Avoid Routine Antimicrobial Ointments and Creams on Tracheostomy Stomas
The routine use of ointments and creams should be avoided on tracheostomy stomas, and petroleum-based products are specifically contraindicated 1. The primary principle of tracheostomy stoma care is to keep the skin clean and dry while avoiding pressure necrosis.
Evidence-Based Stoma Care Protocol
The American Thoracic Society guideline provides clear direction on tracheostomy peristomal skin management 1:
- Daily cleansing with soap and water is the foundation of care
- 1.5% hydrogen peroxide solution can be used specifically to remove encrusted secretions, followed immediately by water cleansing and thorough drying
- The peristomal area and neck skin require daily careful inspection
Why Avoid Routine Antimicrobials?
The guideline explicitly states that routine ointments and creams should be avoided, with petroleum-based products being contraindicated 1. This recommendation is based on several considerations:
- Ointments can trap moisture against the skin, defeating the primary goal of keeping the area dry
- Petroleum-based products can interfere with proper wound healing and create an occlusive environment
- Barrier products themselves can cause contact dermatitis, as demonstrated in research showing stoma care products are a common and underreported source of peristomal dermatitis 2
When Antimicrobials May Be Considered
If infection develops (not for routine prophylaxis), the IDSA guidelines indicate that topical mupirocin or retapamulin are effective for superficial skin infections like impetigo 3. However, this would be treatment of established infection, not routine prevention.
High-Risk Populations Requiring Extra Vigilance
Children who are mechanically ventilated or infants with short, fat necks are at particularly high risk for infection and pressure necrosis, requiring even more meticulous care with the clean-and-dry approach 1.
Alternative Protective Measures
Instead of antimicrobial ointments:
- Duoderm can cushion skin beneath tracheostomy ties to prevent pressure injury 1
- Soft tracheostomy ties may be less irritating than strings 1
- Barrier creams (containing dimethicone and acrylates) applied beneath absorbent dressings showed benefit in maintaining normal skin pH and moisture in research, though this was for barrier protection rather than antimicrobial purposes 4
- Dressings should promote moisture movement away from skin and be loose and nonocclusive in the early postoperative period 1
Common Pitfall to Avoid
The most common error is applying ointments or creams thinking they will prevent infection, when in reality they trap moisture and secretions against the skin, creating the exact environment that promotes bacterial overgrowth and skin breakdown.