metered dose inhalers; nebulizers and vaporizers; aerosols; pandemics; COVID-19; SARS-CoV-2; Coronavirus infection, equipment contamination; infectious disease transmission/prevention & control, bronchodilator agents


Infectious Disease | Pulmonology | Quality Improvement | Respiratory Tract Diseases


Background: The ideal practice for patients requiring metered-dose inhalers (MDI) with coronavirus disease 2019 (COVID-19) is to use patient specific MDIs. However, this practice may not be possible during a time of increased usage throughout the country and limited availability of the medication. Nebulized medications are a concern due to the potential for aerosolized virus and increased exposure for health care workers. An alternative program of canister reassignment is proposed to address concerns for infection prevention, cross-contamination of MDI canisters and the shortage of MDI’s due to the COVID-19 pandemic.

Methods: A comprehensive MDI canister reassignment process was developed for facilities affiliated with a large health care system in response to the COVID-19 pandemic. The MDI canister reassignment process consisted of 4 components: preservation of supply, reassignment workflow, canister cleaning and operational integration. Albuterol MDI administration data was monitored from January 1st to August 31st, 2020.

Results: Following development and rapid implementation of a comprehensive canister reassignment process, albuterol MDI administration data was reviewed from 162 hospitals affiliated with a large health care system. At baseline (prior to the COVID-19 pandemic), 98% of patients received a nebulizer vs. an MDI. After the implementation of the MDI reassignment process (during the COVID-19 pandemic), nebulizer usage decreased by 60% from March 6th to March 31st and was sustained with >50% reduction through August 31st.

Conclusion: MDI canister reassignment was an instrumental process to allow the continued delivery of pharmacologic bronchodilator therapy for COVID-19 patients. It also represents an important infection prevention strategy needed to protect our health care providers from the potential aerosolized virus associated with nebulizers.