Do in-line respiratory filters protect patients? Comparing bacterial removal efficiency of six filters

Abstract

With all pulmonary function diagnostic and respiratory therapy equipment, cross-infection has always been a concern, especially in the cystic fibrosis population, in whom pulmonary function tests are done routinely. The aim of this study was to identify and compare the bacterial removal efficiency (BRE, ability of a filter to remove microorganisms) of six different filters used in hospital settings: Microgard (MG), Spirobac (SB), PALL (PL), and KOKO (KK), used in the pulmonary function laboratory; and Clear-Guard (CG) and Respigard (RG), used in ventilator circuits. Filters were tested in both saturated and nonsaturated conditions. A Pseudomonas aeruginosa suspension of 1 x 10(4) to 1 x 10(8) CFU/mL was nebulized onto each filter. A blood agar plate was held immediately downstream from the filter. Colony-forming units (CFU) were then counted after 24 hr of incubation. A peak flow was applied across the spirometry filters. Bacterial thresholds of the filters were also identified (concentration of bacteria at which a filter no longer has 100% BRE). There was a significant difference in BRE among the six filters in saturated states when challenged with 1 x 10(4) CFU/mL (MG, KK, CG, and RG, 100%; SB, 98.8%; PL, 42.7%; P = 0.003). There was no significant difference between saturated and nonsaturated states, or after application of a peak flow. Filter thresholds were significantly different (KK 1 x 10(8), MG 1 x 10(7), CG 1 x 10(6), RG 1 x 10(5), and SB and PL <1 x 10(4) CFU/mL). In conclusion, when all filters are exposed to the same extreme challenges, significant differences exist in their ability to remove bacteria.