Selective decontamination of the digestive tract in critically ill patients treated in intensive care units: A mixed-methods feasibility study (the SuDDICU study)

Health Technology Assessment

Volumn 18, Issue 25, 2014, Pages 1-169

  Francis, Jill J ^a,b,c   Duncan, Eilidh M ^a,b   Prior, Maria E ^a,b   MacLennan, Graeme S ^b   Dombrowski, Stephan U ^b,d   Bellingan, Geoff ^e   Campbell, Marion K ^b   Eccles, Martin P ^f   Rose, Louise ^g   Rowan, Kathryn M ^h   Shulman, Rob ^e   Wilson, A Peter R ^e   Cuthbertson, Brian H ⁱ  

^a UNIVERSITY OF ABERDEEN   (United Kingdom)

^b UNIVERSITY OF ABERDEEN   (United Kingdom)

^c CITY UNIVERSITY   (United Kingdom)

^d UNIVERSITY OF STIRLING   (United Kingdom)

^e UNIVERSITY COLLEGE HOSPITAL   (United Kingdom)

^f NEWCASTLE UNIVERSITY   (United Kingdom)

^g UNIVERSITY OF TORONTO   (Canada)

^h King's College London   (United Kingdom)

ⁱ SUNNYBROOK RESEARCH INSTITUTE   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIBIOTIC AGENT; ANTIINFECTIVE AGENT;

ADMINISTRATIVE PERSONNEL; ANTIBIOTIC RESISTANCE; ARTICLE; ASEPSIS; CONSULTATION; COST EFFECTIVENESS ANALYSIS; CRITICALLY ILL PATIENT; DISEASE PREDISPOSITION; EVIDENCE BASED MEDICINE; FEASIBILITY STUDY; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE PLANNING; HEALTH CARE POLICY; HOSPITAL INFECTION; HUMAN; INFECTION CONTROL; INFECTION PREVENTION; INTENSIVE CARE; INTENSIVE CARE UNIT; LENGTH OF STAY; MEDICAL STAFF; MICROBIOLOGY; MORTALITY; ONLINE SYSTEM; OUTCOME ASSESSMENT; PATIENT CARE; PHARMACIST; PNEUMONIA; RANDOMIZED CONTROLLED TRIAL (TOPIC); RISK BENEFIT ANALYSIS; SELECTIVE DECONTAMINATION OF THE DIGESTIVE TRACT; SEMI STRUCTURED INTERVIEW; TELEPHONE INTERVIEW; TREATMENT DURATION; UNITED KINGDOM; CRITICAL ILLNESS; CROSS INFECTION; DELPHI STUDY; FEMALE; GASTROINTESTINAL TRACT; HEALTH CARE SURVEY; HEALTH PERSONNEL ATTITUDE; MALE; MIDDLE AGED; NURSING STAFF; PROCEDURES; PSYCHOLOGY; QUALITATIVE RESEARCH; WASTE MANAGEMENT;

ANTI-BACTERIAL AGENTS; ATTITUDE OF HEALTH PERSONNEL; CRITICAL ILLNESS; CROSS INFECTION; DECONTAMINATION; DELPHI TECHNIQUE; FEASIBILITY STUDIES; FEMALE; GASTROINTESTINAL TRACT; GREAT BRITAIN; HEALTH CARE SURVEYS; HUMANS; INTENSIVE CARE UNITS; MALE; MEDICAL STAFF, HOSPITAL; MIDDLE AGED; NURSING STAFF, HOSPITAL; QUALITATIVE RESEARCH; RANDOMIZED CONTROLLED TRIALS AS TOPIC;

EID: 84900298380     PISSN: 13665278     EISSN: 20464924     Source Type: Journal    
DOI: 10.3310/hta18250     Document Type: Article

References (69)

1. Cuthbertson BH, Francis J, Campbell MK, MacIntyre L, Seppelt I, Grimshaw J. A study of the perceived risks, benefits and barriers to the use of SDD in adult critical care units (The SuDDICU study). Trials 2010; 11: 117. http://dx. doi. org/10. 1186%2F1745-6215-11-117.
2. Healthcare Improvement Scotland. The Scottish Patient Safety Programme. 2010. URL: www. patientsafetyalliance. scot. nhs. uk/programme (accessed April 2012).
3. Institute of Healthcare Improvement. Institute of Healthcare Improvement. 2012. URL: www. ihi. org/explore/HAI/Pages/default. aspx (accessed December 2013).
4. Liberati A, D'Amico R, Pifferi S, Torri V, Brazzi L, Parmelli E. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev 2009; 4: CD000022. http://dx. doi. org/10. 1002%2F14651858. CD000022. pub2.
5. de Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009; 360: 20-31. http://dx. doi. org/10. 1056%2FNEJMoa0800394.
6. Silvestri L, van Saene HK, Milanese M, Gregori D, Gullo A. Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized, controlled trials. J Hosp Infect 2007; 65: 187-203. http://dx. doi. org/10. 1016%2Fj. jhin. 2006. 10. 014.
7. Hurley JC. Prophylaxis with enteral antibiotics in ventilated patients: selective decontamination or selective cross-infection? Antimicrob Agents Chemother 1995; 39: 941-7. http://dx. doi. org/10. 1128%2FAAC. 39. 4. 941.
8. Hurley JC. Paradoxical ventilator associated pneumonia incidences among selective digestive decontamination studies versus other studies of mechanically ventilated patients: benchmarking the evidence base. Crit Care 2011; 15: R7. http://dx. doi. org/10. 1186%2Fcc9406.
9. Bastin AJ, Ryanna KB. Use of selective decontamination of the digestive tract in United Kingdom intensive care units. Anaesthesia 2009; 64: 46-9. http://dx. doi. org/10. 1111%2Fj. 1365-2044. 2008. 05676. x.
10. Shah R, Louw J, Veenith T. National survey on current practice of use of selective digestive decontamination in the United Kingdom. Crit Care 2008; 12: 7. http://dx. doi. org/10. 1186% 2Fcc6228.
11. Wunderink RG. Welkommen to our world: emergence of antibiotic resistance with selective decontamination of the digestive tract. Am J Respir Crit Care Med 2010; 181: 426-7. http://dx. doi. org/10. 1164%2Frccm. 200912-1821ED.
12. Ochoa-Ardila ME, García-Cañas A, Gómez-Mediavilla K, González-Torralba A, Alía I, García-Hierro P, et al. Long-term use of selective decontamination of the digestive tract does not increase antibiotic resistance: a 5-year prospective cohort study. Intensive Care Med 2011; 37: 1458-65. http://dx. doi. org/10. 1007%2Fs00134-011-2307-0.
13. Oostdijk EAN, Bonten M. Intestinal colonization with Gram-negative bacteria and subsequent ICU-acquired bacteraemia during selective digestive decontamination. Clin Microbiol Infect 2010; 16(Suppl.): S90.
14. Oostdijk EAN, De Smet AMGA, Blok HEM, Thieme Groen ES, Van Asselt GJ, Benus RFJ, et al. Ecological effects of selective decontamination on resistant gram-negative bacterial colonization. Am J Respir Crit Care Med 2010; 181: 452-7. http://dx. doi. org/10. 1164%2Frccm. 200908-1210OC.
15. Rocha LA, Martin MJ, Pita S, Paz J, Seco C, Margusino L, et al. Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract. A randomized, double blind, placebo-controlled study. Intensive Care Med 1992; 18: 398-404. http://dx. doi. org/10. 1007%2FBF01694341.
16. Ulrich C, Harinck-de Weerd JE, Bakker NC, Jacz K, Doornbos L, de Ridder VA. Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intensive Care Med 1989; 15: 424-31. http://dx. doi. org/10. 1007%2FBF00255597.
17. Winter R, Humphreys H, Pick A, MacGowan AP, Willatts SM, Speller DCE. A controlled trial of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection. J Antimicrob Chemother 1992; 30: 73-87. http://dx. doi. org/10. 1093%2Fjac%2F30. 1. 73.
18. Silvestri L, Petros AJ, De La Cal MA, Visintin S. Selective digestive decontamination. Why are intensivists more 'resistant' than microorganisms? Minerva Anestesiol 2011; 77: 212-19.
19. Zandstra DF, Petros AJ, Taylor N, Silvestri L, de la Cal MA, van Saene HKF. Withholding selective decontamination of the digestive tract from critically ill patients must now surely be ethically questionable given the vast evidence base. Crit Care 2010; 14: 443. http://dx. doi. org/10. 1186% 2Fcc9255.
20. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005; 14: 26-33. http://dx. doi. org/10. 1136%2Fqshc. 2004. 011155.
21. Francis JJ, O'Connor D, Curran J. Theories of behaviour change synthesised into a set of theoretical groupings: introducing a thematic series on the Theoretical Domains Framework. Implement Sci 2012; 7: 35. http://dx. doi. org/10. 1186%2F1748-5908-7-35.
22. National Patient Safety Agency. PSG002: Technical Patient Safety Solutions for Ventilator-Associated Pneumonia in Adults: Guidance. London: National Institute for Health and Care Excellence; 2009.
23. Craig P, Dieppe P, Macintyre S, Mitchie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: 979-83. http://dx. doi. org/10. 1136%2Fbmj. a1655.
24. Michie S, Johnston M. Changing clinical behaviour by making guidelines specific. BMJ 2004; 328: 343-5. http://dx. doi. org/10. 1136%2Fbmj. 328. 7435. 343.
25. Michie S, Lester K. Words matter: Increasing the implementation of clinical guidelines. Qual Saf Health Care 2005; 14: 367-70. http://dx. doi. org/10. 1136%2Fqshc. 2005. 014100.
26. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 2008; 148: 295-309. http://dx. doi. org/10. 7326%2F0003-4819-148-4-200802190-00008.
27. Silvestri L, van Saene HK, Zandstra DF, Marshall JC, Gregori D, Gullo A. Impact of selective decontamination of the digestive tract on multiple organ dysfunction syndrome: systematic review of randomized controlled trials. Crit Care Med 2010; 38: 1370-6.
28. Stoutenbeek CP, van Saene HK, Miranda DR, Zandstra DF. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med 1984; 10: 185-92. http://dx. doi. org/10. 1007%2FBF00259435.
29. Shibli AB, Milbrandt EB, Baldisseri M. Dirty mouth? Should you clean it out? Decontamination for the prevention of pneumonia and mortality in the ICU. Crit Care 2010; 14: 314. http://dx. doi. org/10. 1186%2Fcc9048.
30. Zandstra DF, Petros AJ, Silvestri L, De La Cal MA, Taylor N, Damjanovic V, et al. Selective decontamination of the digestive tract: selectivity is not required. Intensive Care Med 2010; 36: 1783-4. http://dx. doi. org/10. 1007%2Fs00134-010-1945-y.
31. Jongerden IP, de Smet AM, Kluytmans JA, te Velde LF, Dennesen PJ, Wesselink RM, et al. Physicians' and nurses' opinions on selective decontamination of the digestive tract and selective oropharyngeal decontamination: a survey. Crit Care 2010; 14: R132. http://dx. doi. org/10. 1186% 2Fcc9180.
32. Yin RK. Case Study Research, Design and Methods. 3rd edn. London: Sage Publications Ltd; 2003.
33. Ritchie J, Lewis J, Elam G. Designing and Selecting Samples. In Ritchie J, Lewis J, editors. Qualitative Research Practice: A Guide for Social Science Students and Researchers. 1st edn. London: Sage Publications Ltd; 2003. pp. 77-108.
34. Ritchie J. The Applications of Qualitative Methods to Social Research. In Ritchie J, Lewis J, editors. Qualitative Research Practice. London: Sage Publications Ltd; 2003. pp. 24-46.
35. Krippendorff K. Content Analysis: An Introduction to its Methodology. 2nd edn. Thousand Oaks, CA: Sage Publications Ltd; 2004.
36. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In Bryman A, Burgess R, editors. Analysing Qualitative Data. London: Routledge; 1994. pp. 173-95.
37. Rogers EM. Diffusion of Innovations. New York, NY: Free Press; 1983.
38. Jackson T, van Teijlingen E, Bruce J. Light retrograde massage for the treatment of post-stroke upper limb oedema: clinical consequences using the Delphi technique. Br J Occup Ther 2012; 75: 549-54.
39. Kennie-Kaulbach N, Farrell B, Ward N, Johnston S, Gubbels A, Eguale L, et al. Pharmacist provision of primary health care: a modified Delphi validation of pharmacists' competencies. BMC Fam Pract 2012; 13: 27. http://dx. doi. org/10. 1186%2F1471-2296-13-27.
40. Karamitri I, Bellali T, Galanis P, Kaitelidou D. The accessibility of vulnerable groups to health services in Greece: a Delphi study on the perceptions of health professionals. Int J Health Plan Manage 2013; 28: 35-47. http://dx. doi. org/10. 1002%2Fhpm. 2115.
41. Dalkey NC. The Delphi Method: An Experimental Study of Group Opinion. Santa Monica, CA: RAND Corporation; 1969.
42. Park RE, Fink A, Brook RH, Chassin MR, Kahn KL, Merrick NJ, et al. Physician ratings of appropriate indications for three procedures: theoretical indications vs indications used in practice. Am J Public Health 1989; 79: 445-7. http://dx. doi. org/10. 2105%2FAJPH. 79. 4. 445.
43. van Teijlingen E, Pitchford E, Bishop C, Russell E. Delphi method and nominal group techniques in family planning and reproductive health research. J Fam Plan Reprod Health Care 2006; 32: 249-52. http://dx. doi. org/10. 1783%2F147118906778586598.
44. Dalkey NC, Helmer O. An experimental application of the Delphi method to the use of experts. Manage Sci 1963; 9: 458-67. http://dx. doi. org/10. 1287%2Fmnsc. 9. 3. 458.
45. Akins RB, Tolson H, Cole BR. Stability of response characteristics of a Delphi panel: application of bootstrap data expansion. BMC Med Res Method 2005; 5: 37.
46. Francis JJ, Stockton C, Eccles MP, Johnston M, Cuthbertson BH, Grimshaw JM, et al. Evidence-based selection of theories for designing behaviour change interventions: using methods based on theoretical construct domains to understand clinicians' blood transfusion behaviour. Br J Health Psy 2009; 14: 625-46. http://dx. doi. org/10. 1348%2F135910708X397025.
47. Higgins ET, King G. Accessibility of Social Constructs: Information Processing Consequences of Individual and Contextual Variability. In Cantor N, Kihlstrom J, editors. Cognition, Social Interaction, and Personality. Hillsdale, NJ: Erlbaum; 1981. pp. 69-121.
48. Fishbein M. Attitude and the Prediction of Behavior. In Fishbein M, editor. Readings in Attitude Theory and Measurement. New York, NY: Wiley; 1967. pp. 477-92.
49. Ajzen I. The theory of planned behavior. Organ Behav Hum Dec 1991; 50: 179-211. http://dx. doi. org/10. 1016%2F0749-5978%2891%2990020-T.
50. Fleuren M, Wiefferink K, Paulussen T. Determinants of innovation within healthcare organizations: literature review and Delphi study. Int J Quality Health Care 2004; 16: 107-23.
51. Winters JMW, Story MF, Barnekow K, Premo B, Kailes JI, Schwier E, et al. Problems with medical instrumentation experienced by patients with disabilities. Med Syst Rehab 2004; 5: 1778-82. http://dx. doi. org/10. 1177%2F154193120404801532.
52. Dyson J, Lawton R, Jackson C, Cheater F. Does the use of a theoretical approach tell us more about hand hygiene behaviour? The barriers and levers to hand hygiene. J Infect Prevent 2011; 12: 17-24. http://dx. doi. org/10. 1177%2F1757177410384300.
53. Jones J, Hunter D. Using the Delphi and Nominal Group Technique in Health Services Research. In Pope C, Mays N, editors. Qualitative Research in Health Care. 2nd edn. Boston, MA: Blackwell Publishing; 2000. pp. 40-9.
54. Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles ME, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health 2010; 25: 1229-45. http://dx. doi. org/10. 1080%2F08870440903194015.
55. Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol 2008; 57: 660-80. http://dx. doi. org/10. 1111%2Fj. 1464-0597. 2008. 00341. x.
56. Weiner B. An attributional theory of achievement motivation and emotion. Psychol Rev 1985; 92: 548-73. http://dx. doi. org/10. 1037%2F%2F0033-295X. 92. 4. 548.
57. Campbell SM, Shield T, Rogers A, Gask L. How do stakeholder groups vary in a Delphi technique about primary mental health care and what factors influence their ratings? Qual Saf Health Care 2004; 13: 428-34. http://dx. doi. org/10. 1136%2Fqhc. 13. 6. 428.
58. Holey EA, Feeley JL, Dixon J, Whittaker VJ. An exploration of the use of simple statistics to measure consensus and stability in Delphi studies. BMC Med Res Methodol 2007; 7. http://dx. doi. org/10. 1186%2F1471-2288-7-52.
59. von der Gracht HA. Consensus measurement in Delphi studies: review and implications for future quality assurance. Technol Forecast Soc Change 2012; 79: 1525-36.
60. Komorita SS. Attitude content, intensity and the neutral point on a Likert scale. J Soc Psychol 1963; 61: 327-34. http://dx. doi. org/10. 1080%2F00224545. 1963. 9919489.
61. Francis JJ, Eccles MP, Johnston M, Walker A, Grimshaw J, Foy R, et al. Constructing Questionnaires Based on the Theory of Planned Behaviour. A Manual for Health Services Researchers. University of Newcastle upon Tyne: Centre for Health Services Research; 2004.
62. Burns KEA, Duffett M, Kho ME, Meade MO, Adhikari NKJ, Sinuff T, et al. A guide for the design and conduct of self-administered surveys of clinicians. Can Med Assoc J 2008; 179: 245-52. http://dx. doi. org/10. 1503%2Fcmaj. 080372.
63. Intensive Care Society. ICS State of the Art Conference. London, 12-14 December 2011. URL: www. ics. ac. uk/ics-homepage/events/ics-past-meetings-events/state-of-the-art-meeting-2011/(accessed 11 December 2013).
64. Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI). Antimicrobial Stewardship: 'Start Smart-Then Focus'. England: Department of Health; 2011. URL: www. gov. uk/government/uploads/system/uploads/attachment_data/file/215308/dh_131181. pdf (accessed December 2013).
65. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004; 8(6).
66. Eccles MP, Mittman B. Welcome to Implementation Science. Implement Sci 2006; 1: 1.
67. Carr ECJ, Worth A. The use of the telephone interview for research. Nursing Times Res 2001; 6: 511-24. http://dx. doi. org/10. 1177%2F136140960100600107.
68. Oostdijk EAN, Wittekamp HJ, Brun-Buisson C, Bonten MJM. Selective decontamination in European intensive care patients. Intensive Care Med 2012; 38: 533-8. http://dx. doi. org/10. 1007% 2Fs00134-012-2488-1.
69. Davidson KW, Goldstein M, Kaplan RM, Kaufmann PG, Knatterud GL, Orleans CT, et al. Evidence-based behavioral medicine: what is it and how do we achieve it? Ann Behav Med 2003; 26: 161-71. http://dx. doi. org/10. 1207%2FS15324796ABM2603_01.