Metered Dose Inhalers During COVID-19 pandemic

Issue: The purpose of this policy is to establish a process to conserve metered dose inhalers and provide protection for both employees and patients during the COVID-19 pandemic.

Background: The COVID-19 pandemic demands advanced infection prevention measures. Infection transmission may increase during nebulizer treatments due to high volume, long distance propulsion of respiratory aerosols. Administration of metered dose inhalers (MDI) provide a safer alternative for these patients. However, supply of albuterol and other metered dose inhalers nationwide is finite, with future availability unknown.


A. Restriction of albuterol MDIs:   Due to the high risk of COVID-19 transmission during aerosolized treatment, albuterol MDIs will be restricted to patients who are in isolation precautions for COVID-19.  An EPIC alert will fire on albuterol MDIs stating the following:

“KHN is restricting Albuterol MDIs for patients who are in isolation for suspected or confirmed COVID-19. Utilize aerosolized medications as an alternative”

  1. Procedure for managing albuterol MDIs
    a. Albuterol inhalers will only be dispensed to patients who meet restriction criteria
    b. Shared or common canister procedures will be prohibited while patient is in isolation
    c. Albuterol inhalers will be stored per “PC-KHN MEDICATION LOCK-BOX” policy during isolation

2. Procedure for albuterol MDIs on patients with negative COVID-19 test.
a. The inhaler may be returned to stock if a patient is removed from
isolation for all designated infectious organisms as per “IC-KHN

Updated Friday, March 27
3. Procedure for patients seen in the Emergency Room who have suspected or confirmed COVID-19 but are not sick enough to be admitted into the hospital.
a. Puffs of albuterol MDI will only be administered by a respiratory therapist.
b. The therapist will do so using gloves and a spacer.
c. After administration, the spacer will be disposed of, the canister will be wiped down, and the canister will be reused for the next patient.

B. Use of patient home MDIs: During COVID-19 pandemic the network is allowing the use of home MDIs.

a. Please refer to facility-specific “medications brought from home” policy for general procedure. To decrease risk of potential exposure, note the following:

i. Patients with suspected or confirmed COVID-19 infection do not qualify for home MDI use.

ii. MDIs shall be placed in a hazardous bag before sending to pharmacy for identification.

March 19, 2020
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