Efficacy of Chlorhexidine in Disinfecting Biofilm-Contaminated Tracheostomy Tubes in Various Patient Conditions: A Prospective Observational Study.

BACKGROUND

Tracheostomy facilitates airway access by creating a stoma in the anterior tracheal wall but predisposes patients to recurrent respiratory infections. Biofilm formation on tracheostomy tubes-complex microbial communities embedded in an extracellular polymeric matrix-plays a key role in such infections by shielding pathogens from antibiotics and host defenses.

OBJECTIVE

To evaluate the efficacy of 2% chlorhexidine in eradicating biofilms from tracheostomy tubes compared to normal saline.

METHODS

A prospective observational study was conducted over 18 months in the Department of ENT, SRM Medical College Hospital and Research Centre, involving 68 patients with double-lumen tracheostomy tubes. After seven days of tube insertion, inner cannulas were tested for biofilm formation. Biofilm-positive cases were randomized into two groups: Group A (cleaned with normal saline) and Group B (cleaned with 2% chlorhexidine). After seven days, tubes were reassessed for biofilm presence and patient outcomes including secretion type, granulation, and decannulation were recorded.

RESULTS

Initial biofilm detection confirmed microbial colonization in most samples. After cleaning, Group B showed a significant reduction in biofilm presence (P < 0.001) compared to Group A. Chlorhexidine was particularly effective against Pseudomonas aeruginosa and Klebsiella pneumoniae. Clinical outcomes, including early decannulation and reduction in secretion thickness and granulation tissue, were superior in Group B.

CONCLUSION

2% chlorhexidine is significantly more effective than normal saline in reducing biofilm formation on tracheostomy tubes, improving local infection control and patient recovery outcomes.