Nebulizer Project
Matthew Lawrence Brockman
Daniel Puthenpurayil George
Nathan Joseph Hankins
Marissa Kathleen McHugh
1
Outline
I. What’s a Nebulizer, Needs Assessment & Scope of Work Matthew
II. Our Design – Matthew
III. In-Country Implementation – Nathan
IV. In-Country Training – Marissa
V. Issues Encountered – Daniel
VI. Evaluation/Feedback – Nathan
VII. Cost Analysis – Daniel
VIII. Testing and Results – Matthew
IX. Sustainability and Ownership – Matthew
X. Entrepreneurial – Nathan
2
What’s a Nebulizer
 Compressor, filter, tubing, cup, mask
 Compressor not a medical device, simply supplies air
 Cup aerosolizes water with medication
3
Needs Assessment:
Respiratory Problem Causes
Factors contributing to high prevalence of respiratory
problems:






Environmental effects
Desert climate
Dryness
Wind
Dusty air/Dust storms
Allergenic trees
 Garbage and vegetation
burned near homes
 Indoor cooking fires
 Cockroach infestations
4
Needs Assessment:
Nebulizer Availability
Problems receiving nebulizer treatment:
 Limited availability at local clinics
o Only 1-2 nebulizers
o Walking distance
o Closed on weekends
o Open 7AM to Noon
o Frequent power outages
o Days designated for non-respiratory problems
 High cost (about $100) compared to salary
5
Scope of Work and Needs
Assessment
 Problem Statement: Deliver a simple, home-made
nebulizer and an instruction manual
 Costumer:
o Resistants of Choluteca, Honduras who suffer from
respiratory problems
o Larry and Angie Overholt
 Needs Assessment:
o Large portion of the population suffers from asthma
o Environmental causes
o Low availability of nebulizers
6
Our Design
 Filter filters to about 10
micrometers, car or motorcycle
fuel filters will work similarly
 Bike pump acts as compressor
 This project uses actual nebulizer
cup, mask, and tubing
 Soccer ball filters out the duty
cycle of the pump as a capacitive
element
7
In-Country Implementation
The team’s main goals were as follows:
 Source local parts
 Treat and take data in health departments and
villages
 Train people in health departments and villages on
how to build and use
 Distribute manuals on operation and creation of
device
 Donate a nebulizer to each village
 Gain local feedback
8
In-Country Implementation: Week 1
Day
Monday
Date
Tasks Completed
5/5/201
4
- Sourced Parts Locally
- Tested/Troubleshot Local
Parts
- Worked on Manual
- Worked on Manual
- Reassessed Schedule and
Tuesday 5/6/2014 Desired Statistical Method to be
Used
- Tested/Troubleshot Local Parts
9
In-Country Implementation: Week
1
Day
Date
Wednesday
5/7/2014
Tasks Completed
-
- Finalized Manual/Made Copies
Introduced Both Methods, Treated, and Trained
Local Woman, Erma (donated nebulizer)
- Introduced Both Methods and Trained
Nurses/Doctor at Choluteca Health Department
10
In-Country Implementation: Week 1
Day
Date
Tasks Completed
-
Thursday 5/8/2014
-
Introduced Both Methods, Treated Patient, and
Trained Nurses/Nursing Students/Doctor at
Namasigue Health Department (donated
nebulizer, health department had no electricity)
- Purchased Additional Parts
Introduced Both Methods, Treated Children, and
Trained Women’s Guild of Siete de Mayo
(donated nebulizer)
11
In-Country Implementation: Week 1
Day
Date
Friday
5/9/2014
Tasks Completed
- Introduced Method and Trained Nurses/Patients
at Choluteca Health Department (donated
nebulizer)
- Lined up Visits to Private Clinic, Hospital, and
Pharmacy
- Prepared for Pharmacy Advertising
12
In-Country Implementation: Week 1
Day
Date
Tasks Completed
-
Saturday
5/10/2014
Provided free treatments, demonstrated the
method, and handed out manuals outside
pharmacy (met teacher)
- Worked on Poster design for Public Health
Departments
13
In-Country Implementation: Week 2
Day
Date
Tasks Completed
-
Monday
5/12/2014
Introduced Method, Treated Patients, and
Trained Nurses/Doctor/Patients at Dr. Girón’s
Private Clinic (donated nebulizer, committed
to getting more data)
- Printed and Laminated More Manuals
- Updated Treatment Forms
14
In-Country Implementation: Week 2
Day
Tuesday
Date
Tasks Completed
5/13/2014
- Introduced Method and Trained
Nurses/Doctor in Namasigue Health
Department (presented poster)
- Treated Infant Successfully with Only Saline
- Discussed Entrepreneurship Opportunities
- Introduced Method and Trained Women in
Siete de Mayo
15
In-Country Implementation: Week 2
Day
Date
Tasks Completed
-
Wednesday
5/14/2014
Visited Choluteca Health Department
(presented poster)
- Interviewed by Local News TV Station,
TeleVida63
- Searched and Found Teacher of Cambridge
Bilingual School we Met on the Street
Saturday and Presented for His Class
(donated nebulizer)
16
In-Country Implementation: Week 2
17
In-Country Implementation: Week 2
Day
Thursday
Date
Tasks Completed
5/15/2014
- Introduced Method and Trained
Nurses/Patients/Doctors at the Choluteca
Hospital’s Nebulization Clinic, Emergency
Room, and Pediatric Ward (donated
laminated manual)
- Introduced Method and Trained Entire
Waiting Area of Hospital (ran out of manuals)
- Returned to Dr. Girón’s office and were able
to record results of 2 patients using an
electrical nebulizer
- Introduced Method, Treated, and Trained 2
Women of La Bonanza (donated one
nebulizer)
18
In-Country Training
 The training process involved:
 Demonstration of assembly and
operation
 Explanation of evaluation forms
 Review and distribution of manual
 Distribution of posters
19
In-Country Training
 Constructed a user manual
1. Instructions for assembly
2. List of materials including pictures, prices,
and store names
3. Directions for usage and sanitation
4. Reservoir recommendations
5. Troubleshooting
20
In-Country Training
 Distributed laminated, color copies to public
health departments and Dr. Giron’s clinic, the
women’s group in Siete de Mayo, and Mr. Carlos
from Cambridge.
 Distributed black/white copies to woman in
Choluteca, woman in La Bonanza, public health
departments, Dr. Giron’s clinic, and at Farma City.
21
In-Country Training
 All places visited
followed the same basic
pattern
 Trained doctor(s) and
nurses
 Trained asthma and
non-asthma patients
and parents
22
In-Country Training
 Taught nurses how to use peak flow
meters
 Taught nurses how to complete the
pre/post evaluation forms
23
Issues Encountered
 Transportation dependability
 Quality of Honduran materials and healthcare
 Given “North American Prices” – Prices also varied
 Quantity and age of patients
 Language Barrier – Quality of our instruction may have
varied
 Creation of the manuals – Far walk to print
24
Evaluation/Feedback
 Cheap; most who need cannot afford electric
nebulizer (L1,800), ours cost L343
 Generally preferred reservoir design
 General public eager to learn (passed out over
100 manuals)
 “Our country needs this”
 A few people were hesitant at first – required
additional explanation
25
Evaluation/Feedback
 People were often excited by the design and
would tell others - Cambridge teacher had told
students and staff members including the
security guard
 Doctor at Namasigue said it was a useful
design because often patients are without
electricity
26
R&D Cost Pre-Trip
Date
Source
Material Purchased
2/12/2014 mi l l ers ga rden.com In line Universal Gas Filters Fuel filter 1/4" 5/6
2/15/2014 jus tnebul i zers .com Air Filters For Omron CompAir Nebulizer Systems
2/18/2014 Ta rget
Schwinn- Bike pump
2/27/2014 Lowes
Brass hose barb adaptor (1/8" ID x 1/4: MIP)
2/27/2014 Lowes
Brass hose barb adaptor (3/16" ID x 1/4: MIP)
2/27/2014 Lowes
Brass tee pipe (1/4" PIP)
2/27/2014 Lowes
Pressure gauge
3/13/2014 Ta rget
Basketball
3/20/2014 Wa l ma rt
Bell-Bike pump
3/20/2014 Ta rget
Basketball
3/20/2014 Ta rget
Schwinn hand pump
3/20/2014 Ta rget
Size 4 Soccer Ball
3/25/2014 Di ck's Sporting GoodsSize 5 Soccer Ball
3/25/2014 Di ck's Sporting GoodsSize 5 Soccer Ball
3/25/2014 Di ck's Sporting GoodsInflation Needles
3/28/2014 Medi comp
Nebulizer Filter 4mm M
Subtotals
Total Cost
Quantity
5
10
1
2
2
1
1
1
1
1
1
2
1
2
4
50
Individual Price
$
1.80
$
1.39
$
17.29
$
3.58
$
3.88
$
7.47
$
9.98
$
10.99
$
9.96
$
10.99
$
24.59
$
9.99
$
24.99
$
15.99
$
2.49
$
3.23
Cost
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
9.00
13.90
17.29
7.16
7.76
7.47
9.98
10.99
9.96
10.99
24.59
19.98
24.99
31.98
9.96
161.56
377.56
400.95
Shipping
$ 3.00
$ 6.95
$
$
$
$
$
$
$
$
$
$
$
$
$
$ 13.44
$ 23.39
27
R&D Cost During Trip
Date
8-May-14
7-May-14
6-May-14
7-May-14
8-May-14
7-May-14
7-May-14
8-May-14
8-May-14
10-May-14
10-May-14
8-May-14
14-May-14
14-May-14
12-May-14
15-May-14
15-May-14
15-May-14
15-May-14
5-May-14
5-May-14
5-May-14
7-May-14
5-May-14
9-May-14
10-May-14
Total Cost
Supplier
Comercial El Balon
de Oro
Super Torrillo
La Colonia
Farmacias Kielsa
Super Torrillo
Copy Centro
Douglas
Global Cyber
Copy Centro
Douglas
Global Cyber
Copy Centro
Douglas
Global Cyber
Global Cyber
Global Cyber
Global Cyber
Global Cyber
Global Cyber
Copy Centro
Douglas
Farmacia de los
Pobres
Farmacia Familiar
Farmacias Kielsa
Comercial El Balon
de Oro
Auto Partes Dimer
Motorepuestos
Super Torrillo
DeTodo
Copy Centro
Douglas
Item
Payment,
Dollars
Payment,
Lempira
balls
pumps
balls
parts
pumps and balls
$
$
$
$
$
36.59
44.44
6.46
8.29
21.85
L.
L.
L.
L.
L.
copying
copying
$
$
10.98
14.63
L. 225.00
L. 300.00
copying
copying
$
$
5.85
1.95
L. 120.00
L. 40.00
copying
copying
copying
copying
copying
copying
copying
$
$
$
$
$
$
$
4.88
1.22
23.56
2.93
9.76
14.54
1.22
L. 100.00
L. 25.00
L. 483.00
L. 60.00
L. 200.00
L. 298.00
L. 25.00
copying
$
6.10
L. 125.00
Masks
Masks
masks
$
$
$
8.78
3.17
17.80
L. 180.00
L. 65.00
L. 365.00
balls
$
$
$
$
$
6.10
0.98
2.24
18.24
23.06
L. 125.00
L. 20.00
L. 46.00
L. 374.00
L. 472.65
$
$
3.02
298.64
L. 62.00
L. 6,122.10
filters
pump and needles
balls and pumps
copying
750.00
911.00
132.45
170.00
448.00
28
Total R&D Cost
 Mostly from purchasing balls and prototyping materials
 Large purchase of the filters to donate
Pre-Trip
During Trip
Total
$
$
$
400.95
298.64
699.59
29
Per Nebulizer Cost – United States
 Using a size 5 soccer ball and the cheapest of the other
materials, one nebulizer cost the team approximately
$30.57
In line Universal Gas Filters Fuel filter 1/4" 5/6
Bell-Bike pump
Size 5 Soccer Ball
Needle
Nebulizer tubing, cup, and mask set
Total Cost
$
$
$
$
$
$
1.80
9.96
15.99
0.83
1.99
30.57
 Without a reservoir, the nebulizer cost approximately
$13.75 In line Universal Gas Filters Fuel filter 1/4" 5/6
Bell-Bike pump
Nebulizer tubing, cup, and mask set
Total cost
$
$
$
$
1.80
9.96
1.99
13.75
30
Per Nebulizer Cost – Honduras
 Cost with reservoir: $16.73
Motorcycle Fuel Filter
Schwinn- Bike pump
Size 5 Soccer Ball
Needle
Nebulizer tubing, cup, and mask set
Total Cost
L. 20.00 $
L. 125.00 $
L. 150.00 $
L. 5.00 $
L. 43.00 $
L. 343.00 $
0.98
6.10
7.32
0.24
2.10
16.73
 Cost without reservoir: $9.17
Motorcycle Fuel Filter
Schwinn- Bike pump
Nebulizer tubing, cup, and mask set
Total cost
L. 20.00 $
L. 125.00 $
L. 43.00 $
L. 188.00 $
0.98
6.10
2.10
9.17
 Hondurans can likely get these items for a lower price – One
person commented they could get a soccer ball for L. 80.00
31
In-Country Testing Regimen
 Assess situation
 Pre-treatment baseline measurements
 Qualitative testing
 Quantitative testing
 Post-treatment evaluation
 Qualitative analysis
 Quantitative analysis
32
Pre and Post-Treatment
Qualitative Testing
 List observations related to breathing (Is patient
coughing, wheezing, gasping for air, etc.)
 Doctor/Nurse observations or comments
33
Pre and Post-Treatment
Quantitative Testing
 Have patient blow into peak flow meter three times,
take maximum
 Ask patient to rate difficulty of breathing from uno to
diez, uno being perfect lung function
34
Post-Treatment Quantitative
Analysis
 Have patient blow into peak flow meter three times,
take maximum
 Apply Equation 1 to find percent increase
 Ask patient to rate difficulty of breathing from uno to
diez, uno being perfect lung function
 Report difference
Equation 1
Post − Pre
× 100%
Pre
35
Testing: Results
 Treated 14 patients while in country: yielded 8 numerical data
points
 Honduran Nurse at the private clinic collected 2 control data
points and 4 more data points using our nebulizer
 The power of the test will be low, will hopefully increase as
our contacts continue to take data
 Alpha level of 0.05 (medically standard)
 Null Hypothesis: The average percent increase in peak flow
for the medical nebulizer is the same as the average increase
in peak flow for the home made nebulizer.
 Alternative Hypothesis: The average percent increase in peak
flow for the medical nebulizer is greater than the average
increase in peak flow for the home made nebulizer.
36
Testing and Results
Home-Made Nebulizer
Percent
Before
After
Increase
125
160
28%
100
220
120%
70
120
71%
120
170
42%
50
80
60%
110
150
36%
190
245
29%
90
150
67%
100
150
50%
60
150
150%
100
200
100%
60
150
150%
Average
75%
Medical Nebulizer
Percent
Before
After
Increase
100
250
150%
150
200
33%
Average
92%
 p-value was 0.413
 We therefore fail to reject the
null hypothesis that the two
means are the same
 Little data so far
37
Observational Results
 Treatment had qualitative success
 Stopped bronchospasms in one patient
 Patients reported less or no difficulty breathing posttreatment
 Some children fell asleep while using the nebulizer
38
Sustainability and Ownership
 Made from locally available parts for low cost:
sustainable supply of nebulizer
 Ownership: instructions for constructing
 Trained variety of individuals
 Targeted individuals/groups who are most likely to
continue using the device and teach others – parents
39
Sustainability and Ownership
 Cambridge teacher will continue to spread the idea
 Posters and manuals at health departments
 Dr. Giron will make and distribute nebulizers
40
Entrepreneurial Opportunities
 Demand exists
 Product: Nebulizer kit and manual
 End user: Asthma patients
 Costumer: Philanthropic or Social Enterprise
 Non-profits such as NGOs
 Social entrepreneur
 Dr. Girón
 Roger Henriquez
 Carlos Ferrera
41
Conclusions
 This was a reasonably successful pilot study
 There is a need for this project in the developing world
 Well-perceived and culturally acceptable device
 Future studies should collect more data
 Failed to reject the null hypothesis that this method is
as effective as the medical nebulizer.
42
Acknowledgements
 Roger Dzwonczyk
 Mariantonieta Gutierrez
 Angie Overholt and the entire WGM team
 Anna K Young
 Kathy Stone
 Duane Hart
 Nationwide Children’s Hospital
43
Questions?
44