COVID-19 & The Use of Nebulizers

 

Photo Credit: KristyFaith is licensed under CC BY-NC-ND 2.0

The World Health Organization stated that airborne transmission of SARS-CoV-2 (COVID-19) can be possible through medical procedures that generate aerosols. A few experimental studies have shown results of air samples containing the virus through the utilization of high-powered jet nebulizers. With that said— where does that leave aerosol therapy through nebulization in COVID-19 patients?

 

Of course, we may simply opt to use other means for aerosol therapy. Easy peasy lemon squeezy, right? Well yes, if we all live in an ideal world. However, not everyone in our community has the means for other options. At times, a patient’s compliance (or lack thereof) may deem the situation to have no other option than to use that aerosol producing machine. So, what now?

 

This is a subject for discussion. If one is under self-quarantine & isolation at home or in a separate room at home, then by all means one may proceed with aerosol therapy through nebulization. As stated by the Asthma and Allergy Foundation of America— COVID-19 positive or not, the biggest risk to people with asthma is nottreating asthma symptoms when needed at home. Such uncontrolled asthma may lead to overcrowding at the emergency departments of healthcare facilities which, as we all know, are already packed with little to no availability for accommodating any more patients.

 

However, it's a different concern within hospital settings. Patients admitted for COVID-19 with asthma as a co-morbidity may necessitate aerosol therapy through nebulization. Healthcare workers would be put at risk of contracting the disease duringthe therapy process and even an hour after so. MDIs may be utilized instead. In the instance that nebulization is indicated, HCWs must follow standard precautions and also wear eye protection. An N95 or higher-level respirator must be used in place of the surgical mask. It is to note that respirators with exhalation valves are not recommended for source control and should not be used during procedures as unfiltered exhaled breath would compromise sterile field.

So aerosol therapy has been performed on a patient. How will we address the infectious particles in the air? This must have been addressed beforehand, as the patient was being admitted. Those suspicious of carrying an infectious viral load would have been evaluated for their current condition and the actual need for hospitalization. If deemed absolutely necessary for admission, the admitting institution would follow infection control protocol standardized by the CDC.The patient is to be placed in a single-person bedroom with a door closed, preferably an isolation room.

Speaking of isolation rooms, a specialized Airborne Infection Isolation Room (AIIR) is ideal in the placement of patients suspected of or confirmed with COVID-19 who would be undergoing aerosol-generating procedures (like, but not limited to, nebulization). AIIRs are single-patient rooms at, may I stress, negative pressures relative to surrounding areas. A minimum of 6 air changes per hour is advised. This is stressed as infectious particles, especially that from aerosol therapy, must be evacuated to negate the potential spread and infection of the virus from airborne sources. Air from these rooms should be exhausted directly to the outside or filtered through a HEPA filter before air is viable for recirculation. Although it's pretty much common sense for both infection-control and patient privacy, but it is worth stating: room doors should be kept closed except when HCWs are entering or leaving the room YET ENTRY AND EXITS MUST BE KEPT AT MINIMUM. The health facility or institution must document proper negative pressure function of rooms.

So, TLDR— Yes, COVID-19 patients are allowed to use nebulizers for aerosol therapy. Aerosol therapy, itself, is generally permitted. However, standard protocol in executing precautionary measures for infection prevention must be exercised regardless of whether in a self-isolation setting at home or within the premises of a medical facility.

Lastly: let me stress that, unless if absolutely necessary, stay at home. If you have no business being outside, why go there? No matter how many layers of masks one would wear, or how many gallons of sanitizer used, or how long handwashing was performed, and how far social distance is exercised; it's much better to protect yourself and your loved ones from the unknown. Prevention is always better than cure.

Sources in the links provided.