Prevention of ventilator-associated pneumonia in intensive care units: Barriers and compliance

Summary of Critical Care Nurses' Understanding, Adherence, and Barriers in Applying Ventilator-Associated Pneumonia Prevention Guidelines: A Narrative Review

Both adults and pediatric patients who are on mechanical ventilation face high rates of mortality and morbidity due to ventilator-associated pneumonia (VAP), which is the most prevalent deadly hospital-acquired infection. Healthcare organizations provide evidence-based guidelines to help nurses decrease VAP in ICUs; however, there are obstacles to putting these guidelines into practice. An extensive investigation was conducted for pertinent English studies published from January 2014 to February 2024 in the databases of Science Direct, Scopus, PubMed, and CINAHL. The study centered on nurses' understanding, adherence, and obstacles regarding introducing VAP prevention guidelines. The majority of ICU nurses have a basic to intermediate understanding of evidence-based methods to reduce VAP. The nurses in the ICUs typically followed the guidelines for preventing VAP about 60% of the time. A basic analysis of descriptive content identified the obstacles preventing critical care nurses (CCNs) from following VAP PGs. The obstacles were separated into 2 groups: barriers related to nurses (such as education, experience, and training) and barriers related to the work environment (such as lack of supplies, staffing shortage, lack of policies, and ineffective supervision). To improve their skills, CCNs should get frequent updates on courses and seminars related to the VAP PG implementation. Healthcare administrators must be aware of these obstacles and implement work procedures that help CCNs overcome them if they want to increase compliance.

Critical Care Nurses' Knowledge on Prevention of Ventilator-associated Pneumonia: A Cross-sectional Study

Background

This study aims to assess the knowledge of Palestinian critical care nurses regarding the prevention of ventilator-associated pneumonia (VAP), an acquired infection that affects critically ill patients on ventilators in hospitals. Nurses caring for these patients may not always be aware of the most effective methods to prevent VAP.

Materials and methods

A descriptive cross-sectional study was conducted in five government hospitals in Gaza Strip, Palestine over 3 months. A convenience sample technique (72) of critical care nurses was selected. Data were collected through a self-administered questionnaire divided into; demographic characteristics and knowledge about critical care nurses of preventive interventions for VAP. Statistical analysis was performed using SPSS version 25.

Results

More than half of the critical care nurses (67%) were male and the majority of critical care nurses (63%) were aged between 20 and 29 years. Furthermore, 32% of critical care nurses were from Alshifa Medical Complex. The overall mean knowledge among critical care nurses to prevent VAP was 72%, indicating correct answers to knowledge-related queries.

Conclusion

Our study indicated that the knowledge of critical care nurses about VAP prevention was inadequate. Age, marital status, and years of experience were significantly associated with a good level of knowledge about the prevention of VAP (p < 0.05). However, there was no significant association between knowledge about VAP prevention of VAP and gender, qualification level, and type of intensive care unit (ICU).

How to cite this article

El-Kass SM, Alruwili HA, Alrowily MA, Ellayan OM, El-Kass LM, Hijo EE, et al. Critical Care Nurses' Knowledge on Prevention of Ventilator-associated Pneumonia: A Cross-sectional Study. Indian J Crit Care Med 2024;28(12):1122-1129.

Use of nursing care bundles for the prevention of ventilator-associated pneumonia in low-middle income countries: A scoping review

BACKGROUND

Ventilator-associated pneumonia (VAP) is a significant concern in low-middle-income countries (LMICs), where the burden of hospital-acquired infections is high, and resources are low. Evidence-based guidelines exist for preventing VAP; however, these guidelines may not be adequately utilized in intensive care units of LMICs.

AIM

This scoping review examined the literature regarding the use of nursing care bundles for VAP prevention in LMICs, to understand the knowledge, practice and compliance of nurses to these guidelines, as well as the barriers preventing the implementation of these guidelines.

STUDY DESIGN

The review was conducted using Arksey and O'Malley's (2005) five-stage framework and the PRISMA-ScR guidelines guided reporting. Searches were performed across six databases: CINAHL, Medline, Embase, Global Health, Scopus and Cochrane, resulting in 401 studies.

RESULTS

After screening all studies against the eligibility criteria, 21 studies were included in the data extraction stage of the review. Across the studies, the knowledge and compliance of nurses regarding VAP prevention were reported as low to moderate. Several factors, ranging from insufficient knowledge to a lack of adequate guidelines for VAP management, served as contributing factors. Multiple barriers prevented nurses from adhering to VAP guidelines effectively, including a lack of audit/surveillance, absence of infection prevention and control (IPC) teams and inadequate training opportunities.

CONCLUSIONS

This review highlights the need for adequate quality improvement procedures and more efforts to conduct and translate research into practice in intensive care units in LMIC.

RELEVANCE TO CLINICAL PRACTICE

IPC practices are vital to protect vulnerable patients in intensive care units from developing infections and complications that worsen their prognosis. Critical care nurses should be trained and reinforced to practice effective bundle care to prevent VAP.

Barriers to compliance with evidence-based guidelines for ventilator-associated pneumonia among critical care nurses: A scoping review

Background: Healthcare organizations provide evidence-based guidelines designed to support nurses in preventing ventilator-associated pneumonia (VAP) in intensive care units (ICUs), but there are barriers to compliance with such guidelines. This review explicitly explored evidence of compliance barriers among critical care nurses. Methods: A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EBSCO databases for relevant English-language studies published between January 2003 and June 2022, focused on barriers to nursing compliance with VAP prevention guidelines. Data was reported according to the Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines.  Results: 230 publications were screened, resulting in 53 full-text articles being retrieved after removing duplicates, of which 13 relevant to the aims of the review and meeting the inclusion criteria were included for data extraction. One was a qualitative study, while the remainder were quantitative. Simple descriptive content analysis identified the barriers to critical care nurses' compliance with VAP prevention guidelines, and categorized them as: (1) work environment barriers (e.g., lack of equipment and supplies; lack of staff and time; lack of educational support; and ineffective supportive system); (2) nurse-related barriers ( limited personal competencies); and (3) situation-related barriers ( patient health, discomfort, and adverse events). Conclusions: This review revealed important evidence on barriers to VAP prevention guidelines compliance. Nurses are challenged mainly by work-environmental barriers along, with the presence of nurse and situational barriers. It is evident from the findings that further qualitative and mixed-methodology follow-up studies are recommended to further explore the issues in depth.  Healthcare leaders must be aware of these barriers and integrate work policies that assist in overcoming them, to increase compliance.

Barriers to compliance with evidence-based guidelines for ventilator-associated pneumonia among critical care nurses: A scoping review

Background: Healthcare organizations provide evidence-based guidelines designed to support nurses in preventing ventilator-associated pneumonia (VAP) in intensive care units (ICUs), but there are barriers to compliance with such guidelines. This review explicitly explored evidence of compliance barriers among critical care nurses. Methods: A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EBSCO databases for relevant English-language studies published between January 2003 and June 2022, focused on barriers to nursing compliance with VAP prevention guidelines. Data was reported according to the Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines.  Results: 230 publications were screened, resulting in 53 full-text articles being retrieved after removing duplicates, of which 13 relevant to the aims of the review and meeting the inclusion criteria were included for data extraction. One was a qualitative study, while the remainder were quantitative. Simple descriptive content analysis identified the barriers to critical care nurses' compliance with VAP prevention guidelines, and categorized them as: (1) work environment barriers (e.g., lack of equipment and supplies; lack of staff and time; lack of educational support; and ineffective supportive system); (2) nurse-related barriers ( limited personal competencies); and (3) situation-related barriers ( patient health, discomfort, and adverse events). Conclusions: This review revealed important evidence on barriers to VAP prevention guidelines compliance. Nurses are challenged mainly by work-environmental barriers along, with the presence of nurse and situational barriers. It is evident from the findings that further qualitative and mixed-methodology follow-up studies are recommended to further explore the issues in depth.  Healthcare leaders must be aware of these barriers and integrate work policies that assist in overcoming them, to increase compliance.

Intensive care unit registered nurses' perceived barriers towards ventilated associated pneumonia prevention in southeast Iran: a cross-sectional descriptive - an analytical study

OBJECTIVES

Ventilated associated pneumonia (VAP) is one of the most common nosocomial infection and complication occurring in intensive care units (ICUs) worldwide. This study aimed to assess the ICU registered nurses' perceived barriers towards VAP prevention in southeast Iran.

SETTING

This was a cross-sectional descriptive-an analytical study to examine the registered nurses' perceived barriers towards VAP prevention in southeast Iran.

PARTICIPANTS

The study population consisted of 242 nurses working in ICU and emergency departments.

PRIMARY AND SECONDARY OUTCOME MEASURES

The data was collected using demographic characteristics' questionnaire and a researcher-made ventilator-associated pneumonia barriers prevention questionnaire.

RESULTS

The mean score of nurses' perceived barriers towards VAP prevention was 2.82±0.46. The highest mean score of perceived barriers were related to items of 'lack of staff', 'lack of a team-based approach to care and interventions', and 'lack of support from management'.

CONCLUSIONS

This study indicates most of the barriers are related to organisational factors and lack of teamwork. Further studies are needed to obtain more accurate results.

TRIAL REGISTRATION NUMBER

The study protocol was approved by the Ethics Committee of Kerman University of Medical Sciences (IR.KMU.REC.1395.908).

Knowledge, Practice, Compliance, and Barriers toward Ventilator-Associated Pneumonia among Critical Care Nurses in Eastern Mediterranean Region: A Systematic Review

BACKGROUND

Ventilator-associated pneumonia (VAP) has been identified as a serious complication among hospitalized patients and is associated with prolonged hospitalizations and increased costs. The purpose of this study was to examine the knowledge, practices, compliance, and barriers related to ventilator-associated pneumonia among critical care nurses in the eastern Mediterranean region.

METHODS

The PRISMA guidelines guided this systematic review. Four electronic databases (EMBASE, MEDLINE (via PubMed), SCOPUS, and Web of Science) were used to find studies that were published from 2000 to October 2021.

RESULTS

Knowledge of ventilator-associated pneumonia was the highest outcome measure used in 14 of the 23 studies. The review results confirmed that nurses demonstrated low levels of knowledge of ventilator-associated pneumonia, with 11 studies assessing critical care nurses' compliance with and practice with respect to ventilator-associated pneumonia. Overall, the results showed that most sampled nurses had insufficient levels of compliance with and practices related to ventilator-associated pneumonia. The main barriers reported across the reviewed studies were a lack of education (N = 6), shortage of nursing staff (N = 5), lack of policies and protocols (N = 4), and lack of time (N = 4).

CONCLUSIONS

The review confirmed the need for comprehensive interventions to improve critical care nurses' knowledge, compliance, and practice toward ventilator-associated pneumonia. Nurse managers must address barriers that impact nurses' levels of knowledge, compliance with, and practices related to ventilator-associated pneumonia.

Performance Assessment of Medical Professionals in Prevention of Ventilator Associated Pneumonia in Intensive Care Units

Purpose

Ventilator-associated pneumonia (VAP) is one of the most common infections in intensive care units (ICU) with a 6–52% incidence. The VAP mortality rate is 50% to 70%. Medical professionals (MPs) working in the ICU are expected to follow the guidelines to prevent VAP. The study aimed to assess the performance of MPs in preventing VAP and to associate the performance with the baseline information.

Methods

An observational cross-sectional study was conducted in the ICUs of selected hospitals in eastern Saudi Arabia. A total of 152 MPs were selected by random sampling. A structured questionnaire including baseline information, knowledge and performance-related questions was used to collect the data. Frequency, mean, and chi-square tests were used for analysis.

Results

Out of 152 MPs, 40.8% had adequate and 7.9% had inadequate knowledge. A high mean score of 12.9 ± 2.2 was obtained by physicians, followed by 11.3 ± 1.6 by nurses, 9.8 ± 2.2 by RTs, and 8.6 ± 2.1 by interns. Overall, 52.6% had satisfactory performance. Approximately 57.9% and 67.8% of MPs cleaned their hands before touching the patient and the ventilator, respectively. Many (79.6%) MPs used personal protective equipment in the ICU. Some (47.4%) of the MPs changed the patient’s position regularly. About 77.6% of MPs followed the sterile technique when suctioning the airway. There was a significant association found between the performance of MPs on the prevention of VAP with age (p < 0.001), designation (p < 0.05), professional experience (p < 0.05), managing chronic obstructive pulmonary disease conditions (p < 0.05) and training attended (p < 0.001).

Conclusion

Although some of the MPs had satisfactory performance regarding VAP prevention in the ICU, more attention should be paid to training them on clinical guidelines to improve health care quality and reduce the rate of VAP.