The hidden reservoir of SDD users

A next little piece of evidence on the effectiveness of Selective Digestive Decontamination (SDD). Nienke Plantinga pooled all data from the 16,528 patients that had been enrolled in a randomized evaluation of SDD since 25 years, in an Individual Patient Data meta-analysis, see. Not surprisingly SDD was associated with better survival in intensive care unit (ICU), as it was in most of the individual studies. Yet, the pooled etsimates also provide more certainty (and precision) on the beneficical effects of SDD on hospital survival and failed to confirm previous suggestions that SDD was more effective in surgical than in medical patients. Continue reading

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Dead bacteria cannot mutate

As a young and angry PhD student I was confronted with the concept of Selective Digestive Decontamination (SDD). That was in the early nineties (previous millennium). Coming from the field of microbiology I expected that SDD would increase antibiotic resistance. It were intensivists that told me not to worry: “antibiotics in SDD kill bacteria and dead bacteria cannot mutate”. They may have been right, suggests a new study. Continue reading

Agent Orange in spinal surgery

This week I learned from an orthopaedic surgeon that randomized trials were something that could be of use in “pharmaceutical sciences”, but that it is well-known that in the “surgical science” retrospective analyses are better for deriving evidence. We came to this when discussing the benefits of powdered vancomycin in the wounds of spinal surgery. Apparently this is something “all spinal orthopaedics do”, because it works so good. Continue reading

WHO guideline on SSI prevention: more clear than feasible?

The WHO guideline for SSI prevention was launched as if it were the iPhone8. I immediately went looking for what I think is the intervention with the strongest evidence: pre-op nasal mupirocine and CHX bathing, see why here. After an interesting read I’m pleased that the guideline is clear, but I missed an evaluation on feasibility and the evidence for simplification is turned around.

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CPE Thrill-seeking

Yesterday I attended a meeting at the Wellcome headquarters in the middle of London. I deliberately exposed myself to several risks: by car from home to Schiphol, by plane to London City and by public transport to the meeting. Each transition harbors a quantifiable risk of ending up in a hospital (accidents, assaults, cardiac events) where there is a quantifiable risk of developing HAI, and I am especially afraid of CPE.

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Everything is in place.. so that’s alright then

8465992771_213dabc72c_zI am always interested in compliance. What makes staff implement an intervention reliably? What makes a patient follow the advice they’ve been given? A new retrospective cohort study purports to look at what factors influence compliance with preoperative regimes aimed at preventing surgical site infection (SSI). The authors were of the opinion that socio-economic group would be a major factor in whether individuals would be compliant with measures that are likely to reduce the risk of SSI, since this has been demonstrated to be the case in chronic health issues such as asthma. Disappointingly the authors stated that the method of determining at adherence is described elsewhere with the accompanying reference to an 4-minute abstract given at a paediatric orthopaedic conference in Toronto in 2013 which, if you weren’t there, you’ve missed it. However they do provide a small amount of detail and of the 2-5 protocol tasks they only mention bathing and decolonisation of those screened.

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Should we throw out the chlorhexidine with the bathwater?

Noto chg

Following hot on the heels of a series of studies showing that daily bathing using chlorhexidine reduces the risk of HCAI, a recent study suggests that chlorhexidine daily bathing does not reduce HCAI. The headline finding is that chlorhexidine bathing did not reduce HCAI. Before throwing out the chlorhexidine with the bathwater, it’s worth considering the limitations of the study.

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