WITH no difference in treatment success between nebulisation and the use of spacers for patients with respiratory issues, Kingston Public Hospital (KPH) is employing the latter to reduce the risk to health care workers and patients amid the COVID-19 crisis.

Pointing out that the use of spacers is not unique to the COVID-19 experience, the hospital’s Senior Medical Officer (SMO) Dr Natalie Whylie told the Jamaica Observer on Thursday that, during the process of nebulisation, health care workers and surrounding patients being treated in the same area can be potentially exposed to COVID-19 viral particles.

The use of spacers, which are also called holding chambers, reduces that risk. Therefore, the South East Regional Health Authority, through KPH, reached out to Wisynco Group Limited to supply polyethylene terephthalate (PET) bottles to make medical spacers for use in its health care facilities.

“[A spacer] is a device which allows for the delivery of medication to facilitate administration to children or adults who are unable to properly coordinate their breathing with a metered-dose inhaler,” Dr Whylie explained.

Under normal circumstances, the metered-dose inhaler is placed in the patient’s mouth and it is pressed for the medication to be delivered directly into the mouth, while inhaling at the same time so it is delivered into the lungs and not just sprayed into the throat.

“The spacers are normally used in children or in adults who are not able to coordinate that [process],” the doctor said.

She explained that KPH sees patients older than 12 years with respiratory conditions, such as asthma, who may need to be nebulised in the emergency room, on medical wards, or in the operating theatre as part of their treatment.

“The process of nebulisation requires the patient to be given a face mask and the medication is delivered into a chamber, which is connected either to oxygen or compressed air. That then aerosolises [converts into a fine spray] the medication and so the patient inhales at the same time.

“During that process, you get the generation of aerosolised medications and secretions around the patient, because a mask does not completely seal on their face,” Dr Whylie said. “So it is during that process of nebulisation that the health care worker and the surrounding patients can be potentially exposed to COVID-19 viral particles in the aerosolisation.”

The use of the spacer, on the other hand, allows the medication to be delivered into the chamber of the spacer, and then the person breathes in and out into the spacer.

The SMO told the Observer that when KPH reached out to Wisynco, based on the group’s access to PET bottles used for packaging its beverage products, the company did not hesitate.

Guided by specifications from medical officials, Group Engineer and Special Projects Manager Craig Clare and other team members at Wisynco volunteered their time, since late March, to design and manufacture modified spacers in a bid to fill the needs of hospitals islandwide.

“We are doing about a hundred a day and will manufacture 2,000 for use islandwide,” Clare is quoted as saying in a release from Wisynco. “So far, we have supplied KPH, Spanish Town Hospital, and UHWI [University Hospital of the West Indies], with the intention of supplying anybody else that requests.

“The team here are volunteering and putting in the extra hours to get them done for everybody [hospitals in need],” Clare continued.

According to Dr Whylie, the designed spacers fit the metered-dose inhalers “perfectly”.

“So when patients with respiratory conditions come into our emergency room and they require nebulisation, the treatment now is given with a metered-dose inhaler and the spacer,” she said, adding that internationally, this is where many centres are going as current research indicates that there’s no difference in treatment efficacy with a spacer versus nebulisation.

“So it has allowed us to continue to treat our patients and, at the same time, significantly reducing the risk of transmission of COVID-19 to our health care team and surrounding patients who are treated in the same area,” the SMO shared.

She also said that patients get to take the spacers home. Checks with several pharmacies in the Corporate Area revealed that a spacer costs, on average, about $3,400.

“The patient takes it home… and so by extension, the risk to their family members at home would be reduced,” Dr Whylie said.

Patients are also advised how to clean and care for the spacers, she said.

“The Kingston Public Hospital is immensely grateful for the prompt response of Wisynco to this need,” added Dr Whylie.