A tracheostomy is a surgical procedure that creates an opening, called a stoma, through the neck into the windpipe (trachea) to allow air to reach the lungs. This opening is maintained by a tracheostomy tube, which is necessary for patients with upper airway obstructions, those requiring long-term mechanical ventilation, or those needing assistance with clearing lung secretions. The tube bypasses the body’s natural defense mechanisms, such as the filtering and humidifying capabilities of the nose and mouth. This direct path into the lower respiratory tract increases susceptibility to serious respiratory tract and stoma site infections. Healthcare professionals follow rigorous protocols to mitigate this elevated risk, forming the foundation of safe tracheostomy care.
Establishing and Maintaining Aseptic Technique
Infection prevention begins with hand hygiene, the most effective measure against infection transmission. Caregivers must perform a thorough hand wash with soap and water for at least 20 seconds, or use an alcohol-based sanitizer, both before and after every patient interaction and procedure. Contaminated hands are a primary route for introducing pathogens to the stoma site or the airway.
Following hand hygiene, personal protective equipment (PPE) creates a barrier between the caregiver, patient, and environment. This involves donning clean gloves for basic care. For high-risk procedures like suctioning or complex tube changes, a gown, mask, and eye protection are added to prevent exposure to infectious splashes or aerosolized secretions. Establishing a sterile field is concurrent; all necessary supplies are opened and organized on a clean surface, ensuring anything touching the inner airway or wound remains sterile until use.
Maintaining the sterile field throughout the procedure prevents environmental microbes from colonizing the tube or stoma. This involves a non-touch technique, handling sterile equipment only with sterile gloves or instruments. Once the procedure is complete, all used PPE and disposable supplies are immediately discarded to prevent cross-contamination, followed by a final round of hand hygiene.
Infection Prevention During Suctioning Procedures
Suctioning clears accumulated secretions from the trachea but carries a high risk of introducing bacteria directly into the lungs. To minimize this, a sterile technique is used, ensuring the suction catheter and the caregiver’s glove remain untouched by non-sterile surfaces. Before catheter insertion, the patient may be pre-oxygenated. This helps minimize the risk of oxygen desaturation and mucosal trauma, which could increase susceptibility to infection.
Healthcare settings utilize either an open- or closed-system for suctioning. The open system requires a new, sterile catheter for each suction pass, which is discarded after use to prevent bacterial growth. Conversely, the closed-system features a multi-use catheter encased in a plastic sheath. This allows for repeated suctioning without disconnecting the patient from a ventilator circuit, maintaining a closed system and reducing the introduction of outside air and pathogens.
Regardless of the system used, the duration of each suction pass must be limited to 10 to 15 seconds. This time limit prevents excessive negative pressure from damaging the delicate lining of the trachea, known as the mucosa. Mucosal injury creates a direct entry point for pathogens and can lead to inflammation and infection. Suction should only be applied while withdrawing the catheter, never upon insertion, to avoid trauma to the tracheal walls.
Meticulous Stoma Site Care and Dressing Changes
The stoma site is a direct entry point for environmental pathogens and requires management to prevent skin and respiratory infections. Caregivers must visually inspect the site at least once daily, noting signs of a developing infection, such as new redness, swelling, warmth, or thick, purulent, or foul-smelling drainage. Prompt identification allows for early intervention, often including a culture swab to identify the causative organism.
Cleaning the skin around the tracheostomy tube is performed using a non-touch technique with sterile supplies to maintain wound hygiene. The area is typically cleaned with sterile saline solution, or sometimes a half-strength hydrogen peroxide mixture, using cotton-tipped applicators to remove crusted secretions. Cleaning must always move from the stoma opening outward to prevent drawing bacteria toward the airway.
The tracheostomy dressing and the tube holder or ties must be changed whenever they become soiled or damp, as moisture encourages bacterial growth. A pre-cut, split-gauze dressing is placed under the faceplate of the tube to absorb secretions and prevent skin breakdown from friction. The securing ties are replaced using a two-person technique, ensuring the tube remains stable and preventing accidental dislodgement.
Management of Tracheostomy Equipment and Supplies
Infection control extends to the tracheostomy equipment, which can become reservoirs for microbes if not maintained. For tubes with an inner cannula, timely cleaning or replacement is necessary to prevent obstruction and bacterial colonization. A reusable inner cannula is typically cleaned two to three times per day by soaking it in a cleaning solution like diluted hydrogen peroxide, scrubbing with a small brush, and thoroughly rinsing with sterile water.
Disposable inner cannulas are removed and replaced with a new, sterile component according to manufacturer directions or facility policy. Reusable equipment, such as humidification circuits, ventilator tubing, and nebulizer components, are susceptible to microbial growth due to their warm, moist environment. These items must be disassembled, cleaned, disinfected, and allowed to air-dry completely on a clean surface according to a scheduled protocol to prevent the inhalation of contaminated aerosols.
All replacement supplies, including new tubes, dressings, and cleaning kits, must be stored properly until they are needed for use. This ensures that the components touching the patient’s airway or stoma are free from environmental contamination prior to the procedure. Adhering to replacement schedules for both the inner cannula and the entire tracheostomy tube, as determined by the healthcare provider, reduces the overall bacterial load and the risk of chronic infection.