Observational study of current use of selective decontamination of the digestive tract in UK critical care units.
BACKGROUND
Evidence supporting selective decontamination of the digestive tract (SDD) is reasonably strong. We set out to determine use in UK critical care units and to compare patient outcomes between units that do and those that do not use SDD.


METHODS
A total of 250 UK general critical care units were surveyed. Case mix, outcomes, and lengths of stay for admissions to SDD units (with and without an i.v. component) and non-SDD units were compared using data from the Intensive Care National Audit & Research Centre Case Mix Programme database.


RESULTS
A response was received from all the 250 critical care units surveyed. Of these, 13 (5.2%) reported using SDD on some or all admissions, and of these, 3 reported using an i.v. component. Data on 284,690 admissions (April 2008-March 2011) from units reporting to the ICNARC Case Mix Programme (CMP) were included in the analyses. Admissions to SDD (n=196) and non-SDD (n=9) units were a similar case mix with similar infection rates and average lengths of stay in the unit and hospital. There was no difference in risk-adjusted unit or hospital mortality. The rate of unit-acquired infections in blood was significantly lower in SDD units using an i.v. component.


CONCLUSIONS
Use of SDD in UK critical care is very low. The rate of unit-acquired infections in blood was significantly lower in SDD units using an i.v. component, but did not translate into a difference in acute hospital mortality or length of stay. There is a need to better understand the barriers to adoption of SDD into clinical practice and such work is underway.
Intensive Care National Audit & Research Centre (ICNARC), Napier House, 24 High Holborn, London WC1V 6AZ, UK.
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Canter
Intensive Care National Audit & Research Centre (ICNARC), Napier House, 24 High Holborn, London WC1V 6AZ, UK sheila.harvey@icnarc.org.
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Harvey
Intensive Care National Audit & Research Centre (ICNARC), Napier House, 24 High Holborn, London WC1V 6AZ, UK.
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Harrison
Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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Campbell
Intensive Care National Audit & Research Centre (ICNARC), Napier House, 24 High Holborn, London WC1V 6AZ, UK.
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Rowan
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Canada.
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Cuthbertson
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003422:Critical Care / Q000706:statistics & numerical data*; D016208:Databases, Factual; D003666:Decontamination / Q000706:statistics & numerical data*; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology*; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000628:therapy
D000900:Anti-Bacterial Agents
antibacterial agents; critical care; epidemiology; infection