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Infection Control Issues Related to Topical Anesthesia Application

The most commonly used atomizer in North American otolaryngology clinics is powered by compressed air. These atomizers function due to the Venturi effect – pressurized air forced through a narrow opening creates negative pressure that can be harnessed to aspirate topical medication up a second tube where it is fragmented and dispersed onto the nasal or oral mucosa. Though ingenious, this design has a flaw when applied in a clinical setting: At the end of the spray cycle the medication falls back into the reservoir and pulls contaminants from the device tip into the lumen of the second tube and often all the way into the medication reservoir. If the device is not vacuum autoclaved following each use, these contaminants may be sprayed into future patients’ noses and throats.

This cross-contamination concern is not theoretical. Numerous articles have documented immediate contamination of Venturi atomizers after a single use in both bench top and human studies.^1-8 Southwick et al actually documented a series of cases implicating a Venturi atomizer as the source of transmission of pulmonary tuberculosis.³ (Click here for a White Paper review of this literature). These contamination rates occurred despite careful technique where a nasal speculum was used to open the nasal vestibule and the device nozzle was held at a distance and never touched the patient. The majority of the authors studying this problem suggest that clinical use of Venturi devices should be reconsidered due to their potential to cross-infect patients.

Another commonly used topical anesthetic application device is a prepackaged drug in a spray canister with a reusable applicator. Once again several investigations reviewing these devices show that physicians do not routinely clean the reusable applicator tip, exposing future patients to cross contamination from previous cases.^{9, 10}

Fortunately, a simple, inexpensive solution to this cross-contamination problem exists – the MADomizer positive displacement atomizer with a disposable applicator tip. This device functions based on concepts that do not utilize the Venturi effect – thereby eliminating the need for compressed air and eliminating the suck-back phenomenon and internal contamination risks inherent to that technology.⁴ By providing inexpensive disposable atomizer tips, the MADomizer further protects the patient from any chance of inadvertent cross-contamination and eliminates any concerns of device clogging or need for internal tip cleansing. It fits on any clinic table and is also easily transported in the doctor’s consult bag where it can be used in satellite clinics, the emergency room or on the medical ward. By delivering an exact dose of medication via a flexible applicator, it also allows for control of dosing and directed application – useful in some clinic scenarios and for home therapy of selected patients requiring home nasal medications.

The MADomizer is a simple, effective topical medication delivery system that eliminates cross-contamination risk in the clinic, is very easy to maintain, and is portable. In an outpatient clinic and operative setting, the MAD allows targeted delivery and exact dosing of complex drug regimens. At home it provides effective medication delivery across a broad mucosal surface of the paranasal sinuses in a matter of seconds, making it ideal to improve patient compliance. Simply put, this device is safe, effective and customizable to the individual needs of the clinician and his or her patients.

(Click here for recent review of this literature).