Respiratory Trials·org

Topic

Infection control

Decolonisation, catheter care, and preventing transmission.

Bundles and checklists built the field's reputation. A five-element catheter bundle cut bloodstream infections by up to 66% and held the gain for 18 months (Keystone ICU) — though it was a before-and-after study, and when the same idea was cluster-randomised with concurrent controls the mortality benefit vanished (CHECKLIST-ICU).

Decolonisation beat screening and isolation: treating everyone reduced MRSA isolates and bloodstream infection more than targeting carriers (REDUCE MRSA). Chlorhexidine bathing alone, in a unit with already low infection rates, did nothing (Noto 2015) — which suggests mupirocin rather than the bath did the work.

Selective digestive decontamination persuaded the Netherlands (de Smet 2009) and nowhere else, because the benefit depends on low background resistance. Tested internationally in 20,000 patients, it did not reduce mortality (SuDDICU).

For ventilator-associated pneumonia, sitting patients up at 45 degrees cut pneumonia fourfold (Drakulovic 1999) — and 45 degrees turned out to be unachievable, with the 28 degrees actually delivered preventing nothing (van Nieuwenhoven 2006). A single dose of ceftriaxone after intubation does reduce early pneumonia in brain-injured patients (PROPHY-VAP).

Decolonisation strategy

Trial Year Therapy Effect Finding
Noto 2015 2015 Chlorhexidine bathing Daily chlorhexidine bathing did not reduce healthcare-associated infections
REDUCE MRSA 2013 Universal decolonisation Decolonising everyone beat screening and isolating carriers

Positioning to prevent pneumonia

Trial Year Therapy Effect Finding
van Nieuwenhoven 2006 2006 Semirecumbent position 45 degrees proved unachievable in practice, and the 28 degrees actually delivered prevented nothing
Drakulovic 1999 1999 Semirecumbent position Sitting ventilated patients up at 45 degrees cut nosocomial pneumonia fourfold

Selective decontamination

Trial Year Therapy Effect Finding
SuDDICU 2026 Selective digestive decontamination Selective digestive decontamination did not reduce mortality in a large international trial
de Smet 2009 2009 Selective digestive or oropharyngeal decontamination Selective decontamination reduced adjusted mortality in a low-resistance setting

Preventing catheter infection

Trial Year Therapy Effect Finding
Keystone ICU before-and-after study 2006 Evidence-based catheter bundle A simple five-step bundle cut catheter bloodstream infections by two thirds and kept them down

Preventing ventilator-associated pneumonia

Trial Year Therapy Effect Finding
PROPHY-VAP 2024 Single-dose ceftriaxone One dose of ceftriaxone after intubation prevented early pneumonia in brain-injured patients

Key references

Guidelines, standards and reviews for this topic.