Table 4

Advantages and disadvantages of steam disinfection for nebuliser devices

AdvantagesDisadvantages

  • Effective killing of a wide range of bacterial pathogens [60–62], including:

    B. cepacia complex

    B. cepacia

    Burkholderia multivorans

    Candida albicans

    Enterococcus faecium

    Haemophilus influenzae

    Mycobacterium abscessus abscessus

    Mycobacterium abscessus bolletii

    Mycobacterium abscessus massiliense

    Mycobacterium abscessus/chelonae

    Mycobacterium avium intracellulare

    Mycobacterium chelonae

    P. aeruginosa (mucoid, nonmucoid)

    S. aureus (MRSA, MSSA)

    Steno. maltophilia

  • Apart from the Wabi Baby disinfector, all other baby bottle disinfector manufacturers have not endorsed their product for nebuliser disinfection

  • None of the steam disinfector units have indicators to show/confirm that unit has successfully completed its full cycle

  • The commercial Steam Sterilizer Plus Model (Wabi Baby, Frisco, TX, USA) has been examined for its effectiveness in disinfecting nebulisers spiked with CF organisms [63]:

    Achromobacter xylosoxidans

    B. cepacia

    P. aeruginosa

    MSSA

  • P. aeruginosa (mucoid, nonmucoid) and nontuberculous mycobacteria were not detected in either wet or dry fully assembled nebulisers following steam disinfection even in the presence of sputa [62]

  • Different brands of steam disinfectors performed effectively [62]

  • Terminal (end-stage) disinfection will allow for destruction of above pathogens, which may enter during prior stages (tap water, residual sputum, detergent, handling, etc.)

  • Relatively cheap (approximately GBP 50, EUR 80, USD 70)

  • Widely available in electrical shops and from online sellers

  • Wabi Baby device only available in USA

  • Simple to operate

  • No consumable items required, except tap water

  • Fast cycle speeds (approximately 8–15 min to disinfection)

  • Disinfected nebuliser can be stored in disinfector units post-cycle until required (≤24 h), thus avoiding post-disinfection contamination from surfaces, hands, environment, tap water

  • Portable (maybe taken on holiday/travel if voltage compatible)

  • Voltage compatibility in different countries

Can be used with metal components (e.g. metal vibrating mesh)

  • No membrane performance effect with Pari e-Flow rapid device [64]

  • Decrease in nebuliser output with Pari LC Plus device following repeated steam disinfection [55]; however, experimental limitations must be considered [59]

MRSA: methicillin-resistant S. aureus; MSSA: methicillin-sensitive S. aureus.