Tracheostomised patients in the community have lower rates of tube colonisation

Background: Tracheostomised patients present a challenging inpatient burden in acute hospitals. It has been postulated that pathogenic colonisation rates of tubes may be lower within hospital settings, discouraging early discharge. This study analyses the rate of tracheostomy tube colonisation in those managed as inpatients compared to outpatients. A secondary factor assessed whether colonisation of cuffed tubes, with resultant impaired mucociliary clearance, differed from uncuffed tubes. Methods: This cohort was collected non-selectively from 65 consecutive adult patients reviewed by the Westmead Hospital, Department of Otolaryngology tracheostomy service in the hospital and community between September 2017 and March 2019. Patients were controlled for medical variables. Results: Sixty-five patients were analysed for rates of pathogenic microbial colonisation. There were significantly fewer patients with colonised tubes in outpatients compared to inpatients (38.1% vs. 65.9%, χ²=4.485, P=0.034). There was little to no evidence that there was a true difference in colonisation between patients with fenestrated and non-fenestrated tracheostomy tubes (53.8% vs. 59.0%, χ²=0.167, P=0.683). Conclusions: This study suggests that care of tracheostomised patients in the community when safe should be encouraged and fear of colonisation of tubes should not confound this. This difference was unlikely due to differing rates of fenestrated or non-fenestrated tubes as there was no statistically significant difference between those groups.