Research
Physicians' and nurses' opinions on selective decontamination of the digestive tract and selective oropharyngeal decontamination: a survey
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* Corresponding author: Irene P Jongerden i.p.jongerden@umcutrecht.nl
1 Department of Intensive Care Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
2 Department of Perioperative and Emergency Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
3 Laboratory for Microbiology and Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK Breda, the Netherlands
4 Department of Intensive Care, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK Dordrecht, the Netherlands
5 Department of Intensive Care, Medical Center Haaglanden, P.O. Box 432, 2501 CK The Hague, the Netherlands
6 Department of Anesthesiology and Intensive Care, St. Antonius Hospital, P.O. Box 2500, 3430 EM Nieuwegein, the Netherlands
7 Department of Intensive Care, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
8 Departments of Internal Medicine and Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, the Netherlands
9 Department of Anesthesiology and Intensive Care, Amphia Hospital, P.O. Box 90158, 4800 RK Breda, the Netherlands
10 Department of Intensive Care, Mesos Medical Center, P.O. box 2500, 3430 EM Nieuwegein, the Netherlands
11 Department of Intensive Care, Rijnstate Hospital, P.O. Box 9555, 6800 TA Arnhem, the Netherlands
12 Department of Intensive Care, Diakonessen Hospital, P.O. Box 80250, 3508 TG Utrecht, the Netherlands
13 Intensive Care Department, Slotervaart Hospital, P.O. Box 90440, 1006 BK Amsterdam, the Netherlands
14 Department of Intensive Care, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
15 Department of Intensive Care, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, the Netherlands
16 Department of Medical Microbiology and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
Critical Care 2010, 14:R132 doi:10.1186/cc9180
Published: 13 July 2010Abstract
Introduction
Use of selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) in intensive care patients has been controversial for years. Through regular questionnaires we determined expectations concerning SDD (effectiveness) and experience with SDD and SOD (workload and patient friendliness), as perceived by nurses and physicians.
Methods
A survey was embedded in a group-randomized, controlled, cross-over multicenter study in the Netherlands in which, during three 6-month periods, SDD, SOD or standard care was used in random order. At the end of each study period, all nurses and physicians from participating intensive care units received study questionnaires.
Results
In all, 1024 (71%) of 1450 questionnaires were returned by nurses and 253 (82%) of 307 by physicians. Expectations that SDD improved patient outcome increased from 71% and 77% of respondents after the first two study periods to 82% at the end of the study (P = 0.004), with comparable trends among nurses and physicians. Nurses considered SDD to impose a higher workload (median 5.0, on a scale from 1 (low) to 10 (high)) than SOD (median 4.0) and standard care (median 2.0). Both SDD and SOD were considered less patient friendly than standard care (medians 4.0, 4.0 and 6.0, respectively). According to physicians, SDD had a higher workload (median 5.5) than SOD (median 5.0), which in turn was higher than standard care (median 2.5). Furthermore, physicians graded patient friendliness of standard care (median 8.0) higher than that of SDD and SOD (both median 6.0).
Conclusions
Although perceived effectiveness of SDD increased as the trial proceeded, both among physicians and nurses, SOD and SDD were, as compared to standard care, considered to increase workload and to reduce patient friendliness. Therefore, education about the importance of oral care and on the effects of SDD and SOD on patient outcomes will be important when implementing these strategies.
Trial registration
ISRCTN35176830.