Respiratory cleanliness
5 key things to do to prevent problems for patients
by Mary McGoldrick

Patients receiving supplemental oxygen via an oxygen concentrator in the home are common. Unfortunately, compliance issues related to infection prevention and control are also common. To prevent these compliance issues—and, more importantly, to prevent respiratory infections—provide education based on the manufacturer’s instructions for use. When none are provided, follow these five infection prevention and control strategies for a patient on oxygen at a liter flow of up to 5 liters per minute (L/min) in the home except those with an artificial airway, with cystic fibrosis, or who are severely immunosuppressed. These patients and those on higher liter flows of oxygen may require a higher standard of respiratory equipment management and additional disinfection activities.

1 Humidification

When supplemental humidification is needed, distilled water is often used as the moisture source when using a refillable humidifier bottle. Distilled water may also serve as a source for potentially pathogenic organisms such as bacteria and mold because it does not contain a preservative. When the shelf life of distilled water is unknown (i.e., there is no “use by” date on the container), date the distilled water when opened. Consider using a discard time frame of 30 days and storing the distilled water in the refrigerator after opening and between uses.

A common compliance issue is when patients or caregivers add distilled water to the humidifier bottle by “topping off” the container. Teach the patient to change distilled water daily. Empty the humidifier bottle, wash inside and out with soap and water, rinse with a disinfectant, and follow with a hot water rinse; then refill the humidification bottle with distilled water. Note that some manufacturer’s instructions for use require the humidifier bottle to be rinsed daily with a solution of 10 parts water and one part vinegar as a disinfectant. Avoid touching the inside of the bottle or lid after it has been cleaned and disinfected to prevent contamination.

2 “In Use” Nasal Cannula

For patients switching to portable oxygen or pro re nata home oxygen administration, nasal cannula storage can be problematic. The nasal cannula prongs often become contaminated when patients don’t properly protect the cannula between uses (i.e., leaving the nasal cannula on the floor, furniture, bed linens, etc.). Then the patient puts the contaminated nasal cannula back in their nostrils and directly transfers potentially pathogenic organisms from these surfaces onto the mucous membranes inside their nasal passages, putting them at risk of developing a respiratory infection. Educate the patient on how to store the nasal cannula between uses in a manner that does not allow it to have direct contact with potentially contaminated surfaces. Either keep the “in-use” nasal cannula somewhere that does not allow contact with a surface or place it on a cleaned surface, inside an open clean container, or in an open plastic bag.

3 Oxygen Tubing

Replace used oxygen therapy supplies (i.e., nasal cannula, oxygen tubing, water trap, extension tubing) with new sterile supplies at the frequency stated in the manufacturer’s instructions for use. If the manufacturer has not specified a frequency, change the nasal cannula every two weeks, or more often if it is visibly soiled (e.g., heavy nicotine stains on the nasal cannula) or malfunctions (e.g., becomes clogged with respiratory secretions or moisturizers placed in the nostrils). If a water trap is placed in-line with the oxygen tubing, check the trap daily for water and empty as needed. Replace the oxygen tubing, including the water trap, monthly or more frequently as needed.

4 Oxygen Concentrator & Filter

Oxygen concentrator cabinets and filters are sometimes found coated with dust in the home.  Educate the patient or caregiver on how to wipe down the outside of the oxygen concentrator with a lightly damp cloth, preferably at the same time that the external filter is cleaned. The cleaning solution should be applied to the cloth first, and then the cabinet wiped; never spray directly onto the surface of the concentrator. When an external filter is accessible on an oxygen concentrator, check the filter periodically for dust and particle accumulation, depending on the conditions in the home environment. At least weekly, remove the filter, wash with soap and water, rinse, air dry, and replace.

5 Hand Hygiene

Lastly, no infection prevention and control article is complete without addressing hand hygiene. Teach the patient and caregiver to perform proper hand hygiene before and after handling any respiratory therapy equipment.

Continually educate the patient and their caregivers and periodically assess their knowledge. Reinforce these infection prevention and control strategies to keep the patient infection-free and where they want to be—their home.

Mary McGoldrick, MS, RN, CRNI, has been a pioneer in the field of infection prevention and control in homecare and hospice for over 25 years, with seminal works published on infection prevention and control. She provides consulting services on infection prevention and control strategies, regulatory and accrediting body compliance, and serves as an infection preventionist for home health agencies and hospices. McGoldrick is the author of the Home Care Infection Prevention and Control Program manual, an evidenced-based compendium of infection prevention and control policies, checklists and forms. Learn more at She can be reached at (800) 961-7122 or