Bubbling Humidifiers Produce Microaerosols Which Can Carry Bacteria

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Abstract
It is widely held that bubbling humidifiers do not produce microaerosols, although prior studies have resulted in conflicting evidence. We have studied this phenomenon in a clean room using an airborne particle counter and samplers for airborne bacteria. At gas flow rates between 10 and 80 L/min, a Cascade 1 humidifier produced between 460 and 999 water droplets/L humidified gas. Total water volume aerosolized was approximately 10-8 ml/L humidified gas. Seventy-three percent of the particles had diameters between 1 and 5 microns. With the reservoir containing 6.4 × 106P. aeruginosa/ml, it produced between 2 and 9 P. aeruginosa/Lhumidified gas. Most of the bacteria were in particles of a size likely to be deposited in the lung. This bacterial carryover was between 20 and 150 times the amount predicted by multiplication of the water volume aerosolized times the concentration of bacteria in the humidifier reservoir. An Air Life humidifier produced fewer particles which were also of a size likely to be deposited in the lung and, when the reservoir contained P. aeruginosa, it aerosolized bacteria. Wick-type humidifiers did not produce detectable aerosol or bacterial carry-over. Although the clinical significance of these findings has not been established, they provide a rationale for the CDC recommendations for procedures designed to keep bubbling humidifier reservoir water uncontaminated.