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Infection control in the pulmonary function test laboratory.

Rasam SA, Apte KK, Salvi SS - Lung India (2015 Jul-Aug)

Bottom Line: Pulmonary function testing plays a crucial role in the diagnostic evaluation of patients with lung diseases.Use of specialized techniques and equipment can also be of much use in a set up that has a high turnover of patients.This review aims at creating awareness about the possible pathogens and situations commonly encountered in a PFT laboratory.

View Article: PubMed Central - PubMed

Affiliation: Lung Function Testing Department, Chest Research Foundation, Pune, Maharashtra, India.

ABSTRACT
Pulmonary function testing plays a crucial role in the diagnostic evaluation of patients with lung diseases. Cases of cross infection acquired from the pulmonary function laboratory, although rare, have been reported from various countries. It is therefore imperative to identify the risks and potential organisms implicated in cross infections in a pulmonary function test (PFT) laboratory and implement better and more effective infection control procedures, which will help in preventing cross infections. The infrastructure, the daily patient flow, and the prevalent disinfection techniques used in a PFT laboratory, all play a significant role in transmission of infections. Simple measures to tackle the cross infection potential in a PFT laboratory can help reduce this risk to a bare minimum. Use of specialized techniques and equipment can also be of much use in a set up that has a high turnover of patients. This review aims at creating awareness about the possible pathogens and situations commonly encountered in a PFT laboratory. We have attempted to suggest some relevant and useful infection control measures with regard to disinfection, sterilization, and patient planning and segregation to help minimize the risk of cross infections in a PFT laboratory. The review also highlights the lacuna in the current scenario of PFT laboratories in India and the need to develop newer and better methods of infection control, which will be more user-friendly and cost effective. Further studies to study the possible pathogens in a PFT laboratory and evaluate the prevalent infection control strategies will be needed to enable us to draw more precious conclusions, which can lead to more relevant, contextual recommendations for cross infections control in PFT lab in India.

No MeSH data available.


Related in: MedlinePlus

Bacterial filters used in the mouthpiece during spirometry
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Figure 3: Bacterial filters used in the mouthpiece during spirometry

Mentions: Many studies have shown that mouthpieces are the most contaminated PFT equipments and they should not be shared between patients. Use of disposable mouthpieces helps in preventing cross infection in patients. Disposable mouthpieces, nose clips, and flow sensors should be discarded after single use. If reusable mouthpieces are used for testing, they should be sterilized before every use [Figure 2a and b]. One-way valve mouthpieces avoid inhalation of pathogens from infected equipment. However, they hamper the measurement of inspiratory flow when used with peak flow meters. Alternatively, barrier filters may be used with mouth pieces. Barrier filters protect the equipment from contamination and prevent inhalation from the circuit, thus assisting in infection control. If the equipment is contaminated with blood or sputum, it must be sterilized immediately. It is practically difficult to disinfect lung function equipments in between two patients. This can be overcome by using microbial filters in the mouth pieces. Recently, the use of bacterial filters in pulmonary function laboratories has increased [Figure 3]. The choice of filter is important. Early filters had reported to have a bacterial retention efficiency of approximately 67%. Recently, filters using more efficient filters have been demonstrated to be approximately 99.9% efficient at flow rates up to 750 L/min and approximately 97% efficient at removing bacterial colony-forming particles when patients perform forced expiratory maneuvers through them.[10] Filters, containing pleated filters, have been shown to have a unidirectional microbial removal efficacy of greater than 99.9%. As the device is bi-directional, this means that the probability of cross-contamination is one in million, that is, negligible. Roe et al. published a cost comparison of filters versus the current Thoracic Society of Australian and New Zealand guidelines.[15] This analysis showed that in busy laboratory, the cost per test of using a barrier filter was on average approximately five times cheaper than the implementation of the guidelines. Use of a bacterial filter is reassuring for the overly concerned patients. Although significant differences between measurements with and without filters have been demonstrated for FVC, FEV1, airway resistance, and specific airway conductance (sGaw), these differences were unrelated to the average values of measurements (except for sGaw) and limits of agreement were within the range of intra-individual short-term repeatability for almost all of the function indices. Use of filters reduce measured lung volume (2%–4% of FEV1 and FVC, 6% Peak Expiratory Flow [PEF]), which is small and clinically irrelevant.[24] Use of filters during calibration is another method to add resistance provided by the filters in calculation.


Infection control in the pulmonary function test laboratory.

Rasam SA, Apte KK, Salvi SS - Lung India (2015 Jul-Aug)

Bacterial filters used in the mouthpiece during spirometry
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4502201&req=5

Figure 3: Bacterial filters used in the mouthpiece during spirometry
Mentions: Many studies have shown that mouthpieces are the most contaminated PFT equipments and they should not be shared between patients. Use of disposable mouthpieces helps in preventing cross infection in patients. Disposable mouthpieces, nose clips, and flow sensors should be discarded after single use. If reusable mouthpieces are used for testing, they should be sterilized before every use [Figure 2a and b]. One-way valve mouthpieces avoid inhalation of pathogens from infected equipment. However, they hamper the measurement of inspiratory flow when used with peak flow meters. Alternatively, barrier filters may be used with mouth pieces. Barrier filters protect the equipment from contamination and prevent inhalation from the circuit, thus assisting in infection control. If the equipment is contaminated with blood or sputum, it must be sterilized immediately. It is practically difficult to disinfect lung function equipments in between two patients. This can be overcome by using microbial filters in the mouth pieces. Recently, the use of bacterial filters in pulmonary function laboratories has increased [Figure 3]. The choice of filter is important. Early filters had reported to have a bacterial retention efficiency of approximately 67%. Recently, filters using more efficient filters have been demonstrated to be approximately 99.9% efficient at flow rates up to 750 L/min and approximately 97% efficient at removing bacterial colony-forming particles when patients perform forced expiratory maneuvers through them.[10] Filters, containing pleated filters, have been shown to have a unidirectional microbial removal efficacy of greater than 99.9%. As the device is bi-directional, this means that the probability of cross-contamination is one in million, that is, negligible. Roe et al. published a cost comparison of filters versus the current Thoracic Society of Australian and New Zealand guidelines.[15] This analysis showed that in busy laboratory, the cost per test of using a barrier filter was on average approximately five times cheaper than the implementation of the guidelines. Use of a bacterial filter is reassuring for the overly concerned patients. Although significant differences between measurements with and without filters have been demonstrated for FVC, FEV1, airway resistance, and specific airway conductance (sGaw), these differences were unrelated to the average values of measurements (except for sGaw) and limits of agreement were within the range of intra-individual short-term repeatability for almost all of the function indices. Use of filters reduce measured lung volume (2%–4% of FEV1 and FVC, 6% Peak Expiratory Flow [PEF]), which is small and clinically irrelevant.[24] Use of filters during calibration is another method to add resistance provided by the filters in calculation.

Bottom Line: Pulmonary function testing plays a crucial role in the diagnostic evaluation of patients with lung diseases.Use of specialized techniques and equipment can also be of much use in a set up that has a high turnover of patients.This review aims at creating awareness about the possible pathogens and situations commonly encountered in a PFT laboratory.

View Article: PubMed Central - PubMed

Affiliation: Lung Function Testing Department, Chest Research Foundation, Pune, Maharashtra, India.

ABSTRACT
Pulmonary function testing plays a crucial role in the diagnostic evaluation of patients with lung diseases. Cases of cross infection acquired from the pulmonary function laboratory, although rare, have been reported from various countries. It is therefore imperative to identify the risks and potential organisms implicated in cross infections in a pulmonary function test (PFT) laboratory and implement better and more effective infection control procedures, which will help in preventing cross infections. The infrastructure, the daily patient flow, and the prevalent disinfection techniques used in a PFT laboratory, all play a significant role in transmission of infections. Simple measures to tackle the cross infection potential in a PFT laboratory can help reduce this risk to a bare minimum. Use of specialized techniques and equipment can also be of much use in a set up that has a high turnover of patients. This review aims at creating awareness about the possible pathogens and situations commonly encountered in a PFT laboratory. We have attempted to suggest some relevant and useful infection control measures with regard to disinfection, sterilization, and patient planning and segregation to help minimize the risk of cross infections in a PFT laboratory. The review also highlights the lacuna in the current scenario of PFT laboratories in India and the need to develop newer and better methods of infection control, which will be more user-friendly and cost effective. Further studies to study the possible pathogens in a PFT laboratory and evaluate the prevalent infection control strategies will be needed to enable us to draw more precious conclusions, which can lead to more relevant, contextual recommendations for cross infections control in PFT lab in India.

No MeSH data available.


Related in: MedlinePlus