Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T07:42:49.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Is nasal steroid spray bottle contamination a potential issue in chronic rhinosinusitis?

Published online by Cambridge University Press:  31 May 2013

N C-W Tan ,
A J Drilling ,
C Jardeleza  and
P-J Wormald
N C-W Tan
Affiliation:
Department of Surgery – Otolaryngology, University of Adelaide, South Australia, Australia
A J Drilling
Affiliation:
Department of Surgery – Otolaryngology, University of Adelaide, South Australia, Australia
C Jardeleza
Affiliation:
Department of Surgery – Otolaryngology, University of Adelaide, South Australia, Australia
P-J Wormald*
Affiliation:
Department of Surgery – Otolaryngology, University of Adelaide, South Australia, Australia
*
Address for correspondence: Professor P-J Wormald, Department of Surgery – Otolaryngology, Adelaide Universities, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA, Australia, 5011 E-mail: peterj.wormald@adelaide.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Intranasal steroids are the first line of treatment for chronic rhinosinusitis. Although contamination of adjunctive devices (e.g. irrigation bottles) has been much investigated, little is known about nasal contamination of the metered-dose spray bottles used to deliver intranasal steroids, and the potential influence on disease chronicity.

Methods:

Twenty-five prospectively recruited patients with stable chronic rhinosinusitis underwent microbiological analysis of their nasal vestibule and middle meatus and also of their steroid bottle tip and contents. Additionally, bottle tips were inoculated in vitro with Staphylococcus aureus and various sterilisation techniques tested.

Results:

For 18 of the 25 (72 per cent) patients, both nasal and bottle tip swabs grew either Staphylococcus aureus or coagulase-negative staphylococci. Staphylococcus aureus was cultured from 7 of the 25 (28 per cent) patients, and 5 of these 7 had concomitant bacterial growth from both nose and steroid bottle. Thus, the cross-contamination rate was 71 per cent for Staphylococcus aureus infected patients and 20 per cent overall. Sterilisation was effective with boiling water, ethanol wipes and microwaving, but not with cold water or dishwashing liquid.

Conclusion:

Nasal steroid spray bottle tips can become contaminated with sinonasal cavity bacteria. Simple sterilisation methods can eliminate this contamination. Patient education on this matter should be emphasised.

Keywords

Staphylococcus AureusSinusitisNasal SpraysEquipment Contamination
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Supplement S1 , January 2014 , pp. S28 - S33
Copyright
Copyright © JLO (1984) Limited 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Fokkens, W, Lund, V, Mullol, J. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl 2007:1–136Google ScholarPubMed
2Benninger, MS, Ferguson, BJ, Hadley, JA, Hamilos, DL, Jacobs, M, Kennedy, DW et al. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 2003;129(suppl 3):S1–32CrossRefGoogle ScholarPubMed
3Scadding, GK, Durham, SR, Mirakian, R, Jones, NS, Drake-Lee, AB, Ryan, D et al. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 2008;38:260–75CrossRefGoogle ScholarPubMed
4Rizzi, M, Batra, PS, Hall, G, Citardi, MJ, Lanza, DC. An assessment for the presence of bacterial contamination of Venturi principle atomizers in a clinical setting. Am J Rhinol 2005;19:21–3CrossRefGoogle ScholarPubMed
5Dubin, MG, White, DR, Melroy, CT, Gergan, MT, Rutala, WA, Senior, BA. Multi-use Venturi nasal atomizer contamination in a clinical rhinologic practice. Am J Rhinol 2004;18:151–6CrossRefGoogle Scholar
6Lee, JM, Nayak, JV, Doghramji, LL, Welch, KC, Chiu, AG. Assessing the risk of irrigation bottle and fluid contamination after endoscopic sinus surgery. Am J Rhinol Allergy 2010;24:197–9CrossRefGoogle ScholarPubMed
7Keen, M, Foreman, A, Wormald, PJ. The clinical significance of nasal irrigation bottle contamination. Laryngoscope 2010;120:2110–14CrossRefGoogle ScholarPubMed
8Welch, KC, Cohen, MB, Doghramji, LL, Cohen, NA, Chandra, RK, Palmer, JN et al. Clinical correlation between irrigation bottle contamination and clinical outcomes in post-functional endoscopic sinus surgery patients. Am J Rhinol Allergy 2009;23:401–4CrossRefGoogle ScholarPubMed
9Lewenza, S, Charron-Mazenod, L, Cho, JJ, Mechor, B. Identification of bacterial contaminants in sinus irrigation bottles from chronic rhinosinusitis patients. J Otolaryngol Head Neck Surg 2010;39:458–63Google ScholarPubMed
10Singhal, D, Foreman, A, Bardy, JJ, Wormald, PJ. Staphylococcus aureus biofilms: nemesis of endoscopic sinus surgery. Laryngoscope 2011;121:1578–83CrossRefGoogle ScholarPubMed
11Singhal, D, Psaltis, AJ, Foreman, A, Wormald, PJ. The impact of biofilms on outcomes after endoscopic sinus surgery. Am J Rhinol Allergy 2010;24:169–74CrossRefGoogle ScholarPubMed
12Plouin-Gaudon, I, Clement, S, Huggler, E, Chaponnier, C, Francois, P, Lew, D et al. Intracellular residency is frequently associated with recurrent Staphylococcus aureus rhinosinusitis. Rhinology 2006;44:249–54Google ScholarPubMed
13Jervis-Bardy, J, Foreman, A, Boase, S, Valentine, R, Wormald, PJ. What is the origin of Staphylococcus aureus in the early postoperative sinonasal cavity? Int Forum Allergy Rhinol 2011;1:308–12CrossRefGoogle ScholarPubMed
14Tan, NC, Foreman, A, Jardeleza, C, Douglas, R, Tran, H, Wormald, PJ. The multiplicity of Staphylococcus aureus in chronic rhinosinusitis: correlating surface biofilm and intracellular residence. Laryngoscope 2012;122:1655–60CrossRefGoogle ScholarPubMed
15Lanza, DC, Kennedy, DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg 1997;117:S1–7CrossRefGoogle ScholarPubMed
16Rosenfeld, RM. Hand washing. Otolaryngol Head Neck Surg 2009;141:667–9CrossRefGoogle ScholarPubMed
17Boyce, JM, Pittet, D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002;30:S1–46CrossRefGoogle ScholarPubMed
18Foreman, A, Jervis-Bardy, J, Wormald, PJ. Do biofilms contribute to the initiation and recalcitrance of chronic rhinosinusitis? Laryngoscope 2011;121:1085–91CrossRefGoogle Scholar
19Jervis-Bardy, J, Foreman, A, Field, J, Wormald, PJ. Impaired mucosal healing and infection associated with Staphylococcus aureus after endoscopic sinus surgery. Am J Rhinol Allergy 2009;23:549–52CrossRefGoogle ScholarPubMed
20Foreman, A, Wormald, PJ. Can bottle design prevent bacterial contamination of nasal irrigation devices? Int Forum Allergy Rhinol 2011;1:303–7CrossRefGoogle ScholarPubMed
21Spraggs, PD, Hanekom, WH, Mochloulis, G, Joseph, T, Kelsey, MC. The assessment of the risk of cross-infection with a multi-use nasal atomizer. J Hosp Infect 1994;28:315–21CrossRefGoogle ScholarPubMed
22Bhattacharyya, N, Kepnes, L. Bacterial colonization of nasal steroid inhalers in chronic rhinosinusitis. Am J Rhinol 2002;16:319–21CrossRefGoogle ScholarPubMed
23Kuehnert, MJ, Kruszon-Moran, D, Hill, HA, McQuillan, G, McAllister, SK, Fosheim, G et al. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001–2002. J Infect Dis 2006;193:172–9CrossRefGoogle ScholarPubMed
24Feazel, LM, Robertson, CE, Ramakrishnan, VR, Frank, DN. Microbiome complexity and Staphylococcus aureus in chronic rhinosinusitis. Laryngoscope 2012;122:467–72CrossRefGoogle ScholarPubMed