Selective decontamination of the digestive tract: concept and application.

Selective digestive decontamination (SDD) is a prophylactic strategy aimed at preventing or eradicating bacterial overgrowth in the intestinal flora that precedes the development of most infections in the Intensive Care Unit. SDD prevents serious infections, reduces mortality, is cost-effective, has no adverse effects, and its short- or long-term use is not associated with any significant increase in antimicrobial resistance. SDD is one of the most widely evaluated interventions in critically ill patients, yet its use is not widespread. The present article offers a narrative review of the most relevant evidence and an update of the pathophysiological concepts of infection control supporting the use of SDD.

Hospital care for adolescents with cancer in Spain: Needs, resources and organisational model. / Atención hospitalaria a adolescentes con cáncer en España: necesidades, recursos y modelo organizativo.

In Spain, adolescents with cancer are treated in paediatric onco-haematology units or in adult oncologyunits. For this reason, the Spanish Federation of Parents of Children with Cancer carried out 2 surveys, one in 2013 and other in 2014, to determine the differences in provision of psycho-social services to the patients and their relatives between the 2 types of units. Twenty-eight paediatric and 18 adult units provided information. The results showed that the paediatric units were better adapted to the needs of the adolescent and family patients and to Spanish health authority recommendations: more appropriate environment, resources for education and leisure, facilities for parents and relatives. Specialised psycho-social care from psychologists and social workers is insufficient in both cases and the compliance with national and international recommendations is weak. However, specific units for adolescents are starting to be created in Spain, following the experiences in other countries that define the new role of the nurse as an essential linchpin in the care team.

[Effect of selective digestive decontamination on the nosocomial infection and multiresistant microorganisms incidence in critically ill patients]. / Descontaminación selectiva del tubo digestivo: efecto sobre la incidencia de la infección nosocomial y de los microorganismos multirresistentes en enfermos ingresados en unidades de cuidados intensivos.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common complication in mechanically ventilated patients. Other infections related to the use of invasive devices, such urinary tract infections (UTI) and central venous catheter-related bloodstream infections are found in patients admitted in intensive care units (ICU). Selective digestive decontamination (SDD) is a set of manoeuvres (hygiene, topic digestive antimicrobials and short course of systemic antibiotics) aimed at decreasing the incidence of nosocomial infections, mainly VAP, in ICU. The objective of this study was to describe the impact of SDD in the rates of nosocomial infections in an 18-bed medical-surgical ICU. PATIENTS AND METHOD: All patients admitted in the ICU from October 1998 to September 1999 with expected mechanical ventilation for at least 72 h or with an illness where SDD has proven to be efficacious. The infection rates during this period were compared with the infection rates of the period without SDD (October 1997 to September 1998). RESULTS: VAP rates decreased from 12.38 to 3.64 per 1000 days of mechanical ventilation (RR 0.3; CI 95%: 0.16 to 0.53). Urinary tract infection rates decreased form 7.70 to 4.51 per 1000 bladder-catheter days (RR 0.6. CI 95%: 0.37 to 0.93). Central venous catheter related bloodstream infections decreased from 5.92 to 2.73 per 1000 catheter days (RR: 0.5. CI 95%: 0.24 to 0.90). There was no emergence of resistant microorganims when SDD was used. CONCLUSIONS: SDD reduces infection rates in ICU without any significant adverse events.