Physicians' and nurses' opinions on selective decontamination of the digestive tract and selective oropharyngeal decontamination: a survey.
BACKGROUND
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.


BACKGROUND
ISRCTN35176830.
Jongerden
Irene P
IP
Department of Intensive Care Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands. i.p.jongerden@umcutrecht.nl
de Smet
Anne Marie G
AM
Kluytmans
Jan A
JA
te Velde
Leo F
LF
Dennesen
Paul J
PJ
Wesselink
Ronald M
RM
Bouw
Martijn P
MP
Spanjersberg
Rob
R
Bogaers-Hofman
Diana
D
van der Meer
Nardo J
NJ
de Vries
Jaap W
JW
Kaasjager
Karin
K
van Iterson
Mat
M
Kluge
Georg H
GH
van der Werf
Tjip S
TS
Harinck
Hubertus I
HI
Bindels
Alexander J
AJ
Pickkers
Peter
P
Bonten
Marc J
MJ
D019072:Antibiotic Prophylaxis / Q000523:psychology; D001291:Attitude of Health Personnel; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control; D003666:Decontamination; D016529:Emergency Nursing; D041981:Gastrointestinal Tract / Q000382:microbiology*; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D009426:Netherlands; D009723:Nurse-Patient Relations; D009960:Oropharynx / Q000382:microbiology*; D010817:Physician-Patient Relations; D010820:Physicians; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016526:Workload