Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: RGNOSIS: Ecological Effects of Decolonisation Strategies in Intensive Care
Brief Summary: Previous research has shown that applying certain treatments can reduce both the number of infections and the presence of resistant bacteria in the intensive care (ICU) and its patients. These treatments have been used as standard care throughout the world for many years, but they have not been compared to each other yet. The investigators aim to evaluate the effect of 3 different treatments on the occurrence of resistant bacteria and bacterial infections in the ICU and to establish which treatment is the best.

All adult patients undergoing mechanical ventilation are eligible for this study and will receive treatment according to the study scheme. Twice weekly, sputum and rectal samples will be obtained to measure the effects.

All ICU-patients will receive standard treatment, consisting of daily body washing with an antiseptic (chlorhexidine 2%), oral care and a hand-hygiene program for health care workers as endorsed by the WHO. According to 4 different study periods, each participant will receive one of the following extra treatments depending on his or her admission date:

* Standard treatment only (this is the control group)
* Chlorhexidine 1% oral gel, this is an antiseptic.
* Antibiotic mouth paste containing 3 different antibiotics (selective oropharyngeal decontamination, SOD).
* Antibiotic mouth paste and suspension for the stomach and intestines containing 3 different antibiotics (selective digestive decontamination, SDD).

All treatments will be given 4 times daily with the purpose of killing harmful bacteria in the mouth (CHX, SOD,SDD) and digestive tract (SDD).

During the study the investigators will examine the effect of these treatments on:

* the occurrence of blood stream infections with certain bacteria
* cross-transmission of certain bacteria between patients
* presence of these bacteria in the respiratory tract of the patients
* patient survival

Benefits: Previous research has shown that these interventions can reduce infections in intensive care patients.

Risks: The interventions performed (both cultures and treatment) are considered safe and are already given as standard care in many ICUs throughout the world. There is a slight risk that bacteria become resistant to antibiotics: this will be monitored closely during the trial.


Options:
A: Arm Label: povidone iodine; Type: EXPERIMENTAL; Interventions: Drug: povidone iodine | Arm Label: placebo; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo | Intervention Type: DRUG; Name: povidone iodine; Assigned to Arm(s): povidone iodine | Intervention Type: DRUG; Name: Placebo; Assigned to Arm(s): placebo
B: Arm Label: residual gastric volume; Type: OTHER; Interventions: Procedure: monitoring of residual gastric volume | Arm Label: residual gastric volume not monitored; Type: OTHER; Interventions: Procedure: not monitoring of residual gastric volume | Intervention Type: PROCEDURE; Name: monitoring of residual gastric volume; Assigned to Arm(s): residual gastric volume | Intervention Type: PROCEDURE; Name: not monitoring of residual gastric volume; Assigned to Arm(s): residual gastric volume not monitored
C: Arm Label: Arm 1: Usual Care-Active Surveillance; Type: NO_INTERVENTION; Interventions: N/A | Arm Label: Arm 2: Targeted Decolonization; Type: ACTIVE_COMPARATOR; Interventions: Drug: Chlorhexidine bath and nasal mupirocin | Arm Label: Arm 3: Universal Decolonization; Type: ACTIVE_COMPARATOR; Interventions: Drug: Chlorhexidine bath and nasal mupirocin | Intervention Type: DRUG; Name: Chlorhexidine bath and nasal mupirocin; Assigned to Arm(s): Arm 2: Targeted Decolonization, Arm 3: Universal Decolonization
D: Arm Label: Standard care; Type: ACTIVE_COMPARATOR; Interventions: Drug: Chlorhexidine oral care (CHX-Oro), Drug: Selective oropharyngeal decontamination (SOD), Drug: Selective Digestive Decontamination (SDD) | Arm Label: Chlorhexidine oral care (CHX-Oro); Type: EXPERIMENTAL; Interventions: Drug: Chlorhexidine oral care (CHX-Oro) | Arm Label: Selective oropharyngeal decontamination; Type: EXPERIMENTAL; Interventions: Drug: Selective oropharyngeal decontamination (SOD) | Arm Label: Selective digestive decontamination; Type: EXPERIMENTAL; Interventions: Drug: Selective Digestive Decontamination (SDD) | Intervention Type: DRUG; Name: Chlorhexidine oral care (CHX-Oro); Assigned to Arm(s): Chlorhexidine oral care (CHX-Oro), Standard care | Intervention Type: DRUG; Name: Selective oropharyngeal decontamination (SOD); Assigned to Arm(s): Selective oropharyngeal decontamination, Standard care | Intervention Type: DRUG; Name: Selective Digestive Decontamination (SDD); Assigned to Arm(s): Selective digestive decontamination, Standard care

Answer: D