Sterilization plan of the used metered dose inhalers (MDI) to avoid wastage amid COVID-19 pandemic drug shortage

Abstract

Background

Coronavirus is causing a shortage of critical inhalers needed by patients with Asthma and respiratory illness. Patients with Asthma are at higher risk if they tract the novel Coronavirus. As the coronavirus continues to spread, hospitals are turning to use more salbutamol MDI. Salbutamol MDI has become the line of defence for physicians in the emergency room who are treating patients with Corona Virus Disease 2019 (COVID-19) and have respiratory distress .[Hui et al 2020 ,and Center for Drug Evaluation and Research 2020]

During the COVID pandemic, there has been a drastic increase in the use of MDI inhalers; therefore, it led to a decrease in availability and a break in the supply chain. Patients with Asthma are at higher risk if they tract the novel Coronavirus, and an inhaler could be a life or death for them. As the coronavirus continues to spread, hospitals are turning to use more salbutamol Metered Dose inhaler (MDI). Salbutamol MDI is now on short supply as the COVID-19 continues to spread. Salbutamol MDI has become the line of defence for physicians in the emergency room who are treating patients with COVID-19 and have respiratory distress. The current shortage of salbutamol MDI could be a result of stockpiling and hoarding of this life-saving inhaler. That had led to a critical shortage of Salbutamol MDI, and even the case shortage continues with some other alternatives such as Ipratropium MDI and even with long-acting B-agonists such as Salmeterol and Formoterol which also starting to have a limitation on ordering these agents.

Coronavirus sparks fear of medication shortage. Coronavirus panic-buying also may have led to a shortage of critical inhalers. We have also got elderly patients with COPD who may need Ventolin MDI and also premature babies who may have caught Respiratory Syncytial Virus (RSV) and need salbutamol MDI to support their lungs have since been compromised, and they rely heavily on Asthma inhalers. Finding a safe and creative strategy is essential during the COVID-19 pandemic.

Proposed sterilization plan for the used metered dose inhalers (MDI) [1,2,3,4]

There is considerable literature regarding the reprocessing and reuse of previously issued Salbutamol MDI. While a debatable practice, several hospitals have successfully implemented related programs .the current MDI canister protocol states that compliance with disinfecting the MDI nozzle is vital [5, 6]. In one case, cultures were taken of the MDI nozzle before and after disinfection with an alcohol prep pad, as well as after treatments were administered. Growth of Staphylococcus epidermidis occurred in at least 5% of the cultures with all three types of specimens, including those taken after the nozzle was disinfected with an alcohol prep pad. In another case, the hospital assessed the failure to wipe the canister nozzle with an alcohol prep pad before patient use; 1 of 18 (5.5%) cultures resulted in the growth of Streptococci Group D (Enterococci) [7]. A discussion may need to take place in each institution that includes Doctors, infection control, and pharmacy to agree on the best way to implement and ensure safety.

Fig. 1

Metered-dose inhaler with a spacer

Table 1 Step by step approach to the sterilization of Metered-Dose inhaler (MDI) (5-7)

Summary

Nebulized medication therapy has been the standard of care for bronchodilation for respiratory patients. However, nebulization generates aerosol, which increases the risk of droplet contamination as droplets can remain in the air and can spread virus particles. Critical inhaler medication shortage looms as coronavirus cases soar.

The use of metered-dose inhalers (MDI) reduces the risk of aerosol-generating particles. During the COVID pandemic, there has been a drastic increase in the use of MDI inhalers, which has led to a decrease in availability and a break in the supply chain. Hospital teams need to be proactive and start collecting the used MDI when appropriate and sterilize it following the provided procedure and keep in separate stock in case it is required. To minimize the risk of contamination, a discussion may need to take place in each institution that includes Doctors, infection control, SPD team and pharmacy to agree on the best way to implement and ensure safety (Fig. 1) (Table 1).