Infection control in patients undergoing mechanical ventilation: traditional approach versus a new development--selective decontamination of the digestive tract

Abstract

Nosocomial infections are major causes of morbidity and mortality in critically ill patients. Traditional infection control practices focus on preventing infection by controlling patient exposure to microorganisms within the patient's environment. We discuss these practices, along with the factors and organisms responsible for nosocomial infection in the patient undergoing mechanical ventilation. Despite traditional infection control measures, nosocomial infection continues to be a major problem. In recent years evidence has accumulated that points to bacterial colonization of the oropharynx and gastrointestinal tract as a major source of infection. A new technique, selective decontamination of the digestive tract, is being studied extensively for its ability to control colonization of the oral cavity and the gastrointestinal tract. In the technique nonabsorbable topical antibiotics are applied to the oropharynx and instilled into the stomach, and a short course of an intravenous cephalosporin is included. The technique appears a worthwhile addition to traditional infection control measures.