CPAPtalk.com

OMG.......BACTERIA?????

It's EVERYWHERE!!!

http://en.wikipedia.org/wiki/Bacteria

Although one has to read the entire piece, I like the two following sections.

Den (still thinking......"That which doesn't kill you will only make you stronger")



There are approximately ten times as many bacterial cells as human cells in the human body, with large numbers of bacteria on the skin and in the digestive tract.[5] Although the vast majority of these bacteria are rendered harmless or beneficial by the protective effects of the immune system, a few are pathogenic bacteria and cause infectious diseases, including cholera, syphilis, anthrax, leprosy and bubonic plague. The most common fatal bacterial diseases are respiratory infections, with tuberculosis alone killing about 2 million people a year, mostly in sub-Saharan Africa.[6] In developed countries, antibiotics are used to treat bacterial infections and in various agricultural processes, so antibiotic resistance is becoming common. In industry, bacteria are important in processes such as sewage treatment, the production of cheese and yoghurt, and the manufacture of antibiotics and other chemicals.[7]


Bacteria, often Lactobacillus in combination with yeasts and molds, have been used for thousands of years in the preparation of fermented foods such as cheese, pickles, soy sauce, sauerkraut, vinegar, wine and yoghurt.[136][137]

Perhaps one should put an algae eater in their tank to keep it clean.

Appears that this topic has taken on a life of its own, like the primordial ooze in our tanks of distilled water. In my post I was using sterile bandages as an analogy to the purity of distilled water nothing else. Sterile water, mentioned in another post, is expensive and would lose it sterility as well once it is opened. The point I was trying to make is that just because one uses distilled water in their tank doesn't mean that it won't ever support life. Our little CPAP labs demonstrate that things can grow in our tanks of water if they are not cleaned out periodically regardless of the type of water used. I use distilled water to control mineral build up in the tank which would happen if I used the hard water from our tap.

If the solid material that collects in the humidifier tank never makes it up into the hose and into your lungs then the disgusting pics of the machine posted in this topic should not alarm those that support this position. This being the case, it doesn't matter what water one uses or if the tank ever gets cleaned out. One could use pond water or put gold fish in their tanks. Strike the goldfish….they would raise the CO2 level.

Perhaps it is just me, but I kinda like to have a tank that looks like the day it arrived (clean) with water free of visible solids.

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

IIRC that particular piece of "research" was funded by a filter manufacturer (Pall Corporation) and the results have been widely regarded as quite suspect!

when tested at air flow rates of 60 liters per minute for 90 minutes

That's when they wanted to prove a filter (company funding the reseach) was necessary.

On the other hand:

http://www.ncbi.nlm.nih.gov/pubmed/1623 ... scovery_RA

Sterile water is unnecessary in a continuous positive airway pressure convection-type humidifier in the treatment of obstructive sleep apnea syndrome.Wenzel M, Klauke M, Gessenhardt F, Dellweg D, Haidl P, Schönhofer B, Köhler D.
Annostr. 1, Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, D-57392 Schmallenberg, Germany.

OBJECTIVE: We investigated the necessity of using sterile water in humidifiers for avoiding respiratory tract infections during nasal continuous positive airway pressure (nCPAP) therapy. METHODS: Water in a convection-type humidifier (Sirius; Heinen and Löwenstein GmbH; Bad Ems, Germany) was labeled with (99m)Tc-diethylenetriamine penta-acetic acid. Low-flow (2 L/min, 4 L/min, or 6 L/min) and high-flow (31 to 46 L/min) rates were applied, rates typical for nCPAP. Heat and moisture exchange filters were placed behind the start of the tube to measure any radioactive aerosol. RESULTS: We demonstrated that no radioactive aerosols were produced, either with low or high flows. CONCLUSIONS: The convection-type humidifier produces water vapor but does not aerosolize the water. We conclude that bacteria, other microorganisms, or even solutes that may be contained in the water cannot be transported into the air and thus will not be deposited in the lung. In order to avoid respiratory tract infections, sterile water is not required, at least in this particular humidifier. We suggest that nonsterile tap water is probably a safe alternative.

PMID: 16236866 [PubMed - indexed for MEDLINE]

O.

"Was that a patient of mine?"

Well yes and no, it was a gentleman who brought his CPAP into where I work to get it checked out because it had stopped working. My Biomed tech pulled it out of the bag WITHOUT gloves on and began to gag. The pictures do not do this machine justice, it had a VERY over powering odor that went along with it. Upon further inspection of the CPAP and further conversation with the patient we discovered (Much to the joy of my Biotech) that the machine actually belonged to one of the other DME's in town. We kindly informed the gentleman that he would have to take it back to them to be serviced since it was still on rent thru them. Oh and it's worth mentioning that prior to this point he stated that he just got it 3 months ago and he swore up and down that he was using distilled water in the tank and washing it every week. Some people think I rolled of the turnip truck yesterday I swear!!


I'm with you Den, ofcourse if that were really true I would look like the Hulk by now. Hmmm I may have to revise my edition to "If it doesn't kill me......well I guess it doesn't kill me!" LOL

well,,i just use tap water everynight i empty it out in the morning and fill it with cold tap water before bed--my humidifier tank is about 7 months old now ,and i have soaked it in vinager about 6 times,,and taken it apart as just many and givin it a wipe..i have never used distilled water--i don't know where distilled comes from---i use my own water,,,,also i know if the water sits in the tank you will get single celled creatures pretty fast--about 24 hrs--when ever air is exposed to water the creatures come--i don't know if there bad for you or not--but in high school we grew them in about a day----pat

The amount of minerals in the tap water (its "hardness") depends very much on where you live. And that it what decide how quickly you'll get a mineral deposit in your humidifier.

O.

akcpapguy wrote:"Was that a patient of mine?"

Well yes and no, it was a gentleman who brought his CPAP into where I work to get it checked out because it had stopped working. My Biomed tech pulled it out of the bag WITHOUT gloves on and began to gag. The pictures do not do this machine justice, it had a VERY over powering odor that went along with it. Upon further inspection of the CPAP and further conversation with the patient we discovered (Much to the joy of my Biotech) that the machine actually belonged to one of the other DME's in town. We kindly informed the gentleman that he would have to take it back to them to be serviced since it was still on rent thru them. Oh and it's worth mentioning that prior to this point he stated that he just got it 3 months ago and he swore up and down that he was using distilled water in the tank and washing it every week. Some people think I rolled of the turnip truck yesterday I swear!!


I'm with you Den, ofcourse if that were really true I would look like the Hulk by now. Hmmm I may have to revise my edition to "If it doesn't kill me......well I guess it doesn't kill me!" LOL

Hey, did the "gentleman" appear to be healthy?
Maybe he has a stronger immune system than some of the rest of us. Those Alaskans HAVE to be tough to live there.

Did you call your competitors to warn them he was coming?.....
That would have been one of those "priceless" moments to see THEIR reactions to that machine's condition.

Three months, huh? WOW!

Maybe you should send those pictures in to Respironics.......?

Den

ColoradoDreamer wrote:Appears that this topic has taken on a life of its own....

Indeed. I am divided as to how long to drag this on. But, as long as we're still having fun ....

billbolton wrote:IIRC that particular piece of "research" was funded by a filter manufacturer (Pall Corporation) and the results have been widely regarded as quite suspect!

What a surprising assessment! Seems a bit non-specific and "simplistic"! Do you have any citable evidence to support your position?! (Sorry, Bill. I couldn't resist.)

The relationship between scientific research and commercial sponsorship or support is a vexing one. Let's just remember that CPAP equipment also undergoes research - often conducted by or on behalf of the manufacturers. That fact alone does not necessarily damn the research as invalid.

By the way, my citation of this paper was simply in response to a challenge. I have no vested interest, and I make no claims positive or negative as to the validity or usefulness of its data.

ozij wrote:"when tested at air flow rates of 60 liters per minute for 90 minutes" That's when they wanted to prove a filter (company funding the reseach) was necessary. On the other hand:
http://www.ncbi.nlm.nih.gov/pubmed/16236866 CONCLUSIONS: The convection-type humidifier produces water vapor but does not aerosolize the water. We conclude that bacteria, other microorganisms, or even solutes that may be contained in the water cannot be transported into the air and thus will not be deposited in the lung. In order to avoid respiratory tract infections, sterile water is not required, at least in this particular humidifier. We suggest that nonsterile tap water is probably a safe alternative.

This article was published in Chest in 2005. The paper I cited (published in the Journal of Clinical Sleep Medicine in 2007, http://www.ncbi.nlm.nih.gov/pubmed/18198803 ) references and discusses this earlier article in Chest, and questions the validity of their methodology and conclusions. Such is the way of life in the scientific world.

Casting doubt on any piece of scientific literature is, in fact, easy. Ozij did it very nicely (and very rightly) when he drew attention to the rather high flow rate mentioned in the 2007 article. I can do it also: The humidifier used in the 2005 Chest article was an unheated passover type, made by the German manufacturer Sirius, with numerous subsections and baffles. Hardly similar to the single-chamber integrated or stand-alone units most commonly employed in CPAP use today. The 2007 J Clin Sleep Med report, by contrast, employed ResMed S7 machines with integrated HumidAire IIi humidifiers. Easy.

RipVW wrote: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.

I think you raise the most interesting issue of all. I'm with you in confusion. The link you provided for DirectHomeMedical is fascinating. Hudson's own literature for their 1605 filter, at:
http://www.hudsonrci.com/Products/produ ... prod_cat=9
simply identifies it as a "Main Flow Bacterial / Viral Filter" designed "to address a wide variety of clinical applications." They never specifically mention CPAP as one of those uses. (By the way, Hudson/RCI - RespCare - is a division of Teleflex, which is the manufacturer of the Hybrid, NasalAire I and II, and Bravo interfaces.)

DirectHome Medical seems to go overboard in identifying the Hudson 1605 as "Universal BV Filters for CPAP & BiPAP". As you point out, they warn that it shouldn't be used with humidified CPAP systems, or with AutoPAP systems. (And they get the prize for hyperbole, warning about the "viruses and bacteria that often plague CPAP/BiPAP users" and claiming that the filter will produce "good tasting air"!!) It looks as though they've taken considerable liberties in their advertising of the product. If I may generalize from what Bill Bolton has wisely pointed out (in respect to a different dealer's site) in the past ( viewtopic.php?p=248206#248206 ), you can't necessarily trust seller advertisements to reflect accurate product information.

It's also interesting that cpap dot com offers an "In-line Outlet Bacteria Filter for CPAP/BiPAP" from Respironics:
https://www.cpap.com/productpage/Respir ... -pack.html
and describes its placement as cleaning "the air as it leaves a CPAP or Bilevel machine". No mention of humidification issues. The photos of these products all look remarkably similar.


I have thus far tried to carefully avoid mentioning my own practices with regard to cleaning and "bacteriophobia," but it seems right to make full confession now. I fill my humidifier with bottled drinking water, not distilled. I empty, rinse with tap water, and dry the chamber after each use. I wash the chamber with soapy water every 7-or-so uses. I "never" wash my hoses (though I inspect them after each use). I disassemble and tap water rinse my mask after each use, with a soap wash every 7. (I wash the cushion with hand bar soap after each use, more to remove oils than germs). Not sure where that puts me in the paranoia spectrum, but hopefully not at either extreme.

Ozij did it very nicely (and very rightly) when he drew attention to the rather high flow rate mentioned in the 2007 article

She...

And she couldn't read the full 2007 article this time around - couldn't find a link to it.
How do they explain the 60 litre per minute for 90 minutes choice of pressure? Do we know anyone who uses cpap like that?


The paper was actually discussed on the forum when it was new, and the confilct of interest info appeared in the full paper. I find it very strange they only tried and reported the "worst case pressure" (extreme worst case, at that). "It would have been much more helpful to find the bacteria at normal pressures - e.g. those used in the 2005 study: Low-flow (2 L/min, 4 L/min, or 6 L/min) and high-flow (31 to 46 L/min) "...rates typical for nCPAP. "
Not to put too fine a point on it - I'm pretty sure they tried lower pressures, (normal usage pressures) and didn't get the kind of data they were hoping for, the data that would make people say "omigosh I better buy that filter".

O.