SuDDICU Project
SuDDICU Project Launch
June 7th 2010
Health Services Research Unit
University of Aberdeen
HSRU is funded by the Chief Scientist Office of the Scottish Government Health Directorates.
The author accepts full responsibility for this talk.
Brief overview
What ‘s the SuDDICU project again?
Health Services Research Unit
Background
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The Problem:
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Hospital Acquired Infections
(HAIs) are major clinical problem.
HAIs have severe consequences
in ICU patients.
The Procedure:
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Selective Decontamination of the
Digestive (SDD) tract is used to
prevent HAIs and mortality.
SDD is the application of topical
non-absorbable antibiotics to the
throat and stomach and a short
course of intravenous antibiotics.
Health Services Research Unit
Background
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The Evidence:
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Effectiveness: Meta-analyses show that SDD is effective in
reducing HAIs and, in some cases, mortality.
Implementation: Despite favourable evidence, SDD is not used
frequently – 10-15 ICUs in the UK.
Potential Issues:
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SDD too complex
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SDD evidence inadequate
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behavioural problem
e.g. not generalisable, gaps in intervention designs
SDD counterintuitive
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fear of multi-resistant organisms
Health Services Research Unit
Research Questions
1.
2.
3.
4.
5.
6.
7.
8.
What are the clinical and behavioural components of SDD?
How has SDD been implemented and delivered into practice?
What are stakeholders’ views on consequences of SDD?
What are stakeholders’ views on barriers to implementing SDD?
What are stakeholders’ views on validity & adequacy of evidence?
What are the current SDD practices and intentions of intensivists &
microbiologists?
If there are uncertainties in the evidence base, what trial design(s)
and interventions would be preferred to address these?
What are the likely challenges in a large multi-national RCT of
SDD?
Health Services Research Unit
1.
2.
STAGE
What are the clinical and behavioural components of SDD?
How has SDD been implemented and delivered into practice?
3. What are stakeholders’ views on consequences of SDD?
4. What are stakeholders’ views on barriers to implementing SDD?
5. What are stakeholders’
views
validity & adequacy of
CASE STUDIES
OF on
UNITS
Complete by
evidence?
1
DELIVERING SDD
SuDDICU Overview
August 2010
STAGE 2
DELPHI STUDY OF KEY
STAKEHOLDERS’ SDD BELIEFS
STAGE 3
NATIONWIDE SURVEY OF CURRENT
SDD PRACTICE AND BELIEFS
6.
STAGE 4
7.
8.
June 2010 August 2011
April 2011 –
September 2011
What are
the current SDD practices
and intentions of intensivists
& 2011
September
SEMI-STRUCTURED
INTERVIEWS
microbiologists?
WITH INTENSIVE CARE TRIALISTS
November 2011
If there are uncertainties in the evidence base, what trial design(s) and
interventions would be preferred to address these?
What are the likely challenges in a large multi-national
Health Services Research Unit
RCT of SDD?
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Stage 1: Case Studies
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Design: Observational and interview study
Procedures:
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Sample:
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Observation of SDD delivery
Interviews with stakeholders
Clinical lead
Microbiologist
Pharmacist
ICU nurse
2 ICUs currently
delivering SDD
involved in SDD
implementation
and/or delivery
Target n = 2 each
Outcomes:
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Behavioural observation,
Interview responses,
SDD relevant materials and documents
Health Services Research Unit
Stage 1: Case Studies
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Analysis:
• Behavioural Analysis of Complex Clinical
Procedure
Person 1
Time 1
Time 2
Person 2
Person 4
Action 1
Action 2, 3, 4
Time 3
Time 4
Person 3
Action 5, 6, 7
Action 8
Action 9, 10
Action 11
Health Services Research Unit
Stage 1: Case Studies
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Analysis:
• Behavioural Analysis of Complex Clinical
Procedure
Doctor
SDD decision
Pre delivery
Pharmacist
Microbiologist
Selects patient
Orders and prepares
antibiotics
Pick up drugs,
administer SDD
SDD delivery
Post delivery
ICU nurse
Monitoring of
antibiotics stocks
Disposes of
leftovers
Monitor ICU
environment
Health Services Research Unit
Delphi
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Goals of the Delphi interview:
• Access diverse (rather than representative)
expert opinions/beliefs on SDD
• Develop a questionnaire that includes the key
issues and opinions to be able to assess
representative in the next stage of the project
(i.e. Stage 3: Nationwide Questionnaire Study).
Tap into relevant theoretical domains for three
specific behaviours:
1.
2.
3.
Providing SDD
Participating in an effectiveness trial
Participating in an implementation trial
Health Services Research Unit
Skills
Social/Role
Identity
Knowledge
Beliefs about
consequences
Motivation and
goals
Beliefs about
capabilities
Theory
Environmental
context and
resources
Memory,
attention and
decision
processes
Behavioural
regulation
Social
influences
Emotion
Health Services Research Unit
Michie et al., 2005
Stage 2: Delphi Survey
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Design:
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Procedures:
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4 Delphi ‘rounds’
Semi-structured one-to-one telephone interviews
Feedback on interviews via email questionnaire
Feedback and revisions via email questionnaire
International feedback and revisions via email
questionnaire
Sample:
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Clinical lead
Microbiologist
Pharmacist
ICU nurse
stakeholders involved in SDD
implementation and/or delivery
Target n = 10 each
Health Services Research Unit
Stage 3: Nationwide Survey
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Design:
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Nationwide survey (based on responses from Delphi)
Sample:
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Clinical leads (n~2000)
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Microbiologists (n~180)
Procedures:
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One large-scale postal questionnaire
Analysis:
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descriptive statistical methods
statistical prediction techniques
Health Services Research Unit
Stage 4: Trialists interviews
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Design:
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Semi-structured interviews
Sample:
• International trialists (published authors of large
randomised trials in critical care, target n = 10)
Procedures:
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One-to-one telephone administered interview
Analysis:
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Transcripts analysed using content analysis
Health Services Research Unit
Funding update
What ‘s the funding situation?
Health Services Research Unit
SuDDICU International
SuDDICU protocol adopted in 3 countries:
1. UK
2. Canada
3. Australia/New Zealand
Health Services Research Unit
The
Geoff
Marion
Brian
Stephan
Martin
Jill
Marie
Graeme
Craig
Louise
Kathy
Ian
Rob
Peter
Bellingan
Campbell
Cuthbertson
Dombrowski
Eccles
Francis
Johnston
MacLennan
Ramsey
Rose
Rowan
Seppelt
Shulman
Wilson
Team
University College London, UK
University of Aberdeen, UK
Sunnybrook Health Sciences Centre, Canada
University of Aberdeen, UK
Newcastle University, UK
University of Aberdeen, UK
University of Aberdeen, UK
University of Aberdeen, UK
University of Aberdeen, UK
University of Toronto, Canada
Intensive Care National Audit & Research Centre, UK
University of Sydney, Australia
University College Hospital, UK
University College Hospital, UK
Health Services Research Unit
Thank you
Any questions?
Additional feedback, thoughts, or comments please email
Stephan: s.u.dombrowski@abdn.ac.uk
Health Services Research Unit