Microbiological evaluation of different reprocessing methods for cuffed and un-cuffed tracheostomy tubes in home-care and hospital setting.

BACKGROUND: Manufacturers' recommendations on cleaning of tracheostomy tubes focus on general warning information and non-specific manual cleaning procedures. The aim of this experimental study was to evaluate different reprocessing methods and to determine the mechanical integrity and functionality of tracheostomy tubes following reprocessing. METHODS: Sixteen cuffed or un-cuffed tracheostomy tubes obtained from hospital in-patients were reprocessed using one of the following reprocessing methods: a) manual brushing and rinsing with tap water, b) manual brushing followed by disinfection with a glutaraldehyde solution, c) manual brushing followed machine-based cleaning in a dishwasher, and d) manual brushing followed by ultrasound cleaning in a commercially available ultrasound device. Microbial burden of the tubes before and after reprocessing was assessed by measurement of microbial colony-forming units per mL (CFU/mL) of rinsing fluid. After cleaning, tracheostomy tubes were investigated for loss of functionality. FINDINGS: Manual brushing and rinsing with tap water reduced microbial colonization in average by 10(2) CFU/mL, but with poor reproducibility and reliability. Complete microbial reduction was achieved only with additional chemical or machine-based thermal disinfection. Ultrasound sonification yielded no further microbial reduction after manual brushing. CONCLUSION: Manual brushing alone will not result in complete eradication of microorganism colonising cuffed or un-cuffed tracheostomy tubes. However, manual cleaning followed by chemical or thermal disinfection may be regarded as safe and reproducible reprocessing method. If a machine-based reprocessing method is used for cuffed tubes, the cuffs' ventilation hose must be secured in a safe position prior to thermal disinfection.

Milk allergy is frequent in patients with chronic sinusitis and nasal polyposis.

BACKGROUND: Chronic sinusitis and nasal polyps with subsequent nasal blocking, anosmia, and relapsing infections are frequent in the rhinological practice. Often, recurrent disease necessitates repetitive conservative therapy and surgical treatment (functional endoscopic sinus surgery). This study was initiated to scrutinize the relationship of wheat and milk allergies to chronic polypoid sinusitis (CPS) and recurrent disease. METHODS: Blood samples of 50 healthy controls and 50 patients with clinically and radiologically diagnosed CPS and nasal polyposis were screened for common food allergies including wheat and milk allergy. On inclusion into the study, none of the patients reported a symptomatic food allergy. RESULTS: Fifteen of 100 tested subjects (15%) revealed a previously undiagnosed allergy to inhalant (dust, rye, and pollens) and other food allergens (corn and egg white). Six of 50 patients (12%) with CPS exhibited a wheat allergy, and a milk allergy could be identified in 7 patients (14%). In the control group, seven healthy subjects (14%) showed a wheat allergy and no case of milk allergy could be identified (p = 0.0125). CONCLUSION: In contrast to previous studies in other countries presenting a food allergy incidence of ∼75% in patients with nasal polyposis, we could not show such a high incidence. In the group with chronic polyposis 14% of the patients were positive for milk allergy compared with none of the tested healthy subjects, resulting in a strong statistical significance. Therefore, we conclude that cow's milk but not wheat allergy might be a relevant pathogenetic entity in chronic nasal polyps.

Occurrence of coagulation factor deficiency in post-tonsillectomy hemorrhage.

INTRODUCTION: Tonsillectomy is one of the most common surgical procedures in Otorhinolaryngology and approximately 500 tonsillectomies are performed annually at the University Hospital of Vienna. Substantial postoperative bleeding is observed in 1.8% of cases, which is comparable to frequencies of 2-4% reported in other studies. Currently, routine pre-surgical coagulation investigations to predict bleeding status do not include the analysis of individual coagulation factors. MATERIAL AND METHODS: Within 2007 complete coagulation diagnostics were carried out in three patients presenting with recurrent (2-7 times) post-tonsillectomy hemorrhage but normal pre-surgical coagulation status parameters. RESULTS: After the appearance of recurrent late bleeding, single factor diagnostic analysis revealed the causes to be factor XIIa deficiency, reduced factor XIIIa or von Willebrand disease. Recurrent late bleeding was stopped by the application of coagulation active plasma. CONCLUSION: This study shows that, even if routine diagnostics show normal pre-surgical coagulation findings, the investigation of single factors in cases of post-surgical late bleeding may identify coagulation disorders allowing the application of tailored therapy. Including such analysis in pre-operative diagnostics could therefore significantly help to limit postoperative bleeding.

Normative voice range profiles in vocally trained and untrained children aged between 7 and 10 years.

Only limited data on normal vocal constitution and vocal capabilities in school-aged children are available. To take better care of children's voices, it might be helpful to know voice ranges and limits of not only vocally trained but also vocally untrained children. Goal of this study was the evaluation of singing voice capabilities of vocally healthy children with different social and vocal/musical backgrounds using voice range profile measurements (VRP). VRP percentiles that reflect constitutional aspects were suggested. In this cross-sectional study, 186 children (aged between seven and 10 years), attending five schools, were included. VRP measurements were performed under field conditions. Interviews and questionnaires regarding vocal strain and vocal training were applied; the answers were used for classification of singing activity and vocal training (KLASAK). All children reached a mean singing voice range of at least two octaves. By using the answers of interviews and questionnaires, the children could be classified according to vocal strain and vocal training. The groups showed no significant differences regarding VRP measurements. In the following step, percentiles were calculated. Twenty-five percent of all children (P25) reached a minimum voice range of almost two octaves, namely, 22 semitones (ST) from 220 to 784 Hz with soft and loud singing. Half of the children (P50) had a voice range of 24 ST (2 octaves), while soft singing and a larger voice range of 26 ST while loud singing. The measurements of third quartile (P75) revealed that 25% of children have even a larger voice range than 29 dB (from 196 Hz/g to 1047 Hz/c3) and can sing at most frequencies louder than 90 dB. P90 demonstrated that 10% of the children can sing even lower or higher than the frequency range between 196 Hz/g and 1319 Hz/e3 analyzed. The voice range seems not to be constrained by social but by voice/musical background: children of vocally/musically encouraged schools had wider voice ranges. This underlines the necessity of regular singing lessons already in primary schools. The percentile VRP introduced might help to evaluate the vocal constitution and vocal capabilities of a child.

The antimicrobial effect of Octenidine-dihydrochloride coated polymer tracheotomy tubes on Staphylococcus aureus and Pseudomonas aeruginosa colonisation.

BACKGROUND: The surface of polymeric tracheotomy tubes is a favourable environment for biofilm formation and therefore represents a potential risk factor for the development of pneumonia after tracheotomy. The aim of this in-vitro study was to develop octenidine-dihydrochloride (OCT) coated polymer tracheotomy tubes and investigate any effects on Staphylococcus (S.) aureus and Pseudomonas (P.) aeruginosa colonization. Additionally the resistance of the OCT coating was tested using reprocessing procedures like brushing, rinsing and disinfection with glutaraldehyde RESULTS: Contamination with S. aureus: Before any reprocessing, OCT coated tracheotomy tubes were colonized with 103 cfu/ml and uncoated tracheotomy tubes with 105 cfu/ml (P = 0.045). After reprocessing, no differences in bacterial concentration between modified and conventional tubes were observed.Contamination with P. aeruginosa: Before reprocessing, OCT coated tubes were colonized with 106 cfu/ml and uncoated tubes with 107 cfu/ml (P = 0.006). After reprocessing, no significant differences were observed. CONCLUSION: OCT coating initially inhibits S. aureus and P. aeruginosa colonisation on tracheotomy tubes. This effect, however, vanishes quickly after reprocessing of the tubes due to poor adhesive properties of the antimicrobial compound. Despite the known antimicrobial effect of OCT, its use for antimicrobial coating of tracheotomy tubes is limited unless methods are developed to allow sustained attachment to the tube.