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A BREATH OF FRESH AIR

A Breath of Fresh Air: Program Proposal for Proper Noninvasive Equipment Maintenance and

Purpose

Jassmine Bradley, Alysha Brazee, Jaime Martinez & Brittany Sassen

University of Mary
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A BREATH OF FRESH AIR

A Breath of Fresh Air: Program Proposal for Proper Noninvasive Equipment Maintenance and

Purpose

Mission Statement

A Breath of Fresh Air seeks to reduce infections, improve compliance, and provide

proper education to our noninvasive using patients. We strive to provide hands-on training and

instructions and follow-up support.

Rationale. In communities all over the nation, some of the biggest issues are improper

cleaning and maintenance of positive pressure masks and equipment.  It is estimated that twenty-

two million Americans suffer from sleep apnea (ASAA, 2019). Positive pressure is the first line

of medical therapy for patients with obstructive sleep apnea (OSA) (Kacmarek, 2017). Sleep

apnea that is left undiagnosed or untreated increases the likelihood of early stroke, chronic heart

failure (CHF), atrial fibrillation, and is associated with type 2 diabetes and depression (ASAA,

2019). CPAP/BiPAP equipment maintenance is vital for a healthy lifestyle, and if left improperly

maintained, the risk for illness increases dramatically. Bacteria thrive in dark and moist

environments, and when CPAP is initiated, said bacteria in the machine and mask contacts the

patient’s skin, which introduces infections and causes irritation. To mitigate the risk of infection

and irritation, proper equipment cleaning and maintenance are crucial. Although there are very

few definitive studies to support this data, it is very important for the overall health of the

patient. A study done by Ortolano (2007), states nine out of eleven test recovered bacteria from

the tubing of CPAP devices with heated humidifiers. This study also suggests that proper

cleaning and the use of a hydrophobic filter may reduce the passage of these microbes from the

contaminated humidifier. This proposed program will help with education and explain why

cleaning the machine and accessories is detrimental. The education will guide patients to set up
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A BREATH OF FRESH AIR

an achievable schedule for equipment maintenance and replacement (based on everyone’s

insurance). A study by Wozniak, Lasserson & Smith (2014) found increased CPAP compliance

with proper education, support, and behavioral interventions with users suggesting an education

program could increase user compliance. Good compliance has been recognized with decreased

medical costs and infections (Ortolano et al., 2007). This proposed program, called A Breath of

Fresh Air, will be during regularly scheduled pulmonary rehab programs. Patients will be

advised to attend and participate in a hands-on cleaning day. The program will include steps to

make an at-home disinfectant by mixing vinegar and water and learn to clean and dry equipment

and accessories. It will also include information on the other types of disinfectants, such as ozone

gas or activated oxygen molecules (SoClean and Sleep80) and ultraviolet (Lumin). A Q&A

session will be held to ingrain the necessity of clean equipment and allow for group discussions

to aid in user compliance.  The value of this program is immeasurable simply because patients

will have a better understanding and appreciation of the importance of proper maintenance.

Unfortunately, this education is not covered by most insurances; however, by adding it into a

pulmonary rehab program it could be incorporated into the same budget if coordinated properly. 

Needs Assessment. According to Marketdata Enterprises Inc. (2018), Continuous

positive airway pressure (CPAP) devices make up a market that is growing by 7.2% a year.

Studies are showing a direct correlation between infections such as Legionnaires disease,

pneumonia (PNA), and rashes from improper cleaning of NIV equipment, not; which is why this

program is needed. Patients that currently use positive pressure at home should be properly

educated on the maintenance of their equipment. Unfortunately, most have a poor initial

understanding or are simply unaware of the consequences of dirty equipment. This program will

provide patients with reiteration and education, especially to those with comorbidities and
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A BREATH OF FRESH AIR

increased risk of infection. A pulmonary rehab program would be an ideal setting for education.

There are several resources readily available on equipment cleaning that are great for

reinforcement, such as YouTube and company-specific pamphlets.  Several companies make

machines that are designed to help patients keep their equipment clean. The conclusion of the

information that is gathered about CPAP maintenance is that not much follow up is being done to

aid in education for patients in an outpatient setting. Most of the follow up is compliance

reporting sent by each individual lab, not cleanliness of equipment. Please refer to the following

questionnaire that will get the necessary data before, during, and after educational days.

Goals and Objectives. A Breath of Fresh Air is a program that will help the patient

population that uses nocturnal noninvasive support by educating them on the proper ways to

maintain their equipment to prevent future infections. The patients will be able to demonstrate

the proper way to mix a vinegar and water solution to form a disinfectant as well as establish

proper cleaning and drying techniques. Patients will learn the difference between daily, weekly,

and monthly care for their equipment and will be provided with hand-outs to keep them on track.

They will also have the ability to remember their personal maintenance schedule and recall

resources available to obtain additional inquiries for their machine. This program will help the

patient population understand why these cleaning methods are important. Participants will

understand the importance of proper noninvasive maintenance, resulting in reduced hospital

admissions and mitigate respiratory infections.

Activities/Interventions. In order to help our home noninvasive user population be able

to better clean and maintain their noninvasive equipment we will offer an educational

session/seminar. This session will help overcome, frequent misunderstandings, increased

infections, and insufficient care for their noninvasive machines and equipment and provide a new
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A BREATH OF FRESH AIR

foundation of knowledge, maintenance and cleaning schedules, easy to follow cleaning

instructions and the ability to reduce the chances of infections. At no additional cost to the

recipients, this course is sponsored by local hospitals, home care companies, state/county health

departments and grants obtained. This educational seminar will be incorporated into cardiac and

pulmonary rehabilitation programs during the first 6 months, with hopes to expand in the next

year to bariatric training centers, inpatient hospital settings and at health clinics fairs seminars.

We will let our intended population know about this product by using flyers, reminder postcards,

emails and announcement boards at medical facilities. We will pretest our strategy by starting

with a small trial population base. We will measure our success by completion evaluation

feedback and follow-up with both participants and program sponsorships.

Marketing Plan. As we are sifting through the growing pains of this program, our time

will be given voluntarily to start.  We will only need sponsorships/grants for our equipment,

advertisement and information booklets. Our supplies will cost $50.00 for the cleaning agents

(white vinegar $2.64 a gallon, Palmolive Dish soap $2.52 each, mask wipes $9.49 each) and 2

plastic containers one for the actual cleaning demonstration and the other for the storage of

equipment ($26.71 for 4 this gives 3 spare)  We will need $180.00 for 60 educational booklets,

$100.00 for 80 flyers, $160.00 for 80 postcards. The plan is to ask for donations from local

DME companies and/or sleep clinics for the actual NIV equipment for demonstration. The

prices listed above will give us a Grand Total of $481.36. A scholarship or grant of $600.00 will

be more than plenty to get our program started. Funding possibilities will come from

sponsorships from hospitals, state/county health departments, DME companies as well as grants

obtained. The educational opportunity will be held in conjunction with already established

cardiac and pulmonary rehabilitation programs. Doing this will get our program information to a
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A BREATH OF FRESH AIR

large number of patients when we initially start. These patients already have a goal to increase

their health while living with the disease and should be accepting of more Information. We have

expansion goals in the next year to bariatric center sessions, inpatient hospital settings with

noninvasive users and at health fairs. Our session will provide adequate education on how to

properly clean a noninvasive mask, headgear, tubing, and water chamber.  We will education on

appropriate agents to clean with. We will education on when filters need to be changed. We will

educate on when pieces are recommended to be changed out and how it works with Medicare vs

private insurance. This educational session is provided at no additional cost to non-invasive users

and is designed to help users become healthier and more compliant. Promotional strategies

include flyers, postcard reminders, and email.

Evaluation. Patients will fill out a survey pre and post educational services to evaluate

the need and retention of the information provided. The surveys will encourage feedback to

better the program for future participants.

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A BREATH OF FRESH AIR

References

Kacmarek, R. M. (2017). Egan’s fundamentals of respiratory care. St Louis: Elsevier. Retrieved

from pg. 677.

Ortolano, G. A., Schaffer, J., McAlister, M. B., Stanchfield, I., Hill, E., Vandenburgh, L., Cervia,

J. S. (2007, December 15). Filters reduce the risk of bacterial transmission from contaminated

heated humidifiers used with CPAP for obstructive sleep apnea. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556912/.

ResMed Corp. (2015). Sleep Apnea facts and figures. San Diego, CA

Sleep Apnea Information for Clinicians. (n.d.). Retrieved from

https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/

Sleep Review The Journal for Sleep Specialists (2018, May 2). CPAP Devices Market Only 12%

Penetrated, Says Market Research Publisher. Retrieved from

http://www.sleepreviewmag.com/2018/05/cpap-devices-market-12-penetrated-says-market-

research-publisher/.

Schnirman, R., Nur, N., Bonitati, A., & Carino, G. (2017). A case of legionella pneumonia

caused by home use of continuous positive airway pressure. SAGE open medical case reports, 5,

2050313X17744981. DOI:10.1177/2050313X17744981