Comparison of Pediatric Tracheostomy Stoma Cleaning Solutions

BACKGROUND: In the limited literature on cleaning tracheostomy stoma sites, there is no standard guideline for the cleaning solution. The objective of this study was to determine whether signs of stoma-site infection were different among a hospitalized pediatric population when using sterile water, sterile saline solution, or 0.25% acetic acid solution for tracheostomy stoma cleaning. METHODS: A retrospective chart review was completed and included nursing and physician notes. The subjects were <1 y of age, in the neonatal ICU, and received a tracheostomy within the previous 30 days. Clinical signs of infection were visually observed by the providers and documented in the medical record. The subjects were divided into 3 groups, those prescribed 0.25% acetic acid, those prescribed sterile water, and those prescribed sterile saline solution for twice daily tracheostomy stoma care. We compared the rate of signs of infection of the tracheostomy stoma site across the 3 treatments by using a chi-square test. RESULTS: In the 102 subjects included, there were significantly more signs of infection in the subjects for whom 0.25% acetic acid was not used for daily stoma cleaning ( P = .03). There were no differences in signs of infection between those cleaned with saline solution (39%) and those cleaned with sterile water (31%) for daily stoma cleaning. Overall, there were 29% fewer signs of infection when 0.25% acetic acid was used than either sterile water or saline solution. CONCLUSIONS: Analysis of our findings indicated that a 0.25% acetic acid solution used for stoma cleaning may be associated with fewer signs of infection than sterile water or sterile saline solution. More research is warranted toward establishing a standard practice.