Effectiveness of Pediatric Tracheostomy Tube Cleaning

Objective: To determine the effectiveness of typical reprocessing of pediatric tracheostomy tubes (TTs) with detergent-soaked gauze pads. Design: In vitro microbiologic study. Setting: Department of Otolaryngology, University of Florida, Gainesville. Participants: Polyvinyl chloride and silicone TTs of 3 different manufacturers. Intervention: Thirty TTs were cultured with Pseudomonas aeruginosa or Staphylococcus aureus and reprocessed after 4 days. Eighteen additional TTs were exposed to plasma and then cultured with P aeruginosa or S aureus for 7 days. Main Outcome Measures: The presence of biofilms was assessed before and after cleaning by quantitative bacterial counts and scanning electron microscopy. Results: Bacterial counts that were obtained before cleaning of the tubes did not differ among brands. Reprocessing reduced P aeruginosa and S aureus bacterial counts in the 4-day group (P=.003 and P=.004, respectively), but clean TTs had a mean count of 10(5) colony-forming units/mL. Reprocessing did not significantly reduce S aureus or P aeruginosa bacterial counts in TTs pretreated with plasma and exposed to 7-day culture. Conclusions: P aeruginosa and S aureus biofilms in pediatric TTs are not eradicated by standard cleaning methods. Further research is needed to determine the clinical significance of these findings and whether strategies to prevent biofilm formation or more effective disinfection methods would result in improved clinical outcomes.