Nebulization Dos and Don'ts in the ICU

RECOMMENDATIONS FOR NEBULISATION IN THE ICU SETTING

	DO's Perform nebulisation in an airborne infection isolation room AIIR, commonly called as a negative-pressure room, whenever feasible, or in a portable anteroom.		DON'T Follow continuous nebulisation. Intermittent nebulisation (only during inspiration) is more efficient and safe as it minimises aerosol loss during exhalation.
	DO's Protect ventilators and other mechanical devices (e.g.cough- assist machines) with a high-efficiency viral-bacterial filter.		DON'T Allow multiple HCWs inside the ICU (Intensive Care Unit) when nebulisation is being undertaken unless they are wearing a full PPE kit. Restrict entry and exit of HCWs into the ICU to a minimum.
	DO's standardise all the usage parameters with respect to the nebuliser system. Place the nebuliser in the inspiratory line at a distance of at least 30 cm from the patient and ensure airflow of 6–8 L/ minute.		DON'T reuse the equipment and nebuliser accessories unless they have been washed thoroughly using liquid/hospital-grade disinfectants such as isopropanol (70%) or hydrogen peroxide (3%).
	DO's Wear appropriate PPE with safety accessories such as eye protection, face mask, gloves, face shield, shoe and head covers, and gown to avoid possible contamination through aerosol generation.		DON'T Disconnect the humidifier while placing the nebuliser. Only remove the heat and moisture exchanger since its filter can act as a barrier to aerosol delivery.
	DO's Leave the ICU vacant with the door closed for 30 minutes after the patient has vacated the room post-nebulisation. Sanitise the room after nebulisation before letting others enter.		DON'T leave the ICU without cleaning and disinfecting high-touch surfaces (apart from the equipment) with an approved hospital disinfectant.