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

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

Steps:
1. The MDIs must be used with an aerochamber in order for reprocessing to be utilized
2. MDI used on the non-immunosuppressed patient will be recycled once the patient is discharged.
3. When dispensing an MDI, the pharmacy member will heat seal the inhaler (Canister, plastic actuator, and cap) in a plastic baggie with the patient label on the baggie. It is important not to place a label on any part of the inhaler. The pharmacy member will place the sealed baggie containing the inhaler along with one spacer in a plastic bag to be sent to the nursing unit. The outermost plastic bag will be labelled with a sticker to help remind staff of key steps.
4. The inhaler (drug canister + plastic actuator + cap) and the spacer will be kept in the plastic bag in the patient’s room at all times. Upon transfer, all parts of the inhaler and spacer will be transferred with the patient for continued storage and use for the patient.
5. Upon discontinuation of the Patient or Medication, Registered Nurse (RN) or Respiratory Therapist (RT) will ensure all pieces, including drug canister + plastic actuator + cap + spacer, are contained in the patient-specific dispensing bag sent from the pharmacy. RN or RT member will discard the patient label (on the plastic baggie) in the Shred-It bin.
6. (RN) or (RT) will treat all contents as biohazardous and place the bag in the designated bin on each unit.
7. PPE team members will collect MDIs from the bin and deliver to sterile processing for reprocess cleaning and disinfection. PPE team members will wipe the bin following the removal of items each day.
8. The sterile processing department (SPD) personnel will don gloves as the appropriate PPE for disinfecting the inhalers.
9. The spacer will be discarded as a biohazard.
10. The canister of the drug, the plastic actuator with the mouthpiece, and the cap will be wiped thoroughly with 70% isopropyl alcohol:
o Remove drug canister from the plastic actuator.
o Wipe all surfaces, interior and exterior, with alcohol.
o Do not submerge the canister or nozzle in liquid as this can block the nozzle.
o Ensure adequate dry time to allow for disinfection.
11. Once dry, place the canister inside a new zip lock bag and sealed.
12. Soak the actuator and mouthpiece cap in Valsure® neutral pH detergent and water for 10 min.
13. Ensure the appropriate dilution rate is followed. Use a timer. Contact time of 10 min is vital to effective disinfection.
14. Use a nylon brush to scrub away any visible soiling or medication build up in and on the Actuator and Mouthpiece
15. Place inhaler components, not the canister, inside the Anesthetic washer manifold and place in Automated Washer/Disinfector.
o Select the Anesthetic Cycle.
o Once completed, place the components in the HEPA dryer.
o Once components are dry and cool, place in a new zip-lock bag labelled PHARMACY
16. SPD will deliver the reprocessed MDIs to Pharmacy to be dispensed for patients
17. Once the inhaler returns to the pharmacy, the inhaler will be quarantined for an additional five days. The release date will be marked on the bag
18. Weigh canister, return to stock for inhalers, according to the table below.
19. Place canister into actuator and mouthpiece and return to a separate inventory.
InhalerRemaining dosesMean weight (Canister only)
Ipratropium (Atrovent®) *200 doses26.289 g ± 2.629
0 doses13.842 g ± 1.384
Salbutamol (Ventolin®)200 doses28.863 g ± 2.886
0 doses12.843 g ± 1.284
  1. *Ipratropium: discard inhaler when weight reaches 18 g*