Table 3.
Pharmacy practice recommendations for saline use, based on this literature analysis
| • Saline does not destroy SARS-CoV-2 and is thus only to be used as an add-on to basic hygiene measures | |
| • In case of acute common cold or upper respiratory symptoms in times of COVID-19 | |
| Nasal rinse |
From first symptoms of common cold or upper respiratory symptoms Rinse with pure “isotonic” saline (0.9%) 2–3 times/day* • This concentration combines a reliable positive effect on the MCC with desirable partial receptor block of the entry receptor and is well established for treatment or prevention of common cold and upper respiratory symptoms, and as nebulization/aerosol for treatment of bronchiolitis • Isotonic saline is devoid of the side effects that have occasionally been reported for hypertonic saline (effect on cell morphology, increased nasal epithelial permeability, nasal burning/irritation, and when nebulizing: induction of bronchoconstriction or cough) • [*Isotonic saline for nasal rinse unless if hypertonic saline is already used in the frame of other indications, in which case it can be continued] • Heating the saline is not needed; concentrations of salt reached upon inhaling sea salt solution are unknown • No special devices are needed |
| + Gargling |
In case of common cold symptoms with throat involvement: Or in case of COVID-19 positive testing -> Gargling can be done with self-made hypertonic saline 1 table spoon or 20g kitchen salt per litre, or as formulated by DGKH [9]: 1 flat-filled teaspoon in 100 mL: up to 12 times per day -> Don’t swallow; discard in sink |
| Respiratory care |
When using a saline aerosol with a nebulizing apparatus to reduce bio-aerosol formation and/or remove phlegm, hydrate the airways and/or reduce cough -> Continue with habitual strengths of sterile saline concentration (0.9%), unless otherwise indicated, or ask pharmacist -> Follow the cleaning instructions of the manufacturer for the cleaning of the device, to end with hand hygiene -> Preferentially to be performed in well-aerated place or outside |
| See your doctor if not getting better and/or if feeling short of breath or/and very sick with high temperature | |
| • Preventive use | |
|
Daily nasal and oral gargling may be useful in situations, such as also formulated by the DGKH [9]: e.g. • As nasal saline spray for hydration of the nasal mucosa (e.g. when feeling dehydrated due to carrying a mouth mask) • As gargling and nasal rinse, before seeing a frail or immune compromised person, before meals and qPCR-positive household, upon outbreak of respiratory illness in schools, or after visiting an unexpectedly crowded location, and thus if risk of contamination is believed to be higher Distancing and hygiene measures will prevail at any time |
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| • Protective measures: always combine with protective measures | |
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Nose and Mouth • Collect superfluous liquid with tissue paper and discard or in water with detergent and safely dispose in sink • Wash and/or safely collect the saline recipients, to end with hand hygiene Nebulization/aerosol • If there is no way to isolate or to aerate the room, use cotton sheets to cover your lap (plus head) to prevent aerosol dispersion • Ventilate the room and wash hands |
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