Device-Related Infections in Long-term Healthcare Facilities: The Challenge of Prevention

Nico T Mutters; Frank Günther; Alexandra Heininger; Uwe Frank


Future Microbiol. 2014;9(4):487-495. 

In This Article

Prevention of Tracheostomy-associated Infections

There are several indications for placement of tracheostomy devices: relief of upper airway obstruction (tumor or surgery); suctioning and removal of airway secretions; and provision of stable airways in individuals requiring prolonged mechanical ventilation.[12] Of all hospitalized patients requiring mechanical ventilation, approximately 10% will receive a tracheostomy.[63] However, the rate of tracheostomy procedures has increased rapidly in recent years.[12,64] The prevalence of LTCF residents with tracheostomy devices lies at 1.4%, although most of them do not require mechanical ventilation.[12–14] The infections most frequently associated with tracheostomy devices are either tracheobronchitis or mainly pneumonia.[65] Diagnosis is sometimes made difficult due to challenging microbiological assessment since airway colonization with potentially pathogenic bacteria is ubiquitous in these patients.[66] Therefore, other signs and symptoms, such as cough, purulent secretion, systemic signs of infection, impairments in gas exchange and the presence of an infiltrate on chest x-ray, should also be checked.[12] It is striking, however, that the incidence in hospitals is estimated to be very high, since approximately 60% of all patients receiving prolonged ventilator support will develop pneumonia.[65] The incidence density rates of pneumonia in LTCFs and spinal cord injury facilities are between 1.67 and 1.74 per 1000 ventilator-days, respectively.[67,68] To minimize the risk of infection, a program in LTCFs should attempt to reduce the potential of aspiration, minimize atelectasis and provide care for respiratory therapy equipment.[47] In addition, sedation should be reduced and good oral care be provided.[12] An individualized treatment protocol addressing adequate removal of airway secretions and providing adequate airway humidity should be implemented for residents with chronic tracheostomy devices.[69] LTCF residents need to be educated and trained in the handling and clean care of tracheostomy devices to cope with relevant issues associated with these devices.[70] Weaning and decannulation will have the greatest impact on reducing the risk of infection.[12] Finally, appropriate hand hygiene and glove use should be performed during any manipulation of the tracheostomy device.