OMIGOSH... I better clean more often!

DreamStalker · Post by **DreamStalker** » Tue Mar 25, 2008 7:01 am

Velbor wrote:Just a reminder that the concepts of

distilled (= no dissolved ions in the water), and
sterile (= no living microorganisms in the water)

are entirely different.

Distilled water may not necessarily be sterile.
Sterile water may not necessarily be distilled.
Tap and bottled water are certainly neither.
Once opened and used, bottles of sterile or distilled water do not necessarily remain so.

The question is, why do you think you need either of these qualities in your humidifier water? There often may be good reasons, but can you explain them, and why they apply to your particular situation? "I was told to do it" and "I've always done it" don't count in science!

The principle reason for using distilled water is to mitigate mineral precipitation onto the metal reservoir base which may then reduce the effective heat conductance of the humidifier sytem.

Velbor · Post by **Velbor** » Tue Mar 25, 2008 7:26 am

DreamStalker wrote:The principle reason for using distilled water is to mitigate mineral precipitation onto the metal reservoir base which may then reduce the effective heat conductance of the humidifier sytem.

Exactly right, DreamStalker!

I would also add in practical terms that the need for distilled water depends both upon (1) the mineral content of alternative - less expensive or more convenient - water sources available and (2) the amount of water which is vaporized overnight and the corresponding increased saturation of mineral ions in the remaining water.

Point (2) in particular also involves issues of practice: whether one dumps out remaining water each morning, or whether one simply adds additional water. The second practice is more likely to lead to increasing concentration and precipitation.

Finally, in addition to precipitation potentially affecting heat conduction, precipitates often form in "open lattice" structures which retain moisture and thus provide lovely little "nests" in which microorganisms can potentially hide and grow.

Which brings us back to dieselgal's original post, and the wisdom of at least periodic inspection, if not periodic emptying and cleaning. (The acidity of vinegar solutions being useful for dissolving and removing mineral precipitates.)

KHENAULT · Post by **KHENAULT** » Tue Mar 25, 2008 7:48 am

NightHawkeye wrote:Distilled water shouldn't need a filter, should it?

I was talking about the air filter.

K

RipVW · Post by **RipVW** » Tue Mar 25, 2008 8:11 am

Velbor wrote:The question is, why do you think you need either of these qualities in your humidifier water?

I know we need distilled rather than tap water to reduce lime residue buildup in our humidifiers.

Wulfman · Post by **Wulfman** » Tue Mar 25, 2008 10:02 am

In any case, "chunks" of lime/scale/grime/sludge or whatever aren't going to get carried into your airway.......they're too heavy to be carried by the water vapor. It might smell, but then the air we breathe in other places is probably more toxic to our systems.....(I'm thinking urban smog/pollution and factory/refinery emissions).

.

And, "akcpapguy"........Eeeewwwwww......THAT WAS GROSS!
Maybe there IS a limit to cleanliness with these machines.

Den (ain't nothin' floating or growing in or on MY humidifier tank)

Velbor · Post by **Velbor** » Tue Mar 25, 2008 1:38 pm

Wulfman wrote:In any case, "chunks" of lime/scale/grime/sludge or whatever aren't going to get carried into your airway.......they're too heavy to be carried by the water vapor.

It's often claimed that since CPAP humidifiers work by vaporization (entry of water into the airflow at a molecular level rather than through droplets), microorganisms cannot travel from the reservoir. But in fact a glance at the water surface in a humidifier during operation will demonstrate that the airflow is turbulent; "waves" are produced on the surface of the water. Minimal as they may seem, there will in fact be water droplets expelled from the humidifier, and those droplets can carry minute "chunks" of stuff, or more to the point, microorganisms.

How relevant any of this may be to your own health is what is debatable.

I would be so bold as to make reference to one of my previous posts:

viewtopic.php?p=240700#240700

Wulfman · Post by **Wulfman** » Tue Mar 25, 2008 2:27 pm

Don't take my word for it. This is from Fisher & Paykel Healthcare in this link:

http://www.talkaboutsleep.com/sleep-dis ... humid9.htm

Den

Slinky · Post by **Slinky** » Tue Mar 25, 2008 3:23 pm

akcpapguy wrote:dieselgal,

Atleast yours didn't look like this one!!!!

http://s249.photobucket.com/albums/gg21 ... y%20CPAPs/

Yes I took the pictures, NO it's not MY CPAP.......that's all I will say about that!!!

Urghh! One of your patients's, AKCPapGuy??? Looks like something my neighbor to the west would use and own. I think he lives in his Carharts and just throws what's left of them away when they start to disintegrate. I don't think he's bathed since his mom died four years ago.

Velbor · Post by **Velbor** » Tue Mar 25, 2008 5:50 pm

Thank you, Wulfman.

Wulfman wrote:Don't take my word for it. This is from Fisher & Paykel Healthcare in this link: http://www.talkaboutsleep.com/sleep-dis ... humid9.htm

The link you cite goes on to say

F&P wrote:Q. Is it possible for a patient to catch an infection from a humidifier? A. The environment in the heated humidifier chamber under most operating conditions is such that the majority of pathogens are rapidly killed. Even if pathogens were able to exist in the humidification chamber, they would not be able to be transported to the patient. The humidity travels from the chamber in vapor form, which is too small for a bacteria or virus to travel in.

As I said above,

Velbor wrote:It's often claimed that since CPAP humidifiers work by vaporization (entry of water into the airflow at a molecular level rather than through droplets), microorganisms cannot travel from the reservoir.

Thanks for providing the claim which, as I have stated above, is incomplete and inadequate in the presence of turbulent airflow which, in addition to the primary humidification by vaporization, also kicks up larger droplets.

Now, should you believe me, or F&P ?? !!! Watch your humidifier chamber, watch the water surface as you breathe, and think about what you're seeing and what's happening.

Again, the question this doesn't answer is, "Does it matter?" The physics is clear and straightforward, and I object to simplistic answers. The real-life implications are much less clear, and decisions are subject to individual risk-benefit decisions. But those decisions ought to be informed by facts.

Velbor · Post by **Velbor** » Wed Mar 26, 2008 1:19 pm

It occurs to me that I might also comment on another part of the reference from Fisher & Paykel cited by Wulfman from http://www.talkaboutsleep.com/sleep-dis ... humid9.htm

F&P wrote:Q. Is it possible for a patient to catch an infection from a humidifier? A. The environment in the heated humidifier chamber under most operating conditions is such that the majority of pathogens are rapidly killed. Even if pathogens were able to exist in the humidification chamber, they would not be able to be transported to the patient. The humidity travels from the chamber in vapor form, which is too small for a bacteria or virus to travel in.

For F&P HC100 and HC150 humidifiers, this statement may well be valid. I have measured maximum water temperatures in one of each of these units in the vicinity of 60 degrees C. This temperature is, by way of example, near that of milk pasteruization, part of which process is accomplished at 63 degrees C, though still far below that of boiling water (100 degrees C) or standard autoclave sterilization (120 degrees C at 15 psi).

HOWEVER, temperatures in other humidification devices MAY be considerably lower. I have measured temperatures in two ResMed S7 Humidaire IIi humidifiers, and they achieved maximum water temperatures of only slightly above 45 degrees C.

Thus, while the "kills majority of pathogens" statement may be valid for F&P units (depending on what "majority" of which pathogens is implied), it should not be uncritically applied to other CPAP humidifiers.

Hose_Head · Post by **Hose_Head** » Wed Mar 26, 2008 6:54 pm

Velbor wrote:It occurs to me that I might also comment on another part of the reference from Fisher & Paykel cited by Wulfman from http://www.talkaboutsleep.com/sleep-dis ... humid9.htm

F&P wrote:Q. Is it possible for a patient to catch an infection from a humidifier? A. The environment in the heated humidifier chamber under most operating conditions is such that the majority of pathogens are rapidly killed. Even if pathogens were able to exist in the humidification chamber, they would not be able to be transported to the patient. The humidity travels from the chamber in vapor form, which is too small for a bacteria or virus to travel in.
For F&P HC100 and HC150 humidifiers, this statement may well be valid. I have measured maximum water temperatures in one of each of these units in the vicinity of 60 degrees C. This temperature is, by way of example, near that of milk pasteruization, part of which process is accomplished at 63 degrees C, though still far below that of boiling water (100 degrees C) or standard autoclave sterilization (120 degrees C at 15 psi).

HOWEVER, temperatures in other humidification devices MAY be considerably lower. I have measured temperatures in two ResMed S7 Humidaire IIi humidifiers, and they achieved maximum water temperatures of only slightly above 45 degrees C.

Thus, while the "kills majority of pathogens" statement may be valid for F&P units (depending on what "majority" of which pathogens is implied), it should not be uncritically applied to other CPAP humidifiers.

Personally, I'm suspicious of any conclusion that humidifiers will kill pathogens, or cannot pass along pathogens because they are too small. As far as I know, viruses and bacteria don't need a particle, such as a water droplet, in order to hitch a ride directly to your respiratory tract. It's likely that they can be transmitted directly.

As well, warm and moist environments such as found in humidifiers are ideal breading grounds for mold. Molds reproduce by producing spores which, you guessed it, are transported directly as particles in air.

I'm allergic to mold and as a result, I'm very careful to clean the humidifier, hose and mask on a very regular basis.

KarenAZ · Post by **KarenAZ** » Wed Mar 26, 2008 7:29 pm

I dump my reservoir every morning and wash it with original scent Dawn (what they told me to use) and warm water. I also wash my mask out every day. I think that may be too much?!

billbolton · Post by **billbolton** » Wed Mar 26, 2008 7:37 pm

Velbor wrote:in addition to the primary humidification by vaporization, also kicks up larger droplets.

Do you have any citable evidence to support your proposition?

Velbor wrote:]and I object to simplistic answers.

But not. apparently, to simplistic propositions!

Cheers,

Bill

Velbor · Post by **Velbor** » Wed Mar 26, 2008 8:24 pm

billbolton wrote:
Velbor wrote:in addition to the primary humidification by vaporization, also kicks up larger droplets.
Do you have any citable evidence to support your proposition?

Velbor wrote:and I object to simplistic answers.
But not. apparently, to simplistic propositions!

citable evidence wrote:Filtered CPAP Humidifier for Sleep Apnea

This work has been published in abstract form and presented at an annual meeting of the AARC.

Ortolano GA, Schaffer J, McAlister MB, Canonica FP, Satti F, Maguire JM, Cervia JS.
Hydrophobic filter retains microbial barrier characteristics when used with heated humidifier for CPAP in sleep apnea. American Association for Respiratory Care, San Antonio, TX Dec 3-6, 2005 – Respiratory Care 2005;50(11):1546 (Abstr # OF-05-130).

ABSTRACT

RATIONALE: Treatment of choice for obstructive sleep apnea (OSA) is nasal continuous positive airway pressure (nCPAP) during sleep; but, dryness of the upper airway compromises compliance. Heated humidifiers may mitigate such non-compliance, but recent observations suggest their use, particularly if not cleaned, increases the risk of respiratory infections. Humidifier water may be contaminated but the long-held view that passive humidifiers cannot aerosolize water may obscure the perception of risk of infection.
OBJECTIVES: This study challenges the long-held view that ‘passover’ humidifiers do not aerosolize water. With such evidence, this study characterizes the performance of filters to reduce the potential risk of contamination.
METHODS: Heated humidifier water contaminated with bacteria was studied under conditions simulating week long nCPAP for OSA.
RESULTS: Bacteria were recovered in 9 of 11 tests from the breathing tubes of CPAP devices fitted with heated humidifiers with water contaminated with Brevundimonas diminuta or Serratia marcescens. Recoverable bacteria ranged from tens to thousands of colony forming units when tested at air flow rates of 60 liters per minute (LPM) for 90 minutes. Neither organism was recovered from the circuit tubing when a hydrophobic breathing circuit filter was positioned between the humidifier and face mask tubing with a commercially available nCPAP machine tested under simulated-use conditions.
CONCLUSION: Data suggest that OSA patients being treated with nCPAP fitted with humidifiers may be aerosolizing bacteria putting them at risk for respiratory infections, and that the use of a hydrophobic filter may attenuate the passage of microbes from contaminated humidifier water.

Though my own preference remains direct observation of the humidifier chamber during use.

RipVW · Post by **RipVW** » Wed Mar 26, 2008 8:51 pm

Velbor wrote: CONCLUSION: Data suggest that OSA patients being treated with nCPAP fitted with humidifiers may be aerosolizing bacteria putting them at risk for respiratory infections, and that the use of a hydrophobic filter may attenuate the passage of microbes from contaminated humidifier water.

Then, is it advisable/cleaner/safer to use a filter? Sounds like it is, yet when I reviewed the description of one of these hydrophobic filters, noted that it says:
"Inline Bacterial Viral filters should not be used with humidified CPAP & BiPAP systems." (from http://www.directhomemedical.com/filter ... ilter.html)
So, I am confused.

Machine	Mask

Additional Comments: Airmini, Medistrom Pilot 24, CMS 60C Pulse Oximeter, ResScan 6

OMIGOSH... I better clean more often!

Re: OMIGOSH... I better clean more often!

OMIGOSH... I better clean more often!