What is the treatment for a tracheostomy (trach) infection?

Treatment for Tracheostomy Infections

The treatment of tracheostomy infections requires strict adherence to infection control measures, including proper hand hygiene, aseptic technique during tracheostomy care, and appropriate antibiotic therapy when indicated.

Infection Prevention Measures

Hand Hygiene and Personal Protective Equipment

• Decontaminate hands before and after contact with a patient who has a tracheostomy tube, whether or not gloves are worn 1
• Wear gloves when handling respiratory secretions or objects contaminated with respiratory secretions 1
• Use eye protection for all tracheostomy care 1
• Change gloves and decontaminate hands between contacts with different patients and between contacts with a contaminated body site and the respiratory tract 1
• Wear a gown when soiling with respiratory secretions is anticipated 1

Tracheostomy Tube Care

• When changing a tracheostomy tube, wear a gown, use aseptic technique, and replace with a tube that has undergone sterilization or high-level disinfection 1
• Use only sterile fluid to remove secretions from the suction catheter if it will re-enter the patient's lower respiratory tract 1
• If using open-system suction, use a sterile, single-use catheter 1
• Consider using a closed-circuit suction system with an expiratory viral filter to decrease exposure to pathogens 1

Treatment of Established Infections

Assessment

• Obtain appropriate respiratory cultures to identify causative pathogens before starting antibiotics
• Evaluate for signs of local infection (erythema, purulent discharge, granulation tissue) and systemic infection (fever, increased respiratory secretions, changes in secretion color)

Antibiotic Therapy

• For local tracheostomy site infections:

  • Clean the site with sterile saline and apply appropriate antiseptic
  • Systemic antibiotics targeting common pathogens (Staphylococcus aureus, gram-negative enteric bacteria, and Pseudomonas aeruginosa) 2

• For tracheobronchitis or pneumonia:

  • Systemic antibiotics based on culture results and local antibiotic resistance patterns
  • Consider inhaled antibiotics (tobramycin or colistin) as adjunctive therapy, especially for resistant organisms 3, 4

Severe Infections

• For necrotizing tracheostomy infections:
  • Immediate intensive management may be required
  • Consider oral intubation for ventilatory support if the tracheostomy site is compromised
  • Aggressive local wound care with antimicrobial dressings 5

Special Considerations

Preventive Strategies

• Regular tracheostomy care with aseptic technique
• Routine changing of inner cannula according to institutional protocols
• Adequate humidification to prevent mucus plugging
• Consider prophylactic inhaled antibiotics in high-risk patients, though evidence is limited 6

Potential Complications

• Be vigilant for signs of bleeding, especially in anticoagulated patients 1
• Monitor for mucus plugging, which can lead to respiratory distress 1
• Watch for tracheal stenosis or granulation tissue formation, which may require endoscopic evaluation 1

Follow-up

• Regular assessment of the tracheostomy site
• Consider decannulation as soon as safely possible to reduce infection risk 1
• Multidisciplinary follow-up for patients with chronic tracheostomies 1

Remember that despite heavy colonization with potentially pathogenic bacteria, outpatients with chronic tracheostomy can be managed with a relatively low risk of developing severe respiratory tract infections when proper care protocols are followed 2.