Infection Control for Trachs
by Melissa Koker-Kent
When our babies with trachs have their trachs placed and are in the hospital, they receive standardized infection control procedures. The nurses caring for our children follow “sterile” protocol when dealing with our child’s trach, and we are confident that all precautions are being taken to protect our special kids.
When we take them home it is not so simple. Life with a child with a trach--and possibly a vent--is a scary world, especially at first. We are given so much information to process in a very short time. We are expected to go in clueless and come out “pros” in a field we never asked to be a part of.
We eventually get into a routine. We eventually get comfortable caring for our kids. We do everything within our abilities to keep our children’s lives as normal and routine as possible, while simultaneously trying to keep them as healthy as we can. We avoid sick family and friends, we use more hand sanitizer in a week than most use in a lifetime, and we stay out of public situations as much as possible during the dreaded cold and flu season. We take as many precautions as we can.
So what else can we do? How can we help our children live the healthiest lives possible with the added challenge of a direct route between the petri dish that is our world and our child’s lungs?
Clean Versus Sterile Technique
If you have a child with a trach you have probably already figured out most of us use “clean techniques” to care for our children’s tracheotomy. Clean technique is standard procedure for home trach patients. For us, it wasn’t what I felt was safest, but due to the restriction of what insurance allows in supplies and our limited budget, we had no choice but to use this approach to care prior to our son Henry becoming vent dependent.
Henry was allotted three sterile suction catheters per day, and as most parents figure out rather quickly, our kids need suctioning more than three times a day. That means we have to reuse the catheters and of course they are no longer sterile. I was terrified of the idea of using a catheter that was just laying in an open package all day. When I picked it up to suction him I would get sick to my stomach at the idea of all the germs living on it! Henry had battled chronic respiratory infections caused by resistant bacteria for several years, and had spent the majority of the three years prior to his trach placement in the children’s PICU. I was not interested in exposing him to more infections.
So when we can’t use sterile products and procedures, how do we protect our child from infection in our home? I have learned a lot about what works, what doesn’t, what the “pros” say, and what’s realistic over the past couple of years.
What is the best way to keep suction catheters safe from the environment? I am not sure there is a perfect solution for this, but after talking to several nurses, doctors, respiratory therapists, and doing some research on my own, what I have learned is it's essential to keep them as clean and dry as possible. After several ideas proved to be complete failures, I did find the best way for us to do this was gallon size freezer bags with an absorbent cloth folded into the bottom to catch any dripping. We ended up making some cloth storage bags with Velcro on the back to put the freezer bags in. It keeps the catheters in a clean area and allows us to hang the bag on the back of his wheelchair or at his bedside without worrying it would fall onto the floor. We change the bags and absorbent cloth out at least once a week and anytime they look like they need changing.
Another piece of information I was left to figure out on my own was what type of water I should use for trach care. Was tap water safe for anything trach related? Well, I quickly learned the answer is no. Sterile water should be used for flushing the catheter, for cleaning any parts, and for any humidity that is administered. Tap water can carry the germs and bacteria that we are desperately trying to avoid. If you are unable to get sterile water for your child, or you do not get enough to last the entire month, distilled water can be used, but be sure you keep the container closed when not in use.
Cleaning the Trach and Associated Parts
What about cleaning parts? How often should I clean the parts and how can I clean the adapters, extensions, and the trach itself without using tap water? We were told to provide basic stoma care at least once a day, and due to his infection risk we do it twice a day. We use a simple over-the-counter antibiotic cream around the stoma to prevent infections. It is also important to frequently change gauze if you use it. The drainage is not only a risk for skin integrity, but it can also promote an ideal moist condition for bacterial growth. We were also told to change Henry’s trach out weekly, which has been our standard practice since he came home. As far as the adapters and other parts, we change them out every two weeks and clean them weekly.
When it comes to cleaning the parts, I have found no way to avoid using tap water for cleaning, but I have found a method that minimizes infection risk. Use a gentle soap and warm water for cleaning all parts. I like baby soap. There are a couple options for sanitizing the parts after cleaning them. This is important for two reasons. First of all, after you wash them with tap water, you have to get any possible contaminants from the water itself off of them. Second, if we don’t sanitize the parts prior to storing or reusing them, the germs from any infection our child already has or is recovering from are going to be living and breeding all over the parts.
Option one is a simple soak in a vinegar bath. Our respiratory therapist recommended using a couple quarts of sterile or distilled water with a good sized splash of vinegar (I use about one tablespoon per quart of water) and soak the parts for one hour. Allow plenty of time to air dry before storing. We really like freezer bags and I love them for storing parts after they have been sanitized. Another option for storage is to use small storage containers. This works, but I prefer using new bags each time.
After using this method for awhile I discovered something pretty amazing. Baby bottle steam sanitizers work great for sanitizing trach parts. They are fairly inexpensive and very simple to use. Many come with a basket that works great for the small adapters and the trach itself. I love this method. Again, it is essential that the parts are allowed to dry completely before storing. Damp parts in a closed container of any sort can grow mold spores and bacteria. I usually allow the parts to dry for at least 12 hours before storing them.
Neither of these methods gives us sterile parts, but I feel I am doing everything within my power to kill as many threats as possible.
Another important factor in protecting skin integrity is to be sure trach ties are clean and dry. Typically, I change my son’s ties daily, but there are days that due to excessive oral secretions, I have to change them throughout the day. We use the Velcro ties, so we have to wash them in between uses. I like to use a gentle antibacterial soap and hand wash them before allowing them to air-dry. This keeps them from falling apart so quickly, and I feel like it kills many of the germs that could cause an infection. Again, make sure they are fully dried before using again. If you don't, the moisture can cause skin irritation around the neck.
Infection Control Basics
Of course there are also the basics. Always make sure your hands are clean and as germ-free as possible. I keep a large bottle of hand sanitizer at the bedside and on the back of his wheelchair. Washing your hands before handling a clean suction catheter is the simplest thing you can do to help avoid the risk of infection. Also, keeping anyone who is likely to be carrying a viral or bacterial infection away from your child is important. Make sure your staff, friends, family, therapist and any other frequent visitors to your home are aware that your child is at a higher risk for respiratory infection and that they should not visit if they are exhibiting signs of an infection. I keep a sign posted on my door stating the standard spiel about spreading infections. I have found this to deter people from coming over if they are sick.
While being a parent of a child with a trach can be overwhelming, we as parents are the best judges of what works and doesn’t work for our children and our families. Please remember this is written based on my own practices and experiences after consulting our family doctor and others. Please be sure to speak in detail to your child’s doctor about the best and safest way to care for his or her trach. Never be afraid to ask questions. There really are no dumb questions when it comes to your child’s respiratory health and safety.