Evaluation of the microbiological efficacy of cleaning agents for tracheostomy inner cannulas

Area of Science:

• Microbiology
• Infection Control
• Medical Device Decontamination

Background:

• Biofilms on indwelling medical devices, like tracheostomy inner cannulas, increase patient morbidity and infection risk.
• Current decontamination guidelines for reusable inner cannulas lack strong evidence, leading to varied practices.
• Effective decontamination is crucial for reducing bioburden and ensuring patient safety.

Purpose of the Study:

• To compare the bacterial count reduction in tracheostomy inner cannulas after decontamination with detergent versus sterile water.
• To evaluate the microbiological efficacy of sterile water as an alternative to detergent for inner cannula decontamination.
• To provide evidence-based recommendations for tracheostomy care policies.

Main Methods:

• A randomized, controlled, cross-over study design was employed with 60 tracheostomy patients.
• Patients were assigned to decontamination sequences: detergent then sterile water (A > B) or sterile water then detergent (B > A).
• Bacterial counts were enumerated by plating saline flushes of inner cannulas on trypticase soy agar with 5% sheep blood.

Main Results:

• The mean ratio of post-cleaning to pre-cleaning bacterial counts (Log CFU) between detergent and sterile water was 0.918 ± 0.470.
• The 90% confidence interval for this ratio was 0.812 to 1.024.
• Equivalence was demonstrated as the mean ratio fell within the predefined equivalence region of 0.8 to 1.25.

Conclusions:

• Both detergent and sterile water demonstrated microbiological efficacy in decontaminating inner cannulas.
• Sterile water is as effective as detergent in reducing bacterial load for the safe reuse of inner cannulas.
• Findings suggest sterile water can promote cost savings and inform tracheostomy care policies.