Dirty Cpap Equipment is a Dead End Road

[tomjax]

Here comes another chicken little.
You could have all the slime in the world in your tank or water from your toilet or the creek and it would not casue problems.

The bugs simply cannot hitch a ride on the water vapor.

But this will never prevent people from irrational fears.
The slime did not cause any respiratory problems.

[capers]

Tomjax said,

You could have all the slime in the world in your tank or water from your toilet or the creek and it would not casue problems.

The bugs simply cannot hitch a ride on the water vapor.

Which is exactly what my DME said at our first meeting. She reported that she had attended a factory making xpaps (she didn't say which brand but since I live in Australia, I could have a guess at the brand) and they told her that the humidifier could contain green slimy water without it affecting the patient. Nevertheless her company asked all renters to use only distilled water to preserve the appearance of cleanliness.

[timbalionguy]

So uhhh ... we're not supposed to reuse a Kleenex for a week?

OMG DREAMSTALKER!! NOOOOOOOOO!!!!!!! You do not reuse a Kleenex for a week straight!!!!!! You only use it for 6 days, 23 hours and 58 minutes, then you are supposed to get a new one you goofball Chimp!!!!! EWWWWWWWW!!!!! I can't believe you use yours for a week before changing to a new one!!!!!

That's why I use a good quality paper towel like Bounty.....they're good for about a month and have an added benefit of toughening up your nose so your mask doesn't leave marks anymore

I like using the paper meat comes wrapped in. Its nice and coarse, so it catches anything a tissue would miss. Its really strong so you can use it for weeks on end. Gets kind of smelly if there is any residual blood left on the paper but you get used to the smell after a while....

On a more serious note: Have any of you ever seen or used a 'Rainbow' vacuum cleaner? You put water in it, and the water traps the dust, etc. I used one for years, and you would be amazed how dirty the water gets after just one use to vacuum an average sized room. Now imagine your humidifer the same way. As air passes over it, anything in the air (dust, bacteria, pollen, smoke, etc.) gets picked up by the water. If you reuse the water by topping off the humidifer each night, the water only gets dirtier. This is why you are seeing slime even when you use distilled water. I don't know of any CPAP machines that use a HEPA filter, but I don't think even that would prevent this problem.

I dump and rinse my humidifier (tap water is OK for rinse) every day.

My mask is a different story. Plastic parts get rinsed at minimum, and washed once a week. Silicone parts are removed for cleaning separately. The mask seal itself has to be cleaned with full-strength dish soap each day (for degreasing), or it will not seal properly the next night. My face is really oily, and I am working on finding a regimen that will leave my face clean enough that the mask seal will make it through a night.

[DreamStalker]

So uhhh ... we're not supposed to reuse a Kleenex for a week?

OMG DREAMSTALKER!! NOOOOOOOOO!!!!!!! You do not reuse a Kleenex for a week straight!!!!!! You only use it for 6 days, 23 hours and 58 minutes, then you are supposed to get a new one you goofball Chimp!!!!! EWWWWWWWW!!!!! I can't believe you use yours for a week before changing to a new one!!!!!

I carried one around in my pocket for a month once. But then I ran out of toilet paper and had to use it to wipe my butt ... so sometimes it does pay to carry it around for more than a week. I decided to go ahead and stop using it after wiping my butt though.

I don't go backpacking anymore so I suppose I don't have to carry a Kleenex around for more than a week ... thanks for the heads up.

[roster]

......... I checked the Humidifier Tank today and there is Yellowish Slime all on the Inside. I know now that this contributed to the Sinus and Bronchitis Problems I have had. ..........

What are you using for water in your tank? Do you regularly change the air filters?

I just checked my tank after reading this post. I have been topping it off daily with distilled water for more than one year and have not rinsed it out once in that time. (I have another CPAP that I use on trips.) To my eye, the tank looks perfectly clean and the water in it also looks perfectly clean.

Even though you report slime in your tank, I remain very skeptical that this was the cause of your respiratory infections.

But by all means, suit yourself on cleaning routines.

[DreamStalker]

Like Rooster, I've only rinsed out my HC150 reservoir (twice in 3 years) and I have not even rinsed it out in over a year now ... just top it off every other day.

However, I don't use slimy water to refill ... only distilled, always distilled, nothing but distilled. Ergo, my reservoir looks and smells just like it did brand new out of the box.

[JoyD.]

Tomjax said,

The bugs simply cannot hitch a ride on the water vapor.

Sure they can. Bacteria "hitch a ride" on liquids in the form of "droplet nuclei". That is one way colds are spread: not only by hands, but also by sneezing and being in the air via droplet nuclei. My research in microbiology involved droplet nuclei.

[DreamStalker]

Tomjax said,

The bugs simply cannot hitch a ride on the water vapor.

Sure they can. Bacteria "hitch a ride" on liquids in the form of "droplet nuclei". That is one way colds are spread: not only by hands, but also by sneezing and being in the air via droplet nuclei. My research in microbiology involved droplet nuclei.

I thought colds were caused by viruses. Viruses are much smaller than bacteria. Never did any research in micro or macro biology but I have always understood that both viruses and bacteria are indeed too large to hitch a ride on water "vapor" (significantly different than water droplet nuclei). Our HH systems utilize water vapor not aerosolized water droplet nuclei.

[JoyD.]

Tomjax said:
The bugs simply cannot hitch a ride on the water vapor.

JoyD wrote:
Sure they can. Bacteria "hitch a ride" on liquids in the form of "droplet nuclei". That is one way colds are spread: not only by hands, but also by sneezing and being in the air via droplet nuclei. My research in microbiology involved droplet nuclei.

Dreamstalker replied:
I thought colds were caused by viruses. Viruses are much smaller than bacteria. Never did any research in micro or macro biology but I have always understood that both viruses and bacteria are indeed too large to hitch a ride on water "vapor" (significantly different than water droplet nuclei). Our HH systems utilize water vapor not aerosolized water droplet nuclei.

Dreamstalker:
Yes, of course, colds are caused by viruses. "Microbes" (bacteria, viruses, etc) can hitch a ride on droplet nuclei or water vapor.

Does all water reach boiling point in all CPAP machines? I don't know. But if the slime accumulates, it would seem that the water has not boiled to kill the bacteria or the microbes are thermophilic. Are they pathogenic organisms? Again, I don't know. Not all microbes cause disease; some are environmental but not pathogenic in the average person (an immunocompromised person is something else). But I don't think I'd want slimy water in my CPAP humidifier. And I would recommend distilled water since that water has been produced from boiling.

Below are references related to transmission of microbes via "water vapor":

As for water vapor, I located this article by Nathan Schiff, Ph.D., who is the President of Schiff Consulting, a Regulatory
and Environmental Consulting firm. He notes:

"The atmosphere always contains some moisture in the form of water vapor in it, and the when it holds the maximum amount
at a given temperature, the air is saturated with water, the level of discomfort is high and bacterial potency is maintained at a maximum level."

Therefore, in maintaining a healthy work environment, he recommends keeping the humidity low through the use of air conditioning:

"By reducing the relative humidity throughout a facility to less than 50%, biological contaminations is reduced many fold to safe levels whereby bacteria can not proliferate."
More on the page: http://www.schiff-consulting.com/sickenv.htm


Here's United States Patent 5520854 submitted for an invention to prevent the transmission of bacteria in the water vapor emitted from a humidifier, which notes that, for humidifiers without the benefit of the invention:

"...bacteria in both the water and surrounding air accumulate within the humidifier. As a result, the operational efficiency of the humidifier is impaired, and more importantly, bacteria emitted in the water vapor can pose a significant health threat to people breathing the humidified air."
http://www.freepatentsonline.com/5520854.html


Here's an article about the importance of 'De-humidification in Hospitals', by the Bry-Air air conditioning company, which notes:

"In many health care facilities, there is a necessity to assure good indoor air quality, thus large quantities of outside air must be brought into the building through the ventilation system. This outside air can account for over 90% of the moisture load typically seen in many health care buildings. It is important to remember that bacteria travels on water vapor in the air so in order to avoid microbial growth and surgeon/patient discomfort, this moisture must be removed before the fresh air enters the building. This is particularly true in warm, humid climates."
http://www.bry-air.com/applications/mol ... itals.html


And here's a scholarly article, published in U.S. Pharmacist Magazine, and online, titled 'Review of Community-Acquired
Pneumonia in Immunocompetent Adults', by Dawn S. Knudsen, PharmD and Steven T. Boyd, PharmD, BCPS, CDE, CDM, which
notes:

"A suspicion of L. pneumophila can be supported by epidemiologic evidence in the patient?s medical history or past activity.
Commonly, outbreaks arise at the end of the summer and early fall. The bacteria is associated with warm, stagnant water found in certain plumbing systems, hot water tanks, cooling towers, evaporative condensers of large air-conditioning systems, and whirlpool spas. Legionella organisms are not passed from person to person but by inhalation of water vapor containing bacteria."
http://www.uspharmacist.com/index.asp?p ... efault.htm

Hope this provides some valuable information, and encourages the use of distilled water and/or periodic/reasonable cleaning of our CPAP humidifiers.

Joy

[DreamStalker]

Sorry Joy ... your reference is wrong or misleading.

E. Coli is about 2,000 nanometers
Rhinovirus is about 20 nanometers
Water molecule is 0.278 nanometers

It is physically impossible for an object to hitch a ride on an airborne object 100 times smaller ... no can do. It would be like you trying to hitch a ride on a bumble bee. And if you were an E. Coli, it would be like you trying to hitch a ride on a nat


BTW - HH does NOT boil water ... it evaporates water. And I agree, I would not want slime in my HH which is why I use distilled water only ... did I mention distilled water?

[timbalionguy]

Sorry Joy ... your reference is wrong or misleading.

E. Coli is about 2,000 nanometers
Rhinovirus is about 20 nanometers
Water molecule is 0.278 nanometers

It is physically impossible for an object to hitch a ride on an airborne object 100 times smaller ... no can do. It would be like you trying to hitch a ride on a bumble bee. And if you were an E. Coli, it would be like you trying to hitch a ride on a nat


BTW - HH does NOT boil water ... it evaporates water. And I agree, I would not want slime in my HH which is why I use distilled water only ... did I mention distilled water?

You are using the figure here for a molecule of water. Most water droplets are millions of times bigger. I don't have a definitive figure on this, but I suspect that airborne droplets would have a diameter starting at around 10,000 nanometers. If water completely vaporizes, it cannot carry bacteria or viruses. But these particles are light enough in their own right to be carried on a stream of air. The best practice, just to be safe, is keep your humidifier clean. Most of the time, a simple rinse is good enough if you use distilled water.

[DreamStalker]

Sorry Joy ... your reference is wrong or misleading.

E. Coli is about 2,000 nanometers
Rhinovirus is about 20 nanometers
Water molecule is 0.278 nanometers

It is physically impossible for an object to hitch a ride on an airborne object 100 times smaller ... no can do. It would be like you trying to hitch a ride on a bumble bee. And if you were an E. Coli, it would be like you trying to hitch a ride on a nat


BTW - HH does NOT boil water ... it evaporates water. And I agree, I would not want slime in my HH which is why I use distilled water only ... did I mention distilled water?

You are using the figure here for a molecule of water. Most water droplets are millions of times bigger. I don't have a definitive figure on this, but I suspect that airborne droplets would have a diameter starting at around 10,000 nanometers. If water completely vaporizes, it cannot carry bacteria or viruses. But these particles are light enough in their own right to be carried on a stream of air. The best practice, just to be safe, is keep your humidifier clean. Most of the time, a simple rinse is good enough if you use distilled water.

My HH is clean ... has been clean for about 3 years (since I got it). I use distilled water.

My HH does not utilize water droplets of any size ... but rather water vapor (the molecular kind with a fairly standard size of 0.3 nanometers and pretty much just like everyone else's water molecules).

While bacteria and viruses can indeed be carried aloft in air without water molecules or "droplets", I seriously doubt that they could escape the surface water tensional forces to become airborne (please don't make me go do the vector analysis to prove it). So there is no way that slime in the water will become airborne period and then give somebody a sinus infection.

[nomoore]

I cleaned mine because it smelled like bad breath not because it gave me a sinus infection. It did have a slime coating on the inside. Yes, I DO use ONLY DISTILLED WATER. So whether it can give you a sinus infection or not, it can at least grow slime and become stinky when using distilled water. Wash your humidifier tanks people.

[Velbor]

My HH does not utilize water droplets of any size ... but rather water vapor (the molecular kind with a fairly standard size of 0.3 nanometers and pretty much just like everyone else's water molecules). While bacteria and viruses can indeed be carried aloft in air without water molecules or "droplets", I seriously doubt that they could escape the surface water tensional forces to become airborne (please don't make me go do the vector analysis to prove it). So there is no way that slime in the water will become airborne period and then give somebody a sinus infection. :lol: :lol:

Consider:

-- As water level drops during the night, microbes adhering to the walls of the chamber are exposed to the airflow stream and can become airborne. They need not "escape" from the water surface.

-- Laminar flow over the water surface seems to be assumed. LOOK at the surface of the water in your humidifier as you breathe: on a macroscopic level there will be ripples; on a microscopic scale there will surely be larger "spray droplets". These are irrelevant to humidification, but they cannot be prevented without much fancier equipment than we use.

-- Whether occasional microorganisms from the humidifier can "make it down the tube" in sufficient quantity to be clinically relevant to the person behind the mask has been argued on this forum, and studies quoted and criticized. Even so, they don't have to "make it down the tube" all at once: particularly if there is rainout, they can theoretically survive and thrive and migrate down the tube.

-- It's argued that if only distilled water is used, there's nothing for microorganisms to feed on to stay alive. First, distilled water is not sterile water. Even if it were, that condition ends once the bottle is opened. And the air around us: The typical ResMed filter looks as though it will keep out insects. The typical Respironics dual filters probably do a bit better. What protects the blower outlet during the day? What protects the humidifier openings from airborne particulates? Postings in this thread and elsewhere support the proposition that microbes DO GROW in distilled water in humidifiers.

Pretences of certainty are just that. The bottom line is, "Do you feel lucky?" Or alternatively, how paranoid do you choose to be? Or alternatively, what is reasonable and prudent (which may be different for each individual). Velbor

[DreamStalker]

Velbor -

I have great respect for your scientific perspective and always enjoy reading your posts.

I was not assuming laminar flow. And yes the potential does exist for a few droplets to form but the probability for any of them to make it out of the reservoir chamber and then down into and out of the tube is very low IMO. Also, microbes sticking to the sides are more likely to stay stuck and/or if freed by turbulence, only to get stuck in another part of the chamber or back into the water. Even if microbes manage to migrate down the tube over time, as you pointed out they are not going to be in huge numbers and IMO not in significant numbers to make anyone sick.

Once you change the scope beyond the HH reservoir to the mask end you have changed the question and I would bet that one has a much greater chance of getting sick from typing on their PC keyboard or turning a public door knob or getting the pig flu (from a Chinese person) than getting sick from an unclean HH.

Nonetheless, I agree with you that it comes down to asking yourself what are the odds? So someone washes their reservoir and hose every day for fear of getting sick and yet may end up getting sick anyway (it has happened to one of our forum members).

It's been fun but I have to call it a day and go BBQ some chicken