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Mohamed DM, SalahEldin MA, Idris AB, Idris EB, Mohamed SG, Badawi MM. Pneumonia in Sudan: Systematic and Scoping Review of the Literature and Meta-Analysis. Cureus 2023; 15:e46473. [PMID: 37927707 PMCID: PMC10623489 DOI: 10.7759/cureus.46473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
In addition to excessive burden of non-communicable diseases, natural and manmade disasters, and internal conflicts, Sudan is predominantly susceptible to communicable diseases, such as malaria, tuberculosis, and pneumonia, which bring about an extra burden of demand for high-quality healthcare. According to the WHO and the Sudan Health Observatory, pneumonia is one of the leading causes of death in Sudan. This study therefore aimed to illustrate pneumonia literature in Sudan, estimate infection prevalence regardless of the cause among Sudanese children and adults, and demonstrate its related risk factors. A systematic and scoping review of the literature was conducted and regulated in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After abstract and full-text screening, only 15 articles met our inclusion criteria and passed the quality assessment procedure. Seven included studies determined prevalence of pneumonia; the overall pooled prevalence was around 30%. Furthermore, 12 research articles investigated risk factors related to pneumonia among Sudanese population. Further research with larger sample sizes targeting risk factors of pneumonia among Sudanese population is needed to be conducted.
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Affiliation(s)
- D M Mohamed
- Internal Medicine, Sultan Qaboos University Hospital, Muscat, OMN
| | - M A SalahEldin
- Medical Microbiology, University of Khartoum, Khartoum, SDN
| | - A B Idris
- General Surgery, Sudan Medical Specialization Board, Khartoum, SDN
| | - E B Idris
- Medical Microbiology, Rashid Medical Complex, Riyadh, SAU
| | - S G Mohamed
- Medical Microbiology, University of Khartoum, Khartoum, SDN
| | - Marwan M Badawi
- Medical Unit, Higher Academy for Strategic and Security Studies, Khartoum, SDN
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Getahun AB, Belsti Y, Getnet M, Bitew DA, Gela YY, Belay DG, Terefe B, Akalu Y, Diress M. Knowledge of intensive care nurses’ towards prevention of ventilator-associated pneumonia in North West Ethiopia referral hospitals, 2021: A multicenter, cross-sectional study. Ann Med Surg (Lond) 2022; 78:103895. [PMID: 35734742 PMCID: PMC9207106 DOI: 10.1016/j.amsu.2022.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Ventilator-associated pneumonia is a common nosocomial infection that occurs in critically ill patients who are on intubation and mechanical ventilation. Nurses' lack of knowledge may be a barrier to adherence to evidence-based guidelines for preventing ventilator-associated pneumonia. This study aimed to assess the knowledge of intensive care nurses’ towards the prevention of ventilator-associated pneumonia. Methods A multicenter cross-sectional study was conducted among nurses working in the intensive care unit from April to July 2021. A pre-tested and structured questionnaire was used to collect data. All intensive care nurses working in the study area were included in the study. Data was entered into Epi-data 4.1 version (EpiData Association, Denmark) and transferred to STATA version 14 (College Station, Texas 77845-4512 USA) statistical software for analysis. Both bi-variable and multivariable binary logistic regression analysis was used to identify factors associated with knowledge of intensive care unit nurse. Variables with a p-value less than <0.2 in the bi-variable analysis were fitted into the multivariable logistic regression analysis. Both Crude and Adjusted Odds Ratio with the corresponding 95% Confidence Interval was calculated to show the strength of association. In multivariable analysis, variables with a p-value of <0.05 were considered statistically significant. Result A total of 213 intensive care nurses were included in the study, with a response rate of 204(95.77%). The mean knowledge score of intensive care nurses regarding the prevention of ventilator-associated pneumonia out of 20 questions is (10.1 ± 2.41). There are 98 (48.04%) of the participants have been found to have good knowledge and 106 (51.96%) of them are rendered poor knowledge about the overall knowledge related to the prevention of ventilator-associated pneumonia. Higher academic qualifications and taking intensive care unit training were significantly associated with good knowledge of ventilator-associated pneumonia prevention in multi-variable logistic regression. Conclusion Our study indicates that the knowledge of intensive care nurses about ventilator-associated pneumonia prevention is not sufficient. Higher academic qualifications and taking intensive care unit training are significantly associated with a good level of knowledge. Therefore it shows the necessity for thorough training and education. The knowledge of intensive care nurses about ventilator-associated pneumonia prevention is not sufficient. Only 98 (48.04%) of the participants have been found to have good knowledge. Higher academic qualifications and taking intensive care unit training are significantly associated with a good level of knowledge. This study shows the necessity of in-service training and continuing education for intensive care nurses about the prevention of ventilator-associated pneumonia.
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Alkubati SA, Saghir SAM, Al-Sayaghi KM, Alhariri A, Al-Areefi M. Healthcare workers' knowledge of evidence-based guidelines for prevention of ventilator-associated pneumonia in Hodeida, Yemen. J Basic Clin Physiol Pharmacol 2021; 34:321-327. [PMID: 34714992 DOI: 10.1515/jbcpp-2020-0388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 09/30/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients requiring mechanical ventilation in intensive care units (ICUs). VAP is associated with delayed extubation, prolonged hospital stays, increased healthcare costs and mortality rates. The aims of this study to evaluate the level of knowledge for the prevention of VAP among healthcare workers (HCWs) in ICUs and to assess their knowledge in relation to their socio-demographic characteristics. METHODS A descriptive, cross-sectional design was conducted to assess HCWs' knowledge of the guidelines for prevention of VAP in the ICUs of public and private hospitals in Hodeida city, Yemen. Around 140 self-administered multiple-choice questionnaires were distributed between April and July 2017. RESULTS A total of 120 (85.6%) HCWs completed questionnaire were obtained (20 physicians, 20 anesthesia technicians and 80 nurses) in this study. The total mean score of the HCWs' knowledge was low (41 ± 18). A statistically significant difference was found in the HCWs' knowledge scores according to their specialties and gender. Anesthesia technicians had the highest knowledge score followed by physicians and nurses (52.2 ± 16.2, 45.6 ± 21.2 and 37.1 ± 16.9, respectively, p=0.002). Males had higher scores than females (Median [IQR] 4 [3-5] vs. 3 [2-4], p<0.001). Participants who received information about the prevention of VAP had better knowledge than those who did not (46.2 ± 17.7 vs. 36.8 ± 17.3, p=0.006). CONCLUSIONS HCWs had a low knowledge level of the guidelines for the prevention of VAP, which may affect their practice. HCWs' knowledge was affected by their previous received information that increases the necessity to provide them with regular in-service education and training programs.
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Affiliation(s)
- Sameer A Alkubati
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen.,Faculty of Nursing, University of Ha'il, Hail, Saudi Arabia
| | - Sultan A M Saghir
- Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences, Al-Hussein Bin Talal University, Ma`an, Jordan
| | - Khaled M Al-Sayaghi
- Department of Medical Surgical Nursing, College of Nursing, Taibah University, Madina, Saudi Arabia.,Department of Critical Care and Emergency Nursing, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdullah Alhariri
- Preventive Medicine Unit-General Military Hospital (GMH), Hodeida, Yemen
| | - Mahmoud Al-Areefi
- Faculty of Public Health & Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
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Bankanie V, Outwater AH, Wan L, Yinglan L. Assessment of knowledge and compliance to evidence-based guidelines for VAP prevention among ICU nurses in Tanzania. BMC Nurs 2021; 20:209. [PMID: 34696753 PMCID: PMC8543108 DOI: 10.1186/s12912-021-00735-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 09/29/2021] [Indexed: 01/22/2023] Open
Abstract
Background Implementation of evidence-based guidelines (EBGs) related to VAP is an effective measure for the prevention of ventilator-associated pneumonia (VAP). While low knowledge regarding the EBGs related to VAP prevention among ICU nurses is still a major concern among nurses in ICUs globally, the situation in Tanzania is scarcely known. This study aimed to assess the ICU nurses’ knowledge, compliance, and barriers toward evidence-based guidelines for the prevention of VAP in Tanzania. Methods A cross-sectional study, involving ICU nurses of major hospitals in Tanzania, was conducted. A structured questionnaire was administered among 116 ICU nurses. Data analysis included descriptive statistics and the independent sample t-test. Results The mean knowledge score was 3.86(SD = 1.56), based on ten questions (equivalent to 38.6%). Nurses with a degree or higher level of nursing education performed significantly better than the nurses with a diploma or lower level of nursing education (p = 0.004). The mean self-reported compliance score for EBGs for the prevention of VAP was 15.20 (SD = 0.93) which is equivalent to 60.8% based on 25 questions. The main barriers to the implementation of EBGs for VAP prevention were lack of skills (96.6%), lack of adequate staff (95.5%), and lack of knowledge (79.3%). Conclusion Considering the severity and impact of VAP, and the higher risks of HAIs in resource-limited countries like Tanzania, the lower level of knowledge and compliance implies the need for ongoing educational interventions and evaluation of the implementation of the EBGs for VAP prevention by considering the local context.
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Affiliation(s)
- Vicent Bankanie
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China.,Department of Clinical Nursing, University of Dodoma, Dodoma, Tanzania
| | - Anne H Outwater
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Li Wan
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China
| | - Li Yinglan
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China.
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Kalyan G, Bibi R, Kaur R, Bhatti R, Kumari R, Rana R, Kumari R, Kaur M, Kaur R. Knowledge and Practices of Intensive Care Unit Nurses Related to Prevention of Ventilator Associated Pneumonia in Selected Intensive Care Units of a Tertiary Care Centre, India. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:369-375. [PMID: 33344206 PMCID: PMC7737830 DOI: 10.4103/ijnmr.ijnmr_128_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/26/2020] [Accepted: 07/06/2020] [Indexed: 11/26/2022]
Abstract
Background: Ventilator-Associated Pneumonia (VAP) is a recognized nosocomial infection and a leading cause of high morbidity and mortality. Intensive Care Unit (ICU) nurses are in the best position to put the known evidence-based strategies into practice to prevent VAP. The aim of the present study is to assess the knowledge and practices of ICU nurses related to prevention of VAP in selected ICUs of a tertiary care centre in India (2013–2014) and to find out the association between knowledge and practices. Materials and Methods: A descriptive survey was conducted in the different ICUs of a tertiary care hospital in India. Purposive sampling technique was used and 108 ICU staff nurses were enrolled during the period of data collection. The tool used for data collection was a self-developed valid and reliable knowledge-based questionnaire and an observational checklist. The descriptive (frequency and percentages) and inferential (Chi-square test) statistics was used. Results Out of the 108 nurses enrolled in the study, 82 (75.93%) had average, 24 (22.22%) had good and only 2 (1.85%) of the ICU nurses had poor knowledge. Assessment of the practices revealed that 68 (94.44%) nurses had average and only 4 (5.55%) nurses had good practice. There was no association between the knowledge and practices of ICU nurses related to prevention of VAP. (χ2 = 0.14, p = 0.710). Conclusions: Although the nurses were having good to average knowledge scores, their practices were not associated with knowledge scores. There is a need to find out the ways that would help the nurses to adhere to good practices.
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Affiliation(s)
- Geetanjli Kalyan
- BSN, MSN, PhD Scholar, Tutor National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravina Bibi
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravinder Kaur
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Bhatti
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reeta Kumari
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Romina Rana
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupa Kumari
- Nursing Officer, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Nursing Student, Post Degree Diploma (2years) in Nursing Practice in Canada at Langrara, Vancouver, BC, Canada
| | - Rupinder Kaur
- BSN, MSN, Tutor National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Madhuvu A, Endacott R, Plummer V, Morphet J. Nurses' knowledge, experience and self-reported adherence to evidence-based guidelines for prevention of ventilator-associated events: A national online survey. Intensive Crit Care Nurs 2020; 59:102827. [PMID: 32151484 DOI: 10.1016/j.iccn.2020.102827] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore Australian intensive care nurses' knowledge of ventilator-associated pneumonia and self-reported adherence to evidence-based guidelines for the prevention of ventilator-associated events. DESIGN A quantitative cross-sectional online survey was used. SETTING The study was conducted in two Australia intensive care units, in large health services in Victoria and an Australia-wide nurses' professional association (Australian College of Critical Care Nurses). MAIN OUTCOME MEASURES Participants' knowledge and self-reported adherence to evidence-based guidelines. RESULTS The median knowledge score was 6/10 (IQR: 5-7). There was a significant positive association between completion of post graduate qualification and their overall knowledge score p = 0.014). However, there was no association (p = 0.674) between participants' years of experience in intensive care nursing and their overall score. The median self-reported adherence was 8/10 (IQR: 6-8). The most adhered to procedures were performing oral care on mechanically ventilated patients (n = 259, 90.9%) and semi-fowlers positioning of the patient (n = 241, 84.6%). There was no relationship between participants' knowledge and adherence to evidence-based guidelines (p = 0.144). CONCLUSION Participants lack knowledge of evidence-based guidelines for the prevention of ventilator-associated pneumonia. Specific education on ventilator-associated events may improve awareness and guideline adherence.
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Affiliation(s)
- Auxillia Madhuvu
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia.
| | - Ruth Endacott
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Plymouth University/Royal Devon and Exeter Hospital Clinical School, Drake Circus, Plymouth, Devon PL4 8AA, United Kingdom
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia
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Yang L, Dong Z. Adherence to Guidelines on Nutritional Support by Medical Residents in an Intensive Care Unit in China: A Prospective Observational Study. Med Sci Monit 2019; 25:8645-8650. [PMID: 31733142 PMCID: PMC6874836 DOI: 10.12659/msm.917684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The use of evidence-based clinical practice guidelines improves the quality of patient medical care. Although the implementation of clinical guidelines can be a challenge, nutritional support is important for critically ill patients. This prospective observational study aimed to investigate the attention to and implementation of guidelines for nutritional support in an Intensive Care Unit (ICU) in China and to identify factors that determine attention to these guidelines. Material/Methods The study included 16 medical residents who were interviewed while working in an emergency Intensive Care Unit (ICU) during one month. A structured interview questionnaire on attention to patient nutritional guidelines was used. Interviews were conducted daily after an early ICU ward round, and residents were asked questions regarding each patient. Results The response rate from medical residents was 99.6% (455/457). The rate of attention to and implementation of nutritional support guidelines was 57.1% (260/455) and 73.1% (334/457), respectively. Multivariate logistic regression analysis showed that weekdays and weekends (OR, 0.59; 95% CI, 0.38–0.91), medical groups (OR, 0.67; 95% CI, 0.46–0.98), and the numbers of patients admitted (OR, 0.91; 95% CI, 0.85–0.97) were independently associated with attention to nutritional support guidelines by the residents. Conclusions Nutritional guidelines for patients in the ICU were not fully paid attention to by medical residents or implemented. The reasons included high work demands and lack of standardized training. Further studies are needed to determine whether measures to reduce workload and improve medical training can improve adherence to nutritional support guidelines in the ICU.
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Affiliation(s)
- Lei Yang
- Intensive Care Unit (ICU), Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China (mainland).,Intensive Care Unit (ICU), Taipei Medical University Ningbo Medical Center, Ningbo, Zhejiang, China (mainland).,Department of Emergency Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Zhouzhou Dong
- Intensive Care Unit (ICU), Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China (mainland).,Intensive Care Unit (ICU), Taipei Medical University Ningbo Medical Center, Ningbo, Zhejiang, China (mainland)
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The Effects of Oral Care Protocol on the Incidence of Ventilation-Associated Pneumonia in Selected Intensive Care Units in Jordan. Dimens Crit Care Nurs 2019; 38:5-12. [PMID: 30499786 DOI: 10.1097/dcc.0000000000000334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aims to evaluate the effects of oral care protocol on the incidence of ventilator-associated pneumonia (VAP) at selected intensive care units (ICUs) in Jordan using clinical pulmonary infection score. METHODS A quasi-experimental design was used, and 1 large teaching hospital from the Jordanian capital, along with 2 hospitals from the southern region, was selected. A total of 218 patients participated, among which VAP risk in 2 independent groups was evaluated through the Clinical Pulmonary Infection Score sheet. RESULTS The VAP incidence rate was significantly lower in the intervention group (n = 102) as compared with control group (n = 116) (21.6 vs 35.3, respectively; P = .018); in addition, ICU stay and intubation period were significantly shorter among the intervention group. A higher risk of VAP was independently predicted by previous lung diseases (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.185-1.88), open suctioning system (OR, 2.536; 95% CI, 1.261-5.101), and duration of intubation (OR, 1.770; 95% CI, 0.845-2.220). The oral care protocol has effectively improved ventilated patients' oral health, which has statistically reduced the incidence of VAP. It occurred more frequently among patients who have lung disease and those who were intubated for more than 7 days and have an open suctioning system. CONCLUSION Health care teams should ensure that effective care protocol is implemented among patients.
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Yeganeh M, Yekta H, Farmanbar R, Khalili M, Khaleghdoost T, Atrkar Roushan Z. Knowledge of evidence-based guidelines in ventilator-associated pneumonia prevention. J Evid Based Med 2019; 12:16-21. [PMID: 26845460 DOI: 10.1111/jebm.12188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/15/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the intensive care unit nurses' knowledge of evidence-based guidelines for ventilator-associated pneumonia (VAP) prevention at Guilan University of Medical Sciences (GUMS) hospitals, Guilan Province, northern Iran. METHODS This cross-sectional study included 219 nurses working in 14 intensive care units at 11 Guilan hospitals. The questionnaire consisted of three parts of demographic information, nurses' knowledge of evidence-based guidelines for the prevention of VAP, and the barrier for the implementation of these guidelines. RESULTS Of the 219 nurses, 171 (response rate 78.1%) participated in this study, and their mean knowledge score was 4.6. There was no significant relation between nurses' knowledge score and their work experience (P = 0.327), education degree (P = 0.189), and their position (P = 0.168). CONCLUSION The level of knowledge regarding VAP prevention seems inadequate in this study. Although having knowledge about the principles of evidence-based care cannot guarantee the implementation of these principles, lack of knowledge may be a potential barrier to adherence to evidence-based guidelines for the prevention of VAP.
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Affiliation(s)
- Mohammadreza Yeganeh
- Department of medical-surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Yekta
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Rabiollah Farmanbar
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Malahat Khalili
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Tahereh Khaleghdoost
- Department of Nursing, Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkar Roushan
- Department of Health Education, School of Health, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Jansson MM, Syrjälä HP, Talman K, Meriläinen MH, Ala-Kokko TI. Critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. Am J Infect Control 2018; 46:1051-1056. [PMID: 29573832 DOI: 10.1016/j.ajic.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although evidence-based practices are known to improve the quality of care, making it cost-efficient and improving clinical results, barriers to transferring research into clinical practice have hindered this process. AIMS To evaluate critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. MATERIAL AND METHODS In 2015, we conducted an institution-specific, cross-sectional study in a 26-bed adult mixed medical-surgical intensive care unit (ICU) in Finland using quantitative survey of knowledge and self-reported adherence with qualitative gathering of barrier data. A pre-validated multiple-choice Ventilator Bundle Questionnaire was distributed to all registered nurses who were direct care providers (n = 155). RESULTS The final response rate was 55.5% (n = 86), and 47.2% (n = 34) of respondents had more than 10 years of ICU experience. The levels of knowledge and self-reported adherence were 71.1% and 65.8% of the total score, respectively. The level of knowledge was higher among respondents who had received in-service education about ventilator bundle compared with respondents who had not received in-service education (27.0 vs 24.0 [P = .012]). Less experienced nurses reported significantly higher adherence than nurses with more ICU experience (29.0 vs 25.0 [P = .034]). The correlation between knowledge and adherence scores was low (ρ 0.48 [P <.001]). The most well-known and adhered-to guidelines described patient positioning, daily chlorhexidine-based oral care, and strict hand hygiene. The least-known guidelines and those least adhered to described respiratory equipment, management of sedation and analgesia, and practices prior to and during endotracheal suctioning. The main barriers were related to the nurse respondents (e.g., lack of education [25.9%]), environment (e.g., role ambiguities [36.4%] and inadequate resources [21.1%]), and patients (e.g., patient discomfort [4.8%] and fear of adverse effects [4.6%]). CONCLUSIONS Self-reported adherence did not correlate with knowledge and was not related to work experience. Most of the barriers toward evidence-based guidelines indicated a need for changes that are beyond the control of individual nurses.
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Affiliation(s)
- Miia M Jansson
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland.
| | - Hannu P Syrjälä
- Department of Infection Control, Oulu University Hospital, Oulu, Finland
| | - Kirsi Talman
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Merja H Meriläinen
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
| | - Tero I Ala-Kokko
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
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Darawad MW, Sa'aleek MA, Shawashi T. Evidence-based guidelines for prevention of ventilator-associated pneumonia: Evaluation of intensive care unit nurses' adherence. Am J Infect Control 2018; 46:711-713. [PMID: 29305283 DOI: 10.1016/j.ajic.2017.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 11/30/2022]
Abstract
Using self-reported questionnaires, this descriptive study assessed nurses' adherence to ventilator-associated pneumonia (VAP) guidelines, which was found to be 81.3%. Although items concerning infection control achieved the highest scores, items concerning the suctioning process achieved the lowest scores. Participants' score of VAP care knowledge had a significant positive correlation with their score of VAP guidelines adherence. Addressing the strength and weakness domains that affect nurses' adherence is crucial for health care administrators at different managerial levels, which may help in executing different strategies to improve nurses' adherence to VAP strategies.
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Thomas GW. How bedside feedback improves head-of-bed angle compliance for intubated patients. ACTA ACUST UNITED AC 2017; 7:73-80. [PMID: 31187082 DOI: 10.1080/24725579.2017.1281851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
One clinical defense against ventilator-associated pneumonia is maintaining the head-of-bed angle of ventilated patients above 30°. Most previous studies of head-of-bed angles using electronic monitoring have recorded compliance rates of less than 50%. The purpose of this study was to determine how bedside feedback of the head-of-bed angle affects bed angles set by healthcare workers. Electronic inclinometers were installed on 22 beds in an intensive care for a period of 38 days. Intubated patients were randomly assigned into two cohorts. One cohort received a graphical display of the bed angle adjacent to the in-room computer display. The head-of-bed angle of each intubated patient was continuously recorded, yielding 1,528 h of observation. The mean head-of-bed angle was 28.78° for beds with displays and 25.50° for those without, a significant difference. The most significant effects were for angles near 30°. Beds in the display cohort were three times as likely to be in a compliant position as beds in the no-display cohort. The results suggest that electronic bedside feedback improves head-of-bed angle compliance by raising angles slightly below the compliance threshold into compliance. This result may support studies of how compliant bed-angle protocols affect health outcomes.
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Affiliation(s)
- Geb W Thomas
- Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA, USA
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Maurya S, Mishra SB, Azim A, Baronia AK, Gurjar M. Ventilator-associated complications: A study to evaluate the effectiveness of a planned teaching program for intensive care unit staff nurses-an Indian experience. Am J Infect Control 2016; 44:1422-1423. [PMID: 27125913 DOI: 10.1016/j.ajic.2016.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/25/2016] [Accepted: 03/02/2016] [Indexed: 01/01/2023]
Abstract
The role of nursing staff is important for both prevention and early diagnosis of complications associated with mechanical ventilation. The objective of our study was to assess the knowledge of nurses working in an intensive care unit for at least 6 months regarding ventilator-associated complications and its prevention. A quasiexperimental study was conducted using a questionnaire with 50 questions formulated by the panel of experts. A planned teaching program was developed based on related literature regarding ventilator-associated complications and its prevention and was presented to the staff nurses. The level of knowledge of the nursing staff was assessed before and after the workshop. Fifty nurses were included in the study. Among the staff nurses, 53.40% had average knowledge regarding ventilator-associated complications. Posttest, 77.20% of the total score was obtained for ventilator-associated complications. Regular training programs can be effective in improving the knowledge of nursing staff.
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Affiliation(s)
- Sunil Maurya
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Shakti B Mishra
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India.
| | - Arvind K Baronia
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India
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Pujante-Palazón I, Rodríguez-Mondéjar JJ, Armero-Barranco D, Sáez-Paredes P. [Prevention of ventilator-associated pneumonia: a comparison of level of knowledge in three critical care units]. ENFERMERIA INTENSIVA 2016; 27:120-8. [PMID: 26822814 DOI: 10.1016/j.enfi.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the level of knowledge of the prevention of ventilator-associated pneumonia guidelines of nurses working in three intensive care units (ICU) in 3 university hospitals in a Spanish region, and evaluate the relationship between this level of knowledge and years worked in the ICU. METHOD A descriptive, prospective, cross-sectional, multicentre study was conducted using a validated and reliable questionnaire, made up by 9 questions with closed answers drawn from the EVIDENCE study. A total of 98 questionnaires were collected from ICU nurses of the three university hospitals (A, B, and C) from January to April 2014. The sample from hospital A responded the most, in contrast with the sample from hospital B, which was the one with the less participation. The Pearson correlation was calculated in order to determine the relationship between nurse years worked in ICU and level of knowledge. RESULTS Hospital A obtained in the best mean score in the questionnaire, 6.33 (SD 1.4) points, followed by hospital C with 6.21 (SD 1.4), and finally, the hospital B with 6.06 (SD 1.5) points. A p=.08 was obtained on relating years worked with the level of knowledge. CONCLUSION The results showed a high level of knowledge compared other studies. There was a tendency between the years worked in the unit and the level of knowledge in ventilator-associated pneumonia prevention.
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Affiliation(s)
- I Pujante-Palazón
- Enfermería, Facultad de Enfermería, Universidad de Murcia (UMU), Murcia, España.
| | - J J Rodríguez-Mondéjar
- Servicio Murciano de Salud, Unidad de Cuidados Intensivos (UCI), HGU Reina Sofía de Murcia, España; Ciencias de la Salud, Universidad de Murcia, España
| | | | - P Sáez-Paredes
- Servicio Murciano de Salud, UCI del HGU JMª Morales Meseguer de Murcia, España; Proyecto Neumonía Zero, HGU JMª Morales Meseguer de Murcia, España
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Wang L, Li X, Yang Z, Tang X, Yuan Q, Deng L, Sun X. Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst Rev 2016; 2016:CD009946. [PMID: 26743945 PMCID: PMC7016937 DOI: 10.1002/14651858.cd009946.pub2] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is associated with increased mortality, prolonged length of hospital stay and increased healthcare costs in critically ill patients. Guidelines recommend a semi-recumbent position (30º to 45º) for preventing VAP among patients requiring mechanical ventilation. However, due to methodological limitations in existing systematic reviews, uncertainty remains regarding the benefits and harms of the semi-recumbent position for preventing VAP. OBJECTIVES To assess the effectiveness and safety of semi-recumbent positioning versus supine positioning to prevent ventilator-associated pneumonia (VAP) in adults requiring mechanical ventilation. SEARCH METHODS We searched CENTRAL (2015, Issue 10), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1946 to October 2015), EMBASE (2010 to October 2015), CINAHL (1981 to October 2015) and the Chinese Biomedical Literature Database (CBM) (1978 to October 2015). SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing semi-recumbent versus supine positioning (0º to 10º), or RCTs comparing alternative degrees of positioning in mechanically ventilated patients. Our outcomes included clinically suspected VAP, microbiologically confirmed VAP, intensive care unit (ICU) mortality, hospital mortality, length of ICU stay, length of hospital stay, duration of ventilation, antibiotic use and any adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently and in duplicate screened titles, abstracts and full texts, assessed risk of bias and extracted data using standardised forms. We calculated the mean difference (MD) and 95% confidence interval (95% CI) for continuous data and the risk ratio (RR) and 95% CI for binary data. We performed meta-analysis using the random-effects model. We used the grading of recommendations, assessment, development and evaluation (GRADE) approach to grade the quality of evidence. MAIN RESULTS We included 10 trials involving 878 participants, among which 28 participants in two trials did not provide complete data due to loss to follow-up. We judged all trials to be at high risk of bias. Semi-recumbent position (30º to 60º) versus supine position (0° to 10°) A semi-recumbent position (30º to 60º) significantly reduced the risk of clinically suspected VAP compared to a 0º to 10º supine position (eight trials, 759 participants, 14.3% versus 40.2%, RR 0.36; 95% CI 0.25 to 0.50; risk difference (RD) 25.7%; 95% CI 20.1% to 30.1%; GRADE: moderate quality evidence).There was no significant difference between the two positions in the following outcomes: microbiologically confirmed VAP (three trials, 419 participants, 12.6% versus 31.6%, RR 0.44; 95% CI 0.11 to 1.77; GRADE: very low quality evidence), ICU mortality (two trials, 307 participants, 29.8% versus 34.3%, RR 0.87; 95% CI 0.59 to 1.27; GRADE: low quality evidence), hospital mortality (three trials, 346 participants, 23.8% versus 27.6%, RR 0.84; 95% CI 0.59 to 1.20; GRADE: low quality evidence), length of ICU stay (three trials, 346 participants, MD -1.64 days; 95% CI -4.41 to 1.14 days; GRADE moderate quality evidence), length of hospital stay (two trials, 260 participants, MD -9.47 days; 95% CI -34.21 to 15.27 days; GRADE: very low quality evidence), duration of ventilation (four trials, 458 participants, MD -3.35 days; 95% CI -7.80 to 1.09 days), antibiotic use (three trials, 284 participants, 84.8% versus 84.2%, RR 1.00; 95% CI 0.97 to 1.03) and pressure ulcers (one trial, 221 participants, 28% versus 30%, RR 0.91; 95% CI 0.60 to 1.38; GRADE: low quality evidence). No other adverse events were reported. Semi-recumbent position (45°) versus 25° to 30° We found no statistically significant differences in the following prespecified outcomes: clinically suspected VAP (two trials, 91 participants, RR 0.74; 95% CI 0.35 to 1.56; GRADE: very low quality evidence), microbiologically confirmed VAP (one trial, 30 participants, RR 0.61; 95% CI 0.20 to 1.84: GRADE: very low quality evidence), ICU mortality (one trial, 30 participants, RR 0.57; 95% CI 0.15 to 2.13; GRADE: very low quality evidence), hospital mortality (two trials, 91 participants, RR 1.00; 95% CI 0.38 to 2.65; GRADE: very low quality evidence), length of ICU stay (one trial, 30 participants, MD 1.6 days; 95% CI -0.88 to 4.08 days; GRADE: very low quality evidence) and antibiotic use (two trials, 91 participants, RR 1.11; 95% CI 0.84 to 1.47). No adverse events were reported. AUTHORS' CONCLUSIONS A semi-recumbent position (≧ 30º) may reduce clinically suspected VAP compared to a 0° to 10° supine position. However, the evidence is seriously limited with a high risk of bias. No adequate evidence is available to draw any definitive conclusion on other outcomes and the comparison of alternative semi-recumbent positions. Adverse events, particularly venous thromboembolism, were under-reported.
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Affiliation(s)
- Li Wang
- West China Hospital, Sichuan UniversityChinese Cochrane CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Xiao Li
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Zongxia Yang
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Xueli Tang
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Qiang Yuan
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Lijing Deng
- West China Hospital, Sichuan UniversityIntensive Care UnitNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Xin Sun
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonONCanadaL8N 3Z5
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Damkliang J, Considine J, Kent B, Street M. Using an evidence-based care bundle to improve Thai emergency nurses' knowledge of care for patients with severe traumatic brain injury. Nurse Educ Pract 2015; 15:284-92. [DOI: 10.1016/j.nepr.2015.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 12/10/2014] [Accepted: 03/22/2015] [Indexed: 12/01/2022]
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Thomas GW, Pennathur P, Falk DM, Myers J, Ayres B, Polgreen PM. How lapse and slip errors influence head-of-bed angle compliance rates as measured by a portable, wireless data collection system. IIE TRANSACTIONS ON HEALTHCARE SYSTEMS ENGINEERING 2015; 5:1-13. [PMID: 31168335 DOI: 10.1080/19488300.2014.993005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The recommended protocols to prevent ventilator-associated pneumonia include keeping ventilated patients' head and upper body elevated to an angle between 30 and 45 degrees. These recommendations are largely based on a study that has been difficult to replicate, because studies that have attempted to replicate the original conditions have failed to achieve the necessary bed angles consistently. This work suggests the possibility that two specific types of human error, slips and lapses, contribute to non-compliant bed angles. A novel device provided 83,655 samples of bed angles over a period of 1579 hours. The bed angle was out of compliance 64.2% of the time analyzed. Slips, the accident of raising the bed to an angle slightly less than the desired angle, accounted for most of the out-of-compliance measurements, or 55.9% of the time analyzed. It appears that stochastic variation in the bed adjustments results in the bed being out of compliance. Interventions should be investigated such as increasing the target angle and providing feedback at the moment the bed is raised to close to, but less than, the target angle.
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Affiliation(s)
- Geb W Thomas
- Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA, USA
| | - Priyadarshini Pennathur
- Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA, USA
| | - Derik M Falk
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Jon Myers
- Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA, USA
| | - Brennan Ayres
- Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA, USA
| | - Philip M Polgreen
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
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Jansson MM, Ala-Kokko TI, Ohtonen PP, Meriläinen MH, Syrjälä HP, Kyngäs HA. Human patient simulation education in the nursing management of patients requiring mechanical ventilation: a randomized, controlled trial. Am J Infect Control 2014; 42:271-6. [PMID: 24581015 DOI: 10.1016/j.ajic.2013.11.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge among critical care nurses and their adherence to evidence-based guidelines for preventing ventilator-associated pneumonia is reported to be low. The aim of our study was to evaluate the effectiveness of human patient simulation (HPS) education in the nursing management of patients requiring mechanical ventilation. METHODS A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Finland from February-October 2012. Thirty critical care nurses were allocated evenly to intervention and control groups (n = 15 each). The effectiveness of HPS education was evaluated through the validated Ventilator Bundle Questionnaire and Ventilator Bundle Observation Schedule at baseline and repeated twice-after the clinical and simulation settings, respectivley. RESULTS After HPS education, the average skill scores (Ventilator Bundle Observation Schedule) in the intervention group increased significantly (46.8%-60.0% of the total score) in the final postintervention observation. In the average skill scores, a linear mixed model identified significant time (Pt < .001) and group (P(g) = .03) differences and time-group interactions (P(t*g) = .02) between the study groups after the HPS education. In contrast, the model did not identify any significant change over time (P(t) = .29) or time-group interactions (P(t) = .69) between groups in average knowledge scores (Ventilator Bundle Questionnaire). CONCLUSIONS Our study identified significant transfer of learned skills to clinical practice following HPS education but no influence on the level of participants' factual knowledge.
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Affiliation(s)
- Miia M Jansson
- University of Oulu Graduate School, University of Oulu, Faculty of Medicine, Institute of Health Sciences, Nursing Science, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland; Division of Intensive Care Medicine, Department of Anesthesia, Oulu University Hospital, Oulu, Finland.
| | - Tero I Ala-Kokko
- Division of Intensive Care Medicine, Department of Anesthesia, Oulu University Hospital, Oulu, Finland
| | - Pasi P Ohtonen
- Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
| | - Merja H Meriläinen
- Division of Intensive Care Medicine, Department of Anesthesia, Oulu University Hospital, Oulu, Finland
| | - Hannu P Syrjälä
- Department of Infection Control, Oulu University Hospital, Oulu, Finland
| | - Helvi A Kyngäs
- Institute of Health Science, University of Oulu, Medical Research Center Oulu, Oulu, Finland
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Zhang TT, Tang SS, Fu LJ. The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. J Clin Nurs 2013; 23:1461-75. [PMID: 23952970 DOI: 10.1111/jocn.12312] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2013] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of chlorhexidine for the prevention of ventilator-associated pneumonia and explore the preferred concentration of chlorhexidine. BACKGROUND The implementation of effective oral care measures could reduce the incidence of ventilator-associated pneumonia, but among several randomised controlled trials, whether using chlorhexidine is effective and which concentration is more appropriate remain controversial. DESIGN A meta-analysis was conducted. METHODS We searched the Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, China Biology Medicine disc and Chinese National Knowledge Infrastructure to collect randomised controlled trials of mechanically ventilated adult patients receiving oral care with chlorhexidine to prevent ventilator-associated pneumonia. The quality of randomised controlled trials was critically appraised, data were extracted by two reviewers independently, and disagreement was resolved by consensus. Meta-analyses were conducted for the eligible randomised controlled trials by revman 5.1. Relative risks and 95% CIs were calculated with the Mantel-Haenszel model, and heterogeneity was assessed with the I(2) test. RESULTS Eighteen randomised controlled trials were included and a meta-analysis was used. All studies indicated chlorhexidine could significantly prevent and reduce the incidence of ventilator-associated pneumonia [RR = 0·59, 95% CI (0·50-0·69), p < 0·00001]. Nine studies showed 0·12% chlorhexidine had a significant effect [RR = 0·53, 95% CI (0·43-0·67), p < 0·00001]. Three studies proved the effect of the 2% chlorhexidine on the prevention of ventilator-associated pneumonia [RR = 0·55, 95% CI (0·37-0·81), p = 0·002]. CONCLUSION Chlorhexidine can prevent and reduce the incidence of ventilator-associated pneumonia. Chlorhexidine of 0·12% has the best effect on the prevention of ventilator-associated pneumonia according to the meta-analysis, cost analysis, adverse reactions and drug resistance analysis. RELEVANCE TO CLINICAL PRACTICE Ventilator-associated pneumonia remains a leading cause of morbidity and mortality in intensive care unit, and implementing effective oral care can reduce the incidence of ventilator-associated pneumonia. Chlorhexidine of 0·12% is recommended in our study.
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Affiliation(s)
- Ting-Ting Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Jiaotong University School of Medicine, Shanghai, China
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Jansson M, Kääriäinen M, Kyngäs H. Effectiveness of educational programmes in preventing ventilator-associated pneumonia: a systematic review. J Hosp Infect 2013; 84:206-14. [DOI: 10.1016/j.jhin.2013.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 04/15/2013] [Indexed: 01/05/2023]
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Jansson M, Ala-Kokko T, Ylipalosaari P, Syrjälä H, Kyngäs H. Critical care nurses' knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia--a survey study. Intensive Crit Care Nurs 2013; 29:216-27. [PMID: 23566622 DOI: 10.1016/j.iccn.2013.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 02/13/2013] [Accepted: 02/16/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To explore critical care nurses' knowledge of, adherence to and barriers towards evidence-based guidelines for prevention of ventilator-associated pneumonia. DESIGN A quantitative cross-sectional survey. METHODS Two multiple-choice questionnaires were distributed to critical care nurses (n=101) in a single academic centre in Finland in the autumn of 2010. An independent-samples t-test was used to compare critical care nurses' knowledge and adherence within different groups. The principles of inductive content analysis were used to analyse the barriers towards evidence-based guidelines for prevention of ventilator-associated pneumonia. RESULTS The mean score in the knowledge test was 59.9%. More experienced nurses performed significantly better than their less-experienced colleagues (p=0.029). The overall, self-reported adherence was 84.0%. The main self-reported barriers towards evidence-based guidelines were inadequate resources and disagreement with the results as well as lack of time, skills, knowledge and guidance. CONCLUSION There is an ongoing need for improvements in education and effective implementation strategies. CLINICAL IMPLICATIONS The results could be used to inform local practice and stimulate debate on measures to prevent ventilator-associated pneumonia. Education, guidelines as well as ventilator bundles and instruments should be developed and updated to improve infection control.
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Affiliation(s)
- Miia Jansson
- Institute of Health Science, University of Oulu, Finland.
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An evidence-based oral care protocol to decrease ventilator-associated pneumonia. Dimens Crit Care Nurs 2013; 31:301-8. [PMID: 22874549 DOI: 10.1097/dcc.0b013e3182619b6f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to examine the impact of 0.12% chlorhexidine rinses and an oral care protocol on ventilator-associated pneumonia rates. A quasi-experimental preintervention-postintervention design was used. The sample included all patients admitted to critical care and on mechanical ventilation at any time during the study period. Data were collected 6 months before and 12 months after intervention. Ventilator-associated pneumonia rates were reduced from 4.3 to 1.86 per 1000 ventilator-days during the study period, with an estimated cost avoidance of $700,000 to $798,000.
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Abstract
PURPOSE OF REVIEW Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in endotracheally intubated patients. Strict adherence to preventive measures reduces the risk of VAP. The objective of this paper is to review what has come forward in recent years in the nonpharmacological prevention of VAP. RECENT FINDINGS It seems advantageous to implement care bundles rather than single prevention measures. A solid basis of knowledge seems necessary to facilitate implementation and maintain a high adherence level. Continuous educational efforts have a beneficial effect on attitude toward VAP. Intermittent subglottic secretions drainage, continuous lateral rotation therapy, and polyurethane cuffed endotracheal tubes decrease the risk of pneumonia. In an in-vitro setting, an endotracheal tube with a taper-shaped cuff appears to better prevent fluid leakage compared to cylindrical polyurethane or polyvinylchloride cuffed tubes. Cuff pressure control by means of an automatic device and multimodality chest physiotherapy need further investigation, as do some aspects of oral hygiene. SUMMARY New devices and strategies have been developed to prevent VAP. Some of these are promising but need further study. In addition, more attention is being given to factors that might facilitate the implementation process and the challenge of achieving high adherence rates.
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Elorza Mateos J, Ania González N, Agreda Sádaba M, Del Barrio Linares M, Margall Coscojuela MA, Asiain Erro MC. [Nursing care in the prevention of ventilator-associated pneumonia]. ENFERMERIA INTENSIVA 2011; 22:22-30. [PMID: 21296017 DOI: 10.1016/j.enfi.2010.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 11/22/2010] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Certain nursing interventions reduce the incidence of ventilator-associated pneumonia (VAP). OBJECTIVES a) to analyze in patients with more than 24 hours of invasive mechanical ventilation how frequently oral hygiene, oropharyngeal suction, turning and evaluation of the tolerance of enteral nutrition were performed according to established protocols; b) to record in these same patients endotracheal tube cuff pressures and the degrees of elevation of the head of the bed (HOB); c) to determine over the three months of the study the incidence density of VAP. METHOD This descriptive study was carried out in 26 patients. The nursing interventions of interest were recorded daily. Furthermore, endotracheal tube cuff pressures and the degrees of elevation of HOB were measured 3 times a day. Compliance with the established protocols was considered good when it reached ≥80%. Cases of VAP were determined using CDC criteria. The incidence density was calculated including all the patients (122) with mechanical ventilation during the study period. RESULTS Good compliance with the established protocols was achieved for oral hygiene in 23 patients, for oropharyngeal suction and for turning in 19 patients, and in all patients for the evaluation of the tolerance of enteral nutrition. In 214 measurements endotracheal tube cuff pressure was ≥ 20cm H20 and in 121 lower. In 79 measurements elevation of HOB was ≥30° and in 256 lower. The incidence density of VAP was 7.43/ 1.000 days of mechanical ventilation. CONCLUSIONS : For these nurse interventions aimed at preventing VAP, levels of compliance with established protocols were satisfactory. The incidence density of VAP was low and well within internationally established ranges. Nevertheless, the incidence of VAP could be further reduced with a better control of cuff pressures and by elevating the HOB to between 30° and 45°.
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Affiliation(s)
- J Elorza Mateos
- Diplomadas en Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarre, Spain.
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