Clinical PotpourriThe views of health care professionals about selective decontamination of the digestive tract: An international, theoretically informed interview study☆,☆☆
Section snippets
Background
Selective decontamination of the digestive tract (SDD) is an intervention used in intensive care units (ICUs). Evidence from randomized controlled trials (RCTs) suggests that it has significant potential to reduce hospital-acquired infections (HAIs). Selective decontamination of the digestive tract involves the prophylactic application of topical nonabsorbable antibiotics to the oropharynx and stomach with a short course of intravenous antibiotics. Despite much interest over many years and a
Methods
This study was part of the multinational SuDDICU mixed-methods research program. Full study design and methods are published elsewhere [12]. In brief, the SuDDICU collaboration is an international investigator-initiated independent research collaboration that has assessed the evidence base and outcomes for the use of SDD and the risks, benefits, and barriers to its use.
Participant characteristics
Two hundred forty-six clinicians were invited to participate, and 141 (from 84 hospitals) accepted (57% response rate). Participants’ mean age and years of experience were comparable across the 3 regions (Table 2).
The results are presented in 2 sections below relating to “what” and “how” participants discussed SDD. After this, we present results of the item generation process for the quantitative questionnaire rounds of the Delphi study.
What participants said about SDD
An overview of subtheme content is given below under the
Discussion
This study provides a qualitative perspective on ICU health care professionals’ views about SDD in regions where SDD is not commonly used. Participants’ views indicated a number of barriers to the adoption of SDD; the most widely discussed being in the TDF domain “beliefs about consequences.” A great many of the subthemes were held in common across all 3 geographic regions. Therefore, there appeared to be substantial consistency in the views raised about SDD across these 3 distinct regions.
The
Conclusions
This is the first time that the TDF has been used within a Delphi study and to explore an intervention when there is uncertainty about the evidence base and no clear guidelines on action. Using the framework resulted in identification of salient beliefs and the barriers and facilitators to adoption and implementation of SDD. Examining both what participants said about SDD and the way in which they said it was instructive and demonstrated clearly the degree of clinical caution, uncertainty, and
Acknowledgments
This project was funded in the United Kingdom by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme and will be published in full in the HTA journal series. Visit the HTA programme website for more details www.hta.ac.uk/2299. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health. We acknowledge the support of a Canadian Institutes of Health Research operating grant that
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Use of selective decontamination of the digestive tract in United Kingdom intensive care units
Anaesthesia
A study of the perceived risks, benefits and barriers to the use of SDD in adult critical care units (The SuDDICU study)
Trials
Cited by (16)
Selective digestive decontamination in critically ill children: A survey of Canadian providers
2017, Journal of Critical CareCitation Excerpt :SDD has been extensively studied in adult populations, with a sizable mortality benefit documented among critically ill adults in large randomized trials and meta-analyses, and no evidence of worsening antibiotic resistance [10-14]. However, the use of these decontamination protocols has been limited, even within adult critical care units, due to concerns among clinicians about driving antibiotic resistance, especially in regions with high prevalence of resistant organisms [15-17]. In children, there is limited evidence, mostly generated in Europe, suggesting SDD reduces the incidence of hospital-acquired pneumonia [18].
Intensive care nurses on social media: An exploration of knowledge exchange on an intensive care virtual community of practice
2020, Journal of Clinical Nursing
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Authors’ contributions: EMD conducted the UK interviews and analysis, contributed to the international analysis, and led on the writing of the manuscript. BHC conceived of the study, participated in its design and coordination, contributed to the interpretation of the data, and participated in drafting the manuscript. MEP conducted the UK interviews and analysis, contributed to the international analysis, and participated in drafting the manuscript. APM conducted the Australian/New Zealand interviews and analysis and participated in revising the manuscript. ECW and LET conducted the Canadian interviews and analysis and participated in revising the manuscript. DB conducted the UK analysis and participated in revising the manuscript. RSN and FW conducted the Canadian analysis and participated in revising the manuscript. LR, MKC, GB, and IMS conceived of the study, participated in its design and coordination, contributed to the interpretation of the data, and participated in reviewing the manuscript. JJF conceived of the study, led its design and coordination, contributed to the analysis and interpretation of the data, and participated in drafting and reviewing of the manuscript. All authors approved the final manuscript.
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The SuDDICU collaboration is a collaboration of the Canadian Critical Care trials group and the Australia and New Zealand Intensive Care Society Clinical Trials Group and is supported by the both organizations.