A national survey on current practice of use of selective digestive decontamination in the United Kingdom

Introduction

The incidence of nosocomial pneumonia in patients in intensive care ranges between 7% and 40%, with a crude mortality exceeding 50% [1]. One way to reduce the incidence of ventilator-associated pneumonia in the intensive care is selective digestive decontamination (SDD). In our clinical experience, SDD is not used frequently in the UK, despite its evidence.

Methods

We conducted a telephonic survey and collected data on use of SDD. All ICUs in England were included (256 units) and we obtained a response form 249 units. The average size was 5.8 patients. The response was obtained either from an ICU consultant or a charge nurse in the intensive care. Before we discussed the questionnaire, we assessed the suitability of person answering. We discussed our questionnaire with 73 consultants and 176 charge nurses.

Results

We obtained a response from 249 units out of the 256 units. Only 6% (15 units) out of the 249 units used SDD. In 94% (235) of the units this was not considered for use, and in 4% (12) of the units this was considered but not deemed suitable. In 0.8% (two) of the units it is currently being considered for implementation.

Conclusion

The oropharynx is the major source of potential pathogens that cause lower airway infections. The role of SDD is to eradicate these bacteria from the oropharynx [1]. We found in our telephonic survey that SDD is not used by most of the ICUs in England. The main deterring factors were high frequency of MRSA, drug resistance, lack of incorporation in sepsis bundles, relative disinterest in the drug companies, cost and difficulty in obtaining the preparation.

One of the drawbacks of our survey could have been the fact that we discussed with charge nurses and consultants who were not part of decision-making for the use of SDD in the ICUs. But the bottom line is that SDD is not used in the majority of ICUs.