SITUATION: 

This QuickHit was informed by recent updates to the Enterostomy Tube Stoma Assessment Clinical Practice Guideline (CPG) at SickKids.

BACKGROUND: 

Many children with medical complexity rely on enteral tubes to support nutrition, hydration, and/or medication administration. Enteral tube stomas are at risk for complications such as skin infection, granulation tissue, skin breakdown, and/or sensitivity. Inconsistent assessment and management can lead to unnecessary swabbing, inappropriate antibiotic use, increased healthcare visits, and added costs for families.

The Enterostomy Tube Stoma Assessment CPG provides a standardized, evidence-based approach to managing common stoma issues. Recent updates strengthen guidance to support accurate assessment and appropriate management in home and community settings.

ASSESSMENT: 

Stoma complications (e.g., infection, granulation tissue, dermatitis) are common and require accurate assessment and targeted management to promote healing and prevent escalation. Key practice updates in the CPG include:  

• Stoma infection is a clinical diagnosis, based on signs and symptoms. Routine swabbing is not recommended unless results will guide management (e.g., recurrent or unclear infection).
• Therapeutic wound cleansing is a core component of infection management. Use of  hypochlorous acid (e.g., Vashe™, PureCleanse™) is recommended when infection is suspected or confirmed to reduce bioburden and support healing.
• Granulation tissue management is now more individualized and flexible. This includes salt-based therapies (e.g., salt sprinkle) as accessible, home-based options.

These updates support consistent, evidence-based management in home and community to reduce unnecessary interventions and improve patient and family comfort, safety and experience.

RECOMMENDATION: 

Connected Care recommends the following to support the assessment and management of stoma issues in home and community:

1. Use the Enterostomy Tube Stoma Assessment CPG as a guide for standardized and evidence-based assessment and management of stoma issues.  
2. Assess for infection using signs and symptoms (e.g., erythema, drainage, pain, warmth, fever). Routine swabbing is not recommended and should only be performed if results will guide management.
3. Use hypochlorous acid (e.g., Vashe™, PureCleanse™), available over the counter, for therapeutic cleansing when infection is suspected or confirmed:
   • Soak a clean dry gauze with lukewarm solution
   • Place gauze directly onto skin/tissue ensuring contact and let sit for 10-15 minutes
   • Remove gauze and let skin/tissue air dry, no need to rinse
   • Apply dressing if indicated
4. Manage granulation tissue using an individualized approach based on access, tolerance, and previously effective methods. Consider salt sprinkle as a simple, accessible home-based option:
   • Apply a small amount of table salt (¼ teaspoon) directly on granulation tissue or use a cotton swab to dab salt directly onto tissue
   • Let salt sit for 10 minutes then rinse off with water
   • Repeat daily for up to 1 week, as tolerated  
5. Escalate to the primary provider or specialty team if:
   • Symptoms are worsening or not improving within expected timeframes
   • There are signs of spreading or systemic infection
   • There is uncertainty in diagnosis or management approach