Ventilator-associated pneumonia (vap) in intensive care unit : the role of vap bundle education in reducing its rates
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Date
2013-04
Authors
Che Ishak, Zahniyah
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Introduction: Awareness and knowledge are important aspects of VAP
prevention program. The participants have fair knowledge in VAP and
VAP prevention. However, being knowledgeable does not assure
implementation of evidence-based guideline, and guidelines adherence
require the readiness to sustain that changed behavior.
Study objective is to determine the effect of VAP-bundle educational
program on nurses’ knowledge, practice, and incidence rate as well as
factors associated with ventilator-associated pneumonia in ICU.
Materials and methods: A prospective study on VAP was conducted in
ICU with two study groups, ICU nurses and patients who are ventilated for
48 hours or more. Nurses who consented were subjected to selfadministered
questionnaire before and after VAP-bundle educational
program. While patient’s data before and after was collected from their
medical records from early 2009 to early 2011. VAP was diagnosed
based on Central for Disease Control and Prevention (CDC). The
definition used for diagnosis was based on clinical and organisms isolated
from tracheal aspirate.
Result and discussion: Pre and post-intervention mean and standard
deviation of participants score were fair but were significant different pre
compared to post-intervention, [56.11 (2.82), 62.19 (2.70), mean score
difference: 6.07 (4.95, 7.20) 95% CI, p < 0.001] respectively. Meanwhile
the pre-intervention VAP rates were found to be reduced from 17.3
episodes per 1,000 ventilator-days to 7.0 episodes per 1,000 ventilatordays.
The reduction rate was 59.5% but no significant association with
VAP bundle interventions. It is associated with increased of the nurses’
skills in delivering of care related to oral care practices, maintaining of
endotracheal tube cuff pressure, performing meticulous hands hygiene
and infection control. After adjusting for cofounder, multiple logistic
regression revealed that patients who undergo intrahospital transport are
7.2 times at risk to develop VAP compared to non-transport patients
[Adjusted OR: 7.2, 95% CI: 2.46, 21.28, p < 0.001]. The main reasons for
intrahospital transport were computed tomography scanning, and surgery.
Meanwhile patients who have renal insufficiency are 5.7 times at risk to
develop VAP [Adjusted OR: 5.7, 95% CI: 1.77, 18.84, p = 0.004]. Hortal
et al. (2009) reported that patients who have creatinine levels of > 1.5
mg/dl were at risk to develop VAP (Hortal, Giannella, Pe'rez, et al., 2009).
It is crucial to provide regular continuous nursing education program for at
least 3-4 times a year to increase nurses’ awareness and knowledge on
VAP prevention strategies. It is essential to explore the factors that
contribute to the development of VAP for patients who have renal
insufficiency and undergo intrahospital transportation in the ICU.
Conclusion: There were significant reductions in VAP rate after
intervention period. However the nurses’ knowledge on VAP and the
prevention strategies were inadequate. Intrahospital transport and patient
with renal insufficiency are more at risk to develop VAP.
Keywords: nurses’ knowledge, ventilator-associated pneumonia, rate of
ventilator-associated pneumonia, intrahospital transport, and renal
insufficiency.
Description
Keywords
nurses’ knowledge, ventilator-associated pneumonia, rate of ventilator-associated pneumonia, intrahospital transport, and renal insufficiency.