The views of health care professionals about selective decontamination of the digestive tract: An international, theoretically informed interview study

• Published in: Journal of critical care 2014-08, Vol.29 (4), p.634-640
• Main Authors: Duncan, Eilidh M., PhD, Cuthbertson, Brian H., MB, ChB, MD, FRCA, Prior, Maria E., PhD, Marshall, Andrea P., RN, PhD, Wells, Elisabeth C., PhD, Todd, Laura E., BA, MSc, Bolsover, Denise, MSc, Newlands, Rumana S., BA, MSc, Webster, Fiona, PhD, Rose, Louise, RN, PhD, Campbell, Marion K., BSc (Hons), MSc, PhD, Bellingan, Geoff, Seppelt, Ian M., MB BS, BSc (Med), Francis, Jill J., PhD
• Format: Article
• Language: English
• Subjects: Adult; Antibiotic prophylaxis; Antibiotic Prophylaxis - methods; Antibiotic Prophylaxis - psychology; Attitude of Health Personnel; Australia; Canada; Content analysis; Critical Care; Cross Infection - prevention & control; Decision Making; Decontamination; Delphi Technique; Drug Resistance, Microbial; Female; Gastrointestinal Tract - microbiology; Health Knowledge, Attitudes, Practice; Hospitals; Humans; Intensive care; Intensive care unit; Intensive Care Units; Linguistics; Male; New Zealand; Physicians; Primary Prevention - methods; Qualitative Research; Studies; Theoretical domains framework; United Kingdom
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.03.013

Abstract Purpose Selective decontamination of the digestive tract (SDD) as a prophylactic intervention improves hospital-acquired infection and survival rates. Uptake of SDD is low and remains controversial. This study applied the theoretical domains framework to assess intensive care unit clinicians’ views about SDD in regions with limited or no adoption of SDD. Materials and methods Participants were health professionals with “decisional authority” for the adoption of SDD. Semistructured interviews were conducted as the first round of a Delphi study. Views about SDD adoption, delivery, and further SDD research were explored. Directed content analysis of interview data identified subthemes, which informed item development for subsequent Delphi rounds. Linguistic features of interview data were also explored. Results One hundred forty-one participants provided interview data. Fifty-six subthemes were identified; 46 were common across regions. Beliefs about consequences were the most widely elaborated theme. Linguistic features of how participants discussed SDD included caution expressed when discussing the risks and benefits and words such as “worry,” “anxiety,” and “fear” when discussing potential antibiotic resistance associated with SDD. Conclusions We identified salient beliefs, barriers, and facilitators to SDD adoption and delivery. What participants said about SDD and the way in which they said it demonstrated the degree of clinical caution, uncertainty, and concern that SDD evokes.