The Potential Role of Inhalation Therapy Equipment in Nosocomial Pulmonary Infection*

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Abstract
Gram-negative bacilli are assuming an increasing role in nosocomial infections. In addition to the well-recognized syndromes of pyelonephritis and gram-negative rod bacteremia, acute gram-negative necrotizing pneumonia increased in autopsy frequency from 0.8% in 1952 to 8% in 1963 (p<cO.01). As a common denominator, inhalation therapy equipment was studied as a source of bacterial aerosols. An Andersen air sampler enabled quantitation of both number and size of particles, particles of2500 particles/7.5 1 of air. In contrast, IPPB machines without RN assemblies, humidifiers, pediatric croupettes delivered "air" with bacterial counts comparable to ambient air. Predominent isolates included Pseudomonas sp., Herellea sp. and Flavobacterlum sp. Such organisms have been incirminated in bronchopulmonary infections. Studies were then directed at decontamination. Nebulization of 0.25% acetic acid for 5 min. daily reduced counts to those of ambient air and prevented recontamination. Thus, inhalation therapy equipment is potentially a major contributor to nosocomial infections unless contamination is detected and control implemented.