Nebulized bronchodilator formulations: Unit-dose or multi-dose?

Joseph L. Rau, Ruben D. Restrepo

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Nosocomial infections linked to the use of multi-dose bronchodilator nebulizer formulations have been reported in the literature. OBJECTIVE: Survey American hospital respiratory therapy services to determine practice patterns, opinions, and awareness regarding unit-dose and multi-dose bronchodilator formulations. METHODS: A quota sample targeted 4 hospital size categories (0-100 beds, 101-200 beds, 201-400 beds, and > 400 beds) using a listing of general medical/surgical hospitals from the American Hospital Association. Hospitals were contacted via telephone to identify the director of respiratory therapy services, who was invited to complete a 29-item Web-based survey of their hospital practices and their opinions about and knowledge of issues with multi-dose and unit-dose bronchodilator formulations. RESULTS: One thousand fortyseven hospitals were recruited and 409 valid surveys were completed (completion rate 39%). The reported mean ± SD percentage of unit-dose nebulizer treatments was 80.2 ± 26.2%. Seventy-two percent (296) of respondents indicated having a policy and procedure manual that deals specifically with nebulized bronchodilator solutions, but only 107 reported having internal monitoring guidelines for compliance with those policies and procedures. Multi-dose bottles of bronchodilator concentrate were used with multiple patients in 77% of cases, and on average 9.7 ± 8.5 patients were treated with the same multi-dose bottle. Eighty-one percent of respondents reported that treatments from multi-dose bottles are prepared at the bedside. The length of time a multi-dose bottle was kept (after being opened) ranged from 24 hours (8%) to 1 month (11%), and only 3% of respondents reported following manufacturers' recommendations. In the respondents' opinion the chief advantage of multi-dose was cost per dose (84%), and the chief advantage of unit-dose was less risk of contamination (92%). With other factors (therapist time, cost of saline diluent for multi-dose concentrate, dose-error, and contamination) considered, 73% thought that unit-dose vials were more cost-effective. Three hundred thirty-six respondents (82%) thought that a sterile, low-volume (0.5 mL) unit-dose vial of bronchodilator concentrate would be useful, and 249 (74%) of those 336 respondents indicated that such a formulation would replace multi-dose bottles. Only 56% of respondents knew about the evidence regarding the risk of contamination with multi-dose bottles. CONCLUSIONS: Multi-dose bottles of bronchodilator solution are used in approximately 20% of nebulizer treatments, and without strict adherence to infection control procedures they are a potential source of nosocomial infection. A sterile, low-volume unit-dose vial of bronchodilator concentrate would be a useful alternative to multi-dose concentrate for modifying doses or mixing drugs in nebulizer therapy.

Original languageEnglish (US)
Pages (from-to)926-939
Number of pages14
JournalRespiratory Care
Volume48
Issue number10
StatePublished - Oct 2003
Externally publishedYes

Fingerprint

Bronchodilator Agents
Nebulizers and Vaporizers
Respiratory Therapy
Cross Infection
Costs and Cost Analysis
American Hospital Association
Surveys and Questionnaires
Health Facility Size
Therapeutics
Infection Control
Telephone
Guidelines

Keywords

  • Albuterol
  • Bronchodilator
  • Infection control
  • Multi-dose
  • Nebulizer
  • Unit-dose

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Rau, J. L., & Restrepo, R. D. (2003). Nebulized bronchodilator formulations: Unit-dose or multi-dose? Respiratory Care, 48(10), 926-939.

Nebulized bronchodilator formulations : Unit-dose or multi-dose? / Rau, Joseph L.; Restrepo, Ruben D.

In: Respiratory Care, Vol. 48, No. 10, 10.2003, p. 926-939.

Research output: Contribution to journalArticle

Rau, JL & Restrepo, RD 2003, 'Nebulized bronchodilator formulations: Unit-dose or multi-dose?', Respiratory Care, vol. 48, no. 10, pp. 926-939.
Rau, Joseph L. ; Restrepo, Ruben D. / Nebulized bronchodilator formulations : Unit-dose or multi-dose?. In: Respiratory Care. 2003 ; Vol. 48, No. 10. pp. 926-939.
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title = "Nebulized bronchodilator formulations: Unit-dose or multi-dose?",
abstract = "BACKGROUND: Nosocomial infections linked to the use of multi-dose bronchodilator nebulizer formulations have been reported in the literature. OBJECTIVE: Survey American hospital respiratory therapy services to determine practice patterns, opinions, and awareness regarding unit-dose and multi-dose bronchodilator formulations. METHODS: A quota sample targeted 4 hospital size categories (0-100 beds, 101-200 beds, 201-400 beds, and > 400 beds) using a listing of general medical/surgical hospitals from the American Hospital Association. Hospitals were contacted via telephone to identify the director of respiratory therapy services, who was invited to complete a 29-item Web-based survey of their hospital practices and their opinions about and knowledge of issues with multi-dose and unit-dose bronchodilator formulations. RESULTS: One thousand fortyseven hospitals were recruited and 409 valid surveys were completed (completion rate 39{\%}). The reported mean ± SD percentage of unit-dose nebulizer treatments was 80.2 ± 26.2{\%}. Seventy-two percent (296) of respondents indicated having a policy and procedure manual that deals specifically with nebulized bronchodilator solutions, but only 107 reported having internal monitoring guidelines for compliance with those policies and procedures. Multi-dose bottles of bronchodilator concentrate were used with multiple patients in 77{\%} of cases, and on average 9.7 ± 8.5 patients were treated with the same multi-dose bottle. Eighty-one percent of respondents reported that treatments from multi-dose bottles are prepared at the bedside. The length of time a multi-dose bottle was kept (after being opened) ranged from 24 hours (8{\%}) to 1 month (11{\%}), and only 3{\%} of respondents reported following manufacturers' recommendations. In the respondents' opinion the chief advantage of multi-dose was cost per dose (84{\%}), and the chief advantage of unit-dose was less risk of contamination (92{\%}). With other factors (therapist time, cost of saline diluent for multi-dose concentrate, dose-error, and contamination) considered, 73{\%} thought that unit-dose vials were more cost-effective. Three hundred thirty-six respondents (82{\%}) thought that a sterile, low-volume (0.5 mL) unit-dose vial of bronchodilator concentrate would be useful, and 249 (74{\%}) of those 336 respondents indicated that such a formulation would replace multi-dose bottles. Only 56{\%} of respondents knew about the evidence regarding the risk of contamination with multi-dose bottles. CONCLUSIONS: Multi-dose bottles of bronchodilator solution are used in approximately 20{\%} of nebulizer treatments, and without strict adherence to infection control procedures they are a potential source of nosocomial infection. A sterile, low-volume unit-dose vial of bronchodilator concentrate would be a useful alternative to multi-dose concentrate for modifying doses or mixing drugs in nebulizer therapy.",
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T1 - Nebulized bronchodilator formulations

T2 - Unit-dose or multi-dose?

AU - Rau, Joseph L.

AU - Restrepo, Ruben D.

PY - 2003/10

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N2 - BACKGROUND: Nosocomial infections linked to the use of multi-dose bronchodilator nebulizer formulations have been reported in the literature. OBJECTIVE: Survey American hospital respiratory therapy services to determine practice patterns, opinions, and awareness regarding unit-dose and multi-dose bronchodilator formulations. METHODS: A quota sample targeted 4 hospital size categories (0-100 beds, 101-200 beds, 201-400 beds, and > 400 beds) using a listing of general medical/surgical hospitals from the American Hospital Association. Hospitals were contacted via telephone to identify the director of respiratory therapy services, who was invited to complete a 29-item Web-based survey of their hospital practices and their opinions about and knowledge of issues with multi-dose and unit-dose bronchodilator formulations. RESULTS: One thousand fortyseven hospitals were recruited and 409 valid surveys were completed (completion rate 39%). The reported mean ± SD percentage of unit-dose nebulizer treatments was 80.2 ± 26.2%. Seventy-two percent (296) of respondents indicated having a policy and procedure manual that deals specifically with nebulized bronchodilator solutions, but only 107 reported having internal monitoring guidelines for compliance with those policies and procedures. Multi-dose bottles of bronchodilator concentrate were used with multiple patients in 77% of cases, and on average 9.7 ± 8.5 patients were treated with the same multi-dose bottle. Eighty-one percent of respondents reported that treatments from multi-dose bottles are prepared at the bedside. The length of time a multi-dose bottle was kept (after being opened) ranged from 24 hours (8%) to 1 month (11%), and only 3% of respondents reported following manufacturers' recommendations. In the respondents' opinion the chief advantage of multi-dose was cost per dose (84%), and the chief advantage of unit-dose was less risk of contamination (92%). With other factors (therapist time, cost of saline diluent for multi-dose concentrate, dose-error, and contamination) considered, 73% thought that unit-dose vials were more cost-effective. Three hundred thirty-six respondents (82%) thought that a sterile, low-volume (0.5 mL) unit-dose vial of bronchodilator concentrate would be useful, and 249 (74%) of those 336 respondents indicated that such a formulation would replace multi-dose bottles. Only 56% of respondents knew about the evidence regarding the risk of contamination with multi-dose bottles. CONCLUSIONS: Multi-dose bottles of bronchodilator solution are used in approximately 20% of nebulizer treatments, and without strict adherence to infection control procedures they are a potential source of nosocomial infection. A sterile, low-volume unit-dose vial of bronchodilator concentrate would be a useful alternative to multi-dose concentrate for modifying doses or mixing drugs in nebulizer therapy.

AB - BACKGROUND: Nosocomial infections linked to the use of multi-dose bronchodilator nebulizer formulations have been reported in the literature. OBJECTIVE: Survey American hospital respiratory therapy services to determine practice patterns, opinions, and awareness regarding unit-dose and multi-dose bronchodilator formulations. METHODS: A quota sample targeted 4 hospital size categories (0-100 beds, 101-200 beds, 201-400 beds, and > 400 beds) using a listing of general medical/surgical hospitals from the American Hospital Association. Hospitals were contacted via telephone to identify the director of respiratory therapy services, who was invited to complete a 29-item Web-based survey of their hospital practices and their opinions about and knowledge of issues with multi-dose and unit-dose bronchodilator formulations. RESULTS: One thousand fortyseven hospitals were recruited and 409 valid surveys were completed (completion rate 39%). The reported mean ± SD percentage of unit-dose nebulizer treatments was 80.2 ± 26.2%. Seventy-two percent (296) of respondents indicated having a policy and procedure manual that deals specifically with nebulized bronchodilator solutions, but only 107 reported having internal monitoring guidelines for compliance with those policies and procedures. Multi-dose bottles of bronchodilator concentrate were used with multiple patients in 77% of cases, and on average 9.7 ± 8.5 patients were treated with the same multi-dose bottle. Eighty-one percent of respondents reported that treatments from multi-dose bottles are prepared at the bedside. The length of time a multi-dose bottle was kept (after being opened) ranged from 24 hours (8%) to 1 month (11%), and only 3% of respondents reported following manufacturers' recommendations. In the respondents' opinion the chief advantage of multi-dose was cost per dose (84%), and the chief advantage of unit-dose was less risk of contamination (92%). With other factors (therapist time, cost of saline diluent for multi-dose concentrate, dose-error, and contamination) considered, 73% thought that unit-dose vials were more cost-effective. Three hundred thirty-six respondents (82%) thought that a sterile, low-volume (0.5 mL) unit-dose vial of bronchodilator concentrate would be useful, and 249 (74%) of those 336 respondents indicated that such a formulation would replace multi-dose bottles. Only 56% of respondents knew about the evidence regarding the risk of contamination with multi-dose bottles. CONCLUSIONS: Multi-dose bottles of bronchodilator solution are used in approximately 20% of nebulizer treatments, and without strict adherence to infection control procedures they are a potential source of nosocomial infection. A sterile, low-volume unit-dose vial of bronchodilator concentrate would be a useful alternative to multi-dose concentrate for modifying doses or mixing drugs in nebulizer therapy.

KW - Albuterol

KW - Bronchodilator

KW - Infection control

KW - Multi-dose

KW - Nebulizer

KW - Unit-dose

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