again, a significant portion of the medication did not make it into the lungs - or the mouth or the throat for that matter. Instead it coated the spacer chamber, as Stephen has described. I found several older studies designed to determine how to eliminate the electrostatic charge. One of the principal findings seemed to be that washing in detergent and water eliminated the charge for anywhere from 24 hours to 7 days, depending on which paper you read. They also found that drying it with a paper towel was a bad idea, because that restored the charge. That's all fine and good, but if I'm only allowed to wash with soap and water, how do you disinfect?
Today, we see spacers proclaiming that they are anti static or non electrostatic to solve the problem. The Aerochamber Plus is made of "anti-static" material. The Pari Vortex says it has an antistatic metallic chamber. The OptiChamber we have is no longer sold, but the most recent version also claims to be made of antistatic material. All of them recommend cleaning with detergent and warm water. But that doesn't make me happy. Now, I do understand that they are generally classified as "non-critical" appliances that require only a low level of disinfection according to the CFF Infection Control Guidelines. And I suppose washing in warm water and detergent fits that bill. And I also assume that's just fine for the average non-CFer. But I really want to disinfect the thing. I've seen my little guy drop his on the dog's bed before. I've also seen him step on it, bite it, and grab it with unwashed hands inside the rim. And I have been duly trained to be extremely cautious of contaminants of all kinds. Despite the fact that I'm not piercing his skin with it, he is breathing it in. And isn't that how the vast majority of infections that cause serious issues for CFer's are introduced into their lungs? Through either the nasal or mouth passages? I want to disinfect it.
The Aerochamber says outright that boiling would destroy the appliance. The Optichamber is silent on the issue as far as I can tell. I'm not sure if I missed it the first time through, but if you dig into the additional materials on the Pari site, the Vortex can be disinfected and even sterilized in a hospital setting. Here's the link:
http://www.pari.de/fileadmin/user_upload/PARI.com_DE/Doc/de/Docs/051D0035-EN-VORTEX-Flyer.pdf
More detailed instructions are here:
http://www.pari.de/fileadmin/user_upload/PARI.com_DE/Doc/de/IFU/051D2021-A-Sued-IFU-PARI-VORTEX.pdf
It says you can either steam it (but not in a microwave since it has a metal chamber) or boil it in a pot for at least 5 minutes, making sure all the parts are submerged in the pot but not touching the heated bottom. Sounds good to me. Thank you Pari.
If anyone is aware of another spacer that contains instructions for disinfection, please sing out!
My conclusion, first of all, at this point is that I want a Pari Vortex. It can be disinfected.
What I've discovered is that the initial problem, which spacers (also known as valved holding chambers) were designed to resolve, was that most people, adults as well as children, do not use the metered dose inhalers, by themselves without spacers (MDI's) efficiently. Most of the medication wound up at the back of the throat or in the mouth, rather than in the lungs. Good timing and technique was a problem that the vast majority of people experienced, whether they were aware of it or not. It was too difficult to breathe in at the precise moment that the inhaler was depressed - so the medication hit the mouth or throat before a breath was taken, and little medication made it into the lungs.
Spacers allowed the sprayed medication to be held in a chamber until a breath was taken. So the medication finally made it into the lungs, rather than the mouth or throat. Unfortunately they then discovered that the inside of the chamber held an electrostatic charge which attracted the medication particles and adhered them to the walls of the spacer. So, again, a significant portion of the medication did not make it into the lungs - or the mouth or the throat for that matter. Instead it coated the spacer chamber, as Stephen has described. I found several older studies designed to determine how to eliminate the electrostatic charge. One of the principal findings seemed to be that washing in detergent and water eliminated the charge for anywhere from 24 hours to 7 days, depending on which paper you read. They also found that drying it with a paper towel was a bad idea, because that restored the charge. That's all fine and good, but if I'm only allowed to wash with soap and water, how do you disinfect?
Today, we see spacers proclaiming that they are anti static or non electrostatic to solve the problem. The Aerochamber Plus is made of "anti-static" material. The Pari Vortex says it has an antistatic metallic chamber. The OptiChamber we have is no longer sold, but the most recent version also claims to be made of antistatic material. All of them recommend cleaning with detergent and warm water. But that doesn't make me happy. Now, I do understand that they are generally classified as "non-critical" appliances that require only a low level of disinfection according to the CFF Infection Control Guidelines. And I suppose washing in warm water and detergent fits that bill. And I also assume that's just fine for the average non-CFer. But I really want to disinfect the thing. I've seen my little guy drop his on the dog's bed before. I've also seen him step on it, bite it, and grab it with unwashed hands inside the rim. And I have been duly trained to be extremely cautious of contaminants of all kinds. Despite the fact that I'm not piercing his skin with it, he is breathing it in. And isn't that how the vast majority of infections that cause serious issues for CFer's are introduced into their lungs? Through either the nasal or mouth passages? I want to disinfect it.
The Aerochamber says outright that boiling would destroy the appliance. The Optichamber is silent on the issue as far as I can tell. I'm not sure if I missed it the first time through, but if you dig into the additional materials on the Pari site, the Vortex can be disinfected and even sterilized in a hospital setting. Here's the link:
http://www.pari.de/fileadmin/user_upload/PARI.com_DE/Doc/de/Docs/051D0035-EN-VORTEX-Flyer.pdf
More detailed instructions are here:
http://www.pari.de/fileadmin/user_upload/PARI.com_DE/Doc/de/IFU/051D2021-A-Sued-IFU-PARI-VORTEX.pdf
It says you can either steam it (but not in a microwave since it has a metal chamber) or boil it in a pot for at least 5 minutes, making sure all the parts are submerged in the pot but not touching the heated bottom. Sounds good to me. Thank you Pari.
If anyone is aware of another spacer that contains instructions for disinfection, please sing out!
Aboveallislove
Super Moderator
OMG. I LOVE YOU!!! How in the world you found that is amazing. I had CALLED PARI. She said not to boil. I asked why? She didn't know. I asked her to ask. She said I will but they won't tell you to boil it!!!.
Thank you so much! And the Vortex really is cool and I got a great deal at allegromedical.com (like $12)
Thank you so much! And the Vortex really is cool and I got a great deal at allegromedical.com (like $12)
A P.S. The second link I posted above, which has instructions for the Vortex in three different languages, contains a cautionary note as follows:
CAUTION
– The VORTEX® can be disinfected up to 60 times as described in chapter 4. If you
use the device every day, replace all components of your holding chamber after a
year, because the material can change over time. This might impair the effective-
ness of the treatment.
So as with all "spacers" (they're really VHCs) replace them at least once a year, more often depending on your routines.
I do not understand why this information wasn't in the PIL - Patient Information Leaflet with AboveAlls equipment. Nor do I understand why we don't hear this from the CF Team. Nor why we are given free spacers at the Clinics that were unable to disinfect instead of something at least like the Vortex. Come here first people for the information you need to prepare your questions for your CF Team!
CAUTION
– The VORTEX® can be disinfected up to 60 times as described in chapter 4. If you
use the device every day, replace all components of your holding chamber after a
year, because the material can change over time. This might impair the effective-
ness of the treatment.
So as with all "spacers" (they're really VHCs) replace them at least once a year, more often depending on your routines.
I do not understand why this information wasn't in the PIL - Patient Information Leaflet with AboveAlls equipment. Nor do I understand why we don't hear this from the CF Team. Nor why we are given free spacers at the Clinics that were unable to disinfect instead of something at least like the Vortex. Come here first people for the information you need to prepare your questions for your CF Team!
Aboveallislove
Super Moderator
Ditto on all you said. I would add that our last Clinic newsletter specifically said "do not boil your spacer as it will" something....Maybe they don't know of the Vortex yet. But he!! the Pari rep. didn't either as she told me I could not boil it and was very snitty with me when I asked why and just said "well, I can find out but they'll still not recommend you boil it." Also, did you notice the full link name...something like A_Sued_FUI_ I was thinking it was an internal "joke" like An A- sued so here's the directions now FU. But then when I googled FUI, it means the setting (in addition to other names!!)
Thank you again Gramma and I'm going to share this with our RT at next clinic!
Oh, and Allegromedical has 60% off and free shipping for $25 and over so you can get 2 vortex (home and car?) for $26 shipped!!
Thank you again Gramma and I'm going to share this with our RT at next clinic!
Oh, and Allegromedical has 60% off and free shipping for $25 and over so you can get 2 vortex (home and car?) for $26 shipped!!
Aboveallislove
Super Moderator
Thanks so much for all your help! I hadn't realized that re the valves and that put me immediately looking for those. I've used the vortex now twice and am thrilled with it!