title: Microbiological evaluation of different reprocessing methods for cuffed and un-cuffed tracheostomy tubes in home-care and hospital setting.
abstract: BACKGROUND
  Manufacturers' recommendations on cleaning of tracheostomy tubes focus on general warning information and non-specific manual cleaning procedures. The aim of this experimental study was to evaluate different reprocessing methods and to determine the mechanical integrity and functionality of tracheostomy tubes following reprocessing.
  
  
  METHODS
  Sixteen cuffed or un-cuffed tracheostomy tubes obtained from hospital in-patients were reprocessed using one of the following reprocessing methods: a) manual brushing and rinsing with tap water, b) manual brushing followed by disinfection with a glutaraldehyde solution, c) manual brushing followed machine-based cleaning in a dishwasher, and d) manual brushing followed by ultrasound cleaning in a commercially available ultrasound device. Microbial burden of the tubes before and after reprocessing was assessed by measurement of microbial colony-forming units per mL (CFU/mL) of rinsing fluid. After cleaning, tracheostomy tubes were investigated for loss of functionality.
  
  
  RESULTS
  Manual brushing and rinsing with tap water reduced microbial colonization in average by 10(2) CFU/mL, but with poor reproducibility and reliability. Complete microbial reduction was achieved only with additional chemical or machine-based thermal disinfection. Ultrasound sonification yielded no further microbial reduction after manual brushing.
  
  
  CONCLUSIONS
  Manual brushing alone will not result in complete eradication of microorganism colonising cuffed or un-cuffed tracheostomy tubes. However, manual cleaning followed by chemical or thermal disinfection may be regarded as safe and reproducible reprocessing method. If a machine-based reprocessing method is used for cuffed tubes, the cuffs' ventilation hose must be secured in a safe position prior to thermal disinfection.
authors.affiliation: Department of Otorhinolaryngology, Medical University of Vienna, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Leonhard
authors.affiliation: Institute for Skin Integrity and Infection Prevention, University of Huddersfield, United Kingdom.
authors.forename: Ojan
authors.initials: O
authors.lastname: Assadian
authors.affiliation: Department of Otorhinolaryngology, Medical University of Vienna, Austria.
authors.forename: Michaela
authors.initials: M
authors.lastname: Zumtobel
authors.affiliation: Department of Otorhinolaryngology, Medical University of Vienna, Austria.
authors.forename: Berit
authors.initials: B
authors.lastname: Schneider-Stickler
keywords: biofilm; cuff; dishwasher; disinfection; infection control; medical device; reprocessing; sonification; tracheostomy tube; ultrasound