Microbial colonization of nebulizers used by asthmatic children.

BACKGROUND: The aim of the present study was to determine the microbial colonization of nebulizers used at home by asthmatic children, and to investigate their parents' cleaning and maintenance routines. METHODS: The nebulizer equipment used at home by 39 asthmatic children was examined. Swabs taken from the inner surface of the reservoir cups, face masks and filters were cultured. Results were recorded as mean number of colony-forming units per cultured surface. Parents were interviewed regarding their cleaning and disinfection routines. RESULTS: Twenty-six reservoir cups (66.7%), 24 face masks (61.5%), and 18 filters (78.3%) were found to be contaminated. Pseudomonas aeruginosa was isolated from 17 reservoir cups (43.6%) and 12 face masks (30.8%), and Staphylococcus aureus from two face masks (5.1%). None of the parents knew that the nebulizer has a filter and that it requires periodic cleaning or changing; only eight of the parents (20.5%) received maintenance instructions from the medical staff, and only 19 (48.7%) cleaned the nebulizer equipment after use. CONCLUSION: Home nebulizers are frequently colonized with microorganisms. As recommended, nebulizers should be washed after each use and air-blown dry. Nebulizer maintenance should be emphasized in educational programs for managing asthma.

Pediatrician attitudes to exclusion of ill children from child-care centers in Israel: pressure on ambulatory practices.

BACKGROUND: The exclusion of ill children from child-care centers may be associated with high social, economic and medical costs. OBJECTIVE: To assess the opinions of pediatricians working in an outpatient setting in Israel on the exclusion/return of children in child-care centers. METHODS: A questionnaire on practices of exclusion/return of children in child-care centers, in general and according to specific signs and symptoms, was administered to a random computer-selected cross-sectional sample of 192 primary care community pediatricians in Israel. RESULTS: One hundred and seventy-three pediatricians completed the questionnaires, for a response rate of 90%; 147 were board-certified and 26 were not. About half the pediatricians felt pressured by parents requesting antibiotic therapy to accelerate the return of their sick child to the child-care center. The majority also believed their practice was overloaded by often unnecessary demands for medical notes by the child-care centers before children could return. More than half based their decision to exclude children on "common sense" and the remainder, on accepted guidelines. Except for scabies and lice, there were no significant correlations between the physicians' stipulation for a note on return of the child and the specific illness guidelines. CONCLUSIONS: This study shows that a high proportion of pediatricians based their exclusion practices on "common sense" and personal understanding instead of established guidelines, and that the guidelines did not affect their opinion on the duration of illness that warrant a note. Furthermore, half were subjected to parental pressure to employ inappropriate practices. These findings, combined with our earlier survey of child-care centers staff, indicate that better education of parents and day-care staff about ill child-care-center-exclusion policy in Israel would increase their common understanding with pediatricians.