As reported in the literature and observed in clinical practice, a variety of tracheotomy care procedures (tracheotomy suctioning and cleaning techniques) are currently used. The purpose of this research was to determine if clean tracheotomy care was more effective than sterile as measured by levels of postoperative pulmonary infection. Ten hospitals with large Head and Neck/ENT services were selected as data collection sites. At these centers a minimum of 15 tracheostomy patient charts were reviewed pre- and postoperatively for clinical and laboratory data related to infection. Patient level of infection was defined using the Weighted Level of Pulmonary Infection Tool, which was constructed for this study. Three categories of aseptic type emerged (clean, sterile, and mixed) because existing tracheotomy care procedures did not fall into one of the two hypothesized types. Data were analyzed using a maximum likelihood approach to mixed model analysis of variance or covariance. The findings indicated significant differences among the three procedures with laboratory, but not clinical, data. Laboratory data supported practicing clean procedures as those associated with the least postoperative infection.