Abstract
Background: Procedures for cleaning pediatric tracheostomy stoma sites vary. The solution used often varies based on surgeon preference. Surgeons were asked why they preferred a particular solution and indicated it was often based on the guidance of a mentor during their training. Complications of stoma site infections cause increased discomfort, possible longer length of stay, increased medication use, additional consults, and possible respiratory tract infections. To determine best practice and standardize care around cleaning solutions, Google Scholar, CINAHL, and Cochran were searched and no relevant publications were found. Practice guidelines based on consensus statements and expert opinions were available, but no research studies within the last five years were found.
Methods: A research study utilizing a retrospective chart review was completed. Inclusion criteria were children under one year of age who had a tracheostomy tube placed in the last five years at our institution. The age limit narrows the study to the most common patient population who receive a trach tube. Data were collected from the first 30 days after a tracheostomy procedure to limit extraneous variables. This included 102 patients. Children's Minnesota IRB approval was obtained. Initial orders for trach site cleaning were reviewed. Nursing narrative notes, Progress notes from providers, along with nursing descriptions of the stoma site during cleaning were reviewed for signs of infection. The symptoms searched for included redness, rash, odor, increased secretions, and any other unusual tissue observations.
Results: There was a statistically significant increase of infections to the patient if 25% acetic acid was not used as the daily stoma cleaning agent. Barriers to data collection were inconsistent nursing narrative notes. Other factors that could have contributed to infection include improper hand washing, and frequency of tube changes.
Conclusions: 25% Acetic acid significantly reduces infection at trach stoma sites when compared to using sterile water or saline. The research showed about a 30% higher chance of infections if not using acetic acid as daily cleaning agent. The cost of using acetic acid is the same as using sterile water or saline. No negative side effects were seen by using 25% acetic acid daily in this study.
Footnotes
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