Selective decontamination of the digestive tract in critically ill patients in Intensive Care Units (the SuDDICU study)

Infections acquired in hospital are a major cause of illness and death for patients and markedly increase health care costs. Critically ill patients who require management in an Intensive Care Unit are particularly susceptible to these infections and do very poorly if they acquire them. Simple interventions such as hand hygiene and improved environmental sanitation can reduce the frequency of these infections but are not by themselves sufficient to prevent them from occurring. One intervention that has gained much interest in the medical literature for reducing infection rates and deaths from hospital acquired infections is selective decontamination of the digestive tract (SDD). SDD involves the application of antibiotic pastes to the mouth, throat and stomach and a short course of antibiotics into a vein. The evidence supporting the use of SDD for preventing infections is strong, with 28 randomised controlled studies in the medical literature. The evidence that it saves lives is less convincing. Health care professionals in the UK have held back from using SDD, possibly due to fears of the effects of overuse of antimicrobials on the frequency of infections with microorganisms such as MRSA and Clostridium difficile and uncertainty as to how the existing evidence applies to UK practice. The proposed research is designed to understand why SDD has not been fully implemented into Intensive Care practice. It may be that the key stakeholders believe that further large studies need to be carried out to determine the role of SDD in UK practice where infections with multi-resistant organisms are common. But since there are so many factors that may affect clinicians' decisions about whether to use this controversial therapy, we need to: (i) understand the reasons clinicians have for not implementing SDD to date; (ii) understand the barriers to implementation of this preventive treatment; and (iii) identify what further information is required before full scale clinical implementation would be considered appropriate.