Effect of repeated tracheostomy tube reprocessing on biofilm formation.
OBJECTIVE
To determine the effect of repeated reprocessing of pediatric tracheostomy tubes (TTs) on biofilm formation.


METHODS
In vitro microbiological study.


METHODS
Pediatric, uncuffed, polyvinyl chloride (PVC) TTs from two different manufacturers (Tracoe Mini and Shiley) were reprocessed mechanically with household detergent and soaked in sodium hypochlorite (bleach). Two TTs of each brand were reprocessed 0 (control), 10, or 20 times. Twenty 2-mm coupons were then obtained from each TT, immersed in human mucus, and cultured with either Staphylococcus aureus or Pseudomonas aeruginosa. Biofilm formation was evaluated with bacterial counts.


RESULTS
Bacterial counts of S. aureus for both brands were significantly higher on the TTs that were reprocessed 20 times compared to those that were not reprocessed (Tracoe: P = .040, Shiley: P  <  .0001) or those that were reprocessed 10 times (Tracoe: P = .022, Shiley: P = .0002). There was no difference between controls and TTs reprocessed 10 times (Tracoe: P = .76, Shiley: P = .24). P. aeuruginosa counts were not significantly different among the varying numbers of reprocessing cycles for either Tracoe or Shiley TTs (P = .08 and P = .97, respectively).


CONCLUSIONS
Repeated reprocessing of PVC TTs with detergent and bleach paradoxically promotes S. aureus biofilm development, possibly due to degradation of the tube surface that facilitates bacterial attachment. Further investigation is needed to determine the optimal technique and limits of reprocessing TTs in clinical practice.


METHODS
NA.
Department of Otorhinolaryngology, University of Oklahoma, Oklahoma City, Oklahoma.
Jennifer
J
Rodney
Department of Otolaryngology, University of Florida, Gainesville, Florida.
Carolyn P
CP
Ojano-Dirain
Department of Otolaryngology, University of Florida, Gainesville, Florida.
Patrick J
PJ
Antonelli
Department of Otolaryngology, University of Florida, University of Florida-Health Shands Hospital for Children, Gainesville, Florida, U.S.A.
Rodrigo C
RC
Silva
D018441:Biofilms; D015169:Colony Count, Microbial; D004203:Disinfection / Q000379:methods*; D004866:Equipment Contamination; D006801:Humans; D011143:Polyvinyl Chloride; D011550:Pseudomonas aeruginosa; D013211:Staphylococcus aureus; D014139:Tracheostomy / Q000295:instrumentation*
D011143:Polyvinyl Chloride
Bacterial biofilms; effect of reprocessing; tracheostomy tube