Clinician views on selective decontamination of the digestive tract in mechanically ventilated patients in intensive care units: A survey.

OBJECTIVE

Selective decontamination of the digestive tract (SDD) has been investigated as a strategy to reduce the incidence of ventilator-associated pneumonia (VAP) and other healthcare-associated infections in intensive care unit (ICU) patients receiving mechanical ventilation. There is some evidence to suggest that the use of SDD is associated with a reduction in healthcare-associated infection and mortality; however, the uptake of SDD in ICUs in Australia and New Zealand (ANZ) remains low. To better understand the potential reasons, we designed a questionnaire to gather views from specialists in intensive care medicine, infectious diseases, and medical microbiology.

DESIGN

The study incorporated an online survey.

SETTING AND PARTICIPANTS

An online survey was distributed to specialists in intensive care medicine, infectious diseases, and medical microbiology working in ANZ.

MAIN OUTCOME MEASURES

The main outcome measures are views about SDD and perceived barriers to implementation in ICUs in ANZ.

RESULTS

A total of 103 responses were obtained, of which 55 were from intensive care medicine specialists and the remainder from infectious disease/medical microbiology specialists. No respondents currently used SDD in their hospital ICU. Intensive care medicine specialists self-reported better understanding of the evidence base regarding SDD (P = 0.032) and were more likely to believe that SDD was a safe therapy (P < 0.001) and that it was associated with a reduction in the incidence of VAP (P < 0.001) and ICU mortality (P < 0.001). Infectious disease/medical microbiology specialists were more likely to believe there is currently a lack of evidence of benefit (P < 0.001) and a risk of harm (P < 0.001) associated with SDD.

CONCLUSIONS

Specialists in intensive care medicine had more positive views about use of SDD in ventilated patients than did specialists in infectious diseases/medical microbiology, but no respondents reported using SDD in their clinical practice.