Effects of active and passive implementation of ventilator associated pneumonia guideline on nurses’ performance in critical care units: A controlled clinical trial
,
Abstract
Background & Aim: Ventilator associated pneumonia (VAP) is the most common infections in critical care units, which leads to more length of hospital stay, costs, and high mortality. Therefore, prevention is a priority according to clinical guidelines. The aim of this study is determine the effects of passive versus active implementation of VAP guidelines on nurses’ performance in critical care units.
Methods & Materials: In this controlled clinical trial, 110 nurses who working in critical care units in selected hospitals affiliated to Tehran University of Medical Sciences were enrolled to study by convenience sampling at three groups, including active intervention group (n = 40), passive intervention (n = 36), and control (n = 34). First, nurses’ performance in prevention of VAP was evaluated by an observational checklist. In passive intervention group, posters containing recommendations of prevention of VAP was installed over the wall for each bed. In active intervention group, in addition to poster installation, there were training sessions with feedback on nurses’ performance. In control group without any intervention, just nurses’ preventative performance was evaluated before and 1 month later. A month later the nurses’ performance were observed. Data were analyzed by descriptive and inferential tests (Fisher’s exact test, chi-square, ANOVA, and paired t-test) in SPSS version 16.
Results: Results showed that the nurses’ mean percentage score in three groups was 46.80 ± 5.79 and after intervention it changed from 47.76 ± 4.61 to 63.32 ± 6.97 (P < 0.001) in active group, from 45.24 ± 5.72 to 55.03 ± 10.20 (P < 0.001) in passive group and 47.33 ± 6.86 to 47.90 ± 6.06 in control group (P = 0.263). Nurses’ performance in active group improved significantly in comparison to passive group and in passive group, it improved significantly in comparison to control group (P < 0.001).
Conclusion: The results of this study showed that both active and passive methods are effective on nurses’ performance in prevention of VAP. Therefore, considering the existing situation in the country and the high workload of nurses, we can offer VAP guideline as a protocol in critical care units.
Bouzbid S, Gicquel Q, Gerbier S, Chomarat M, Pradat E, Fabry J, et al. Automated de- tection of nosocomial infections: evaluation of different strategies in an intensive care unit 2000-2006. J Hosp Infect 2011; 79(1): 38-43.
Finch AM. All-or-none: A ventilator- associated pneumonia prevention strategy [Thesis]. Duluth, Minnesota: The College of St. Scholastica 2010.
Rebmann T, Greene LR. Preventing ventila- tor-associated pneumonia: An executive summary of the Association for Profession- als in Infection Control and Epidemiology, Inc, Elimination Guide. Am J Infect Control 2010; 38(8): 647-9.
Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia: A review. European Journal of Internal Medicine 2010; 21(5): 360-8.
Apisarnthanarak A, Pinitchai U, Thongphu- beth K, Yuekyen C, Warren DK, Zack JE, et al. Effectiveness of an educational program to reduce ventilator-associated pneumonia in a tertiary care center in Thailand: a 4-year study. Clin Infect Dis 2007; 45(6): 704-11.
Ghazvini K, Ghanaat J, Malek jafarian M, Yazdan Panah M, Irani N. Incidence of Nosocomial Pneumonia And Bacterial Agents Causing This Infection in Intensive Care Unit in Ghaem University Hospital in Mashhad. J Ilam Univ Med Sci 2005; 13(4): 55-62. [In Persian].
Nassaji M, Mosavi S, Ghorbani R. Incidenc- es of nosocomial pneumonia in patients above 15 years in intensive care units of university hospital in Semnan. Koomesh 2004; 5(1): 89-94. [In Persian].
Ban KO. The effectiveness of an evidence- based nursing care program to reduce venti- lator-associated pneumonia in a Korean ICU. Intensive Crit Care Nurs 2011; 27(4): 226-32.
Association for Professionals in Infection Control and Epidemiology. Guide to the elimination of ventilator-associated pneu- monia [Online]. [cited 2009]; Available from: URL: http://www.apic.org/Resource_/Elimination GuideForm/18e326ad-b484-471c-9c35- 6822a53ee4a2/File/VAP_09.pdf
Ruffell A, Adamcova L. Ventilator- associated pneumonia: prevention is better than cure. Nurs Crit Care 2008; 13(1): 44-53.
Hawe CS, Ellis KS, Cairns CJ, Longmate A. Reduction of ventilator-associated pneumo- nia: active versus passive guideline imple- mentation. Intensive Care Med 2009; 35(7): 1180-6.
Rosenthal VD, Alvarez-Moreno C, Villamil- Gomez W, Singh S, Ramachandran B, Navoa-Ng JA, et al. Effectiveness of a mul- tidimensional approach to reduce ventilator- associated pneumonia in pediatric intensive care units of 5 developing countries: Interna- tional Nosocomial Infection Control Consor- tium findings. Am J Infect Control 2012; 40(6): 497-501.
Kaynar AM, Mathew JJ, Hudlin MM, Gingras DJ, Ritz RH, Jackson MR, et al. At- titudes of respiratory therapists and nurses about measures to prevent ventilator- associated pneumonia: a multicenter, cross- sectional survey study. Respir Care 2007; 52(12): 1687-94.
Gallagher JA. Implementation of ventilator- associated pneumonia clinical guideline (Bundle). The Journal for Nurse Practition- ers 2012; 8(5): 377-82.
Marra AR, Cal RG, Silva CV, Caserta RA, Paes AT, Moura DF, Jr., et al. Successful prevention of ventilator-associated pneumo- nia in an intensive care setting. Am J Infect Control 2009; 37(8): 619-25.
Bird D, Zambuto A, O'Donnell C, Silva J, Korn C, Burke R, et al. Adherence to venti- lator-associated pneumonia bundle and inci- dence of ventilator-associated pneumonia in the surgical intensive care unit. Arch Surg 2010; 145(5): 465-70.
Bouadma L, Mourvillier B, Deiler V, Derennes N, Le CB, Lolom I, et al. Changes in knowledge, beliefs, and perceptions throughout a multifaceted behavioral pro- gram aimed at preventing ventilator- associated pneumonia. Intensive Care Med 2010; 36(8): 1341-7.
Onion CW, Bartzokas CA. Changing atti- tudes to infection management in primary care: a controlled trial of active versus pas- sive guideline implementation strategies. Fam Pract 1998; 15(2): 99-104.
Al-Tawfiq JA, Abed MS. Decreasing venti- lator-associated pneumonia in adult inten- sive care units using the Institute for Healthcare Improvement bundle. Am J In- fect Control 2010; 38(7): 552-6.
Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advi- sory Committee. MMWR Recomm Rep 2004; 53(RR-3): 1-36.
Getting started kit: prevent ventilator- associated pneumonia: how-to guide. Crit Care Nurs Q 2006; 29(2): 157-73.
Seto Wing H, Cheng Chi Fung J, Ching Tai Yin P, Ho Pak L, Kwan Kai Cho J, Leung Lai Man R, et al. Recommendations on prevention of ventilator-associated pneumonia [Online]. [cited 2010 Jun]; Available from: URL: http://www.chp.gov.hk/files/pdf/recommend ations_on_prevention_of_ventilator- associated_pneumonia_r.pdf
Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, et al. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can J Infect Dis Med Microbiol 2008; 19(1): 19-53.
SARI Working Group. Guidelines for the prevention of ventilator-associated pneumo- nia in adults in Ireland. Dublin, Ireland: Health Protection Surveillance Centre; 2011.
Coffin SE, Klompas M, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strat- egies to prevent ventilator-associated pneu- monia in acute care hospitals. Infect Control Hosp Epidemiol 2008; 29(Suppl 1): S31-S40.
Allah-Bakhshian A, Moghaddasian S, Za- manzadeh V, Parvan K, Allah-Bakhshian M. Knowledge, attitude, and practice of ICU nurses about nosocomial infections control in teaching hospitals of Tabriz. Iran J Nurs 2010; 23(64): 17-28. [In Persian].
Reiss-Karimian F, Rostaminejad A. As- sessment of knowledge and practice of nurs- es in Yasuj hospitals about nosocomial in- fections. Armaghane-danesh 2003; 8(3): 41- 5. [In Persian].
Biancofiore G, Barsotti E, Catalani V, Landi A, Bindi L, Urbani L, et al. Nurses' knowledge and application of evidence- based guidelines for preventing ventilator- associated pneumonia. Minerva Anestesiol 2007; 73(3): 129-34.
| Files | ||
| Issue | Vol 1 No 3 (2014): Summer | |
| Section | Original Article(s) | |
| Keywords | ||
| prevention of ventilator associated pneumonia guideline nurses’ performance critical care unit controlled clinical trial | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
