Original articleCritical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia – A survey study
Introduction
Ventilator-associated pneumonia (VAP) is the commonly encountered (12–33.8%) nosocomial infection in critical care situations (Karhu et al., 2011, Ylipalosaari et al., 2006). Previous prevalence and prospective cohort studies have shown that VAP is associated with high morbidity and mortality rates as well as prolonged lengths of intensive care unit (ICU) and hospital stay (Babcock et al., 2004, Ylipalosaari et al., 2006). Prevention of this nosocomial infection could reduce costs and improve patient-related outcomes and patient safety and the quality of care (Babcock et al., 2004, Marra et al., 2009, Safdar et al., 2005).
Routine critical care nursing interventions have been shown to reduce the incidence of VAP (Ricart et al., 2003). The Institute for Healthcare Improvement (IHI, 2006), the Centers for Disease Control and Prevention (CDC, 2003) and Rello et al. (2010) have designed VAP bundles (VBs) to help reduce or eliminate VAP and promote adherence to evidence-based guidelines (EBGs), in order to improve patient outcomes (Table 1).
According to previous studies, critical care nurses’ knowledge about EBGs for preventing VAP is currently limited (Blot et al., 2007, Labeau et al., 2008). The lack of knowledge may be a barrier towards adherence to EBGs (El-Khatib et al., 2010). Despite frequent reminders and supplementary education, adherence (Gurses et al., 2008, Ricart et al., 2003) and attitudes (Kaynar et al., 2007, Pogorzelska and Larson, 2008) towards EBGs are reportedly poor. Further research is needed to evaluate critical care nurses’ knowledge, attitudes and beliefs in order to understand, inform and develop current practices for VAP prevention (Ajzen, 2005), especially in Scandinavia, where the topic has largely been undiscussed in contrast to the Middle East (El-Khatib et al., 2010) and the majority of European countries (Blot et al., 2007, Labeau et al., 2008, Ricart et al., 2003).
The objectives of this study were to explore critical care nurses’ knowledge of, adherence to and barriers towards EBGs for prevention of VAP. The key research questions were as follows:
- (1)
What do critical care nurses know about EBGs for prevention of VAP?
- (2)
To what extent do critical care nurses adhere to EBGs for prevention of VAP?
- (3)
What are the barriers towards EBGs for prevention of VAP?
Section snippets
Design
A quantitative cross-sectional survey was conducted based on two pre-validated multiple-choice questionnaires developed to explore critical care nurses’ knowledge of, adherence to and barriers towards EBGs for prevention of VAP.
Sample and settings
The study was conducted in a single academic centre in Finland in a 22-bed mixed adult general ICU in the autumn of 2010. Participants were selected for the survey using convenience (accidental) sampling: participants were included in the survey if they happened to be in
Demographics
The questionnaires were distributed to available critical care nurses (n = 101). The final response rates ranged from 56.4% (registered nurses) to 100% (nursing assistants). Demographic information of the study participants is shown in Table 2. The majority of participants (89.1%) were registered nurses, often with >10 yrs ICU experience (40.6%).
Knowledge
The mean score (Fig. 1) in the knowledge test was 5.99 (SD 1.40) based on ten questions (i.e., 59.9% correct answers), and 66.3% of participants achieved
Discussion
The study was conducted in a single university hospital and based on a nonprobability method of sampling. Therefore, it is difficult to generalise the results. Critical care nurses’ mean score in the knowledge test was 59.9%, whereas previous studies have reported mean scores ranging from 41.2% (Blot et al., 2007) to 78.1% (El-Khatib et al., 2010). The variability of the scores might be due to differences between the specific healthcare delivery models (El-Khatib et al., 2010), routine critical
Conclusions
The average knowledge level was low. Professional experience was shown to be associated with better knowledge scores. A number of helpful barriers towards EBGs were identified. There is an ongoing need for improvements in education and effective implementation strategies.
Ethical considerations
Approval for the survey was obtained from University Hospital. In Finland, according to the Medical Research Act (488/1999, and amendments 295/2004), approval of the local ethics committee is not required in studies focusing on staff members. Submission of a questionnaire was considered consent to participating in the study. Participants were assured of the voluntary nature of their participation. The anonymity of data was assured by coding the data. The data were stored on a password-protected
Conflict of interest
None.
Funding
None.
Contributions
M.J., T.A.K. and H.K. contributed to the study design. M.J. contributed to data collection and analysis. M.J., T.A.K., P.Y., H.S. and H.K. contributed to manuscript preparation.
Acknowledgements
The authors wish to thank all the critical care nurses who participated in this study and head nurses who participated in data collection. Also, the assistance of Mrs. H. Laukkala with the statistical analysis is highly appreciated.
References (58)
Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways
Respir Care
(2010)Attitudes, personality and behavior
(2005)- 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) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia
AJRCCM
(2005)- et al.
An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects
Chest
(2004) - et al.
Practices and an assessment of health care workers’ perceptions of compliance with infection control knowledge of nosocomial infections
AJCC
(2005) - et al.
Eliminating nosocomial infections at ascension health
J Qual Patient Saf
(2006) - et al.
Adherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit
Arch Surg
(2010) - et al.
Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit
AJIC
(2009) - et al.
Effects of staff training on the care of mechanically ventilated patients: a prospective cohort study
BJA
(2009)
Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses
Int Care Med
A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures
Crit Care Med
Long-term impact of a multifaceted prevention program on ventilator-associated pneumonia in a medical intensive care unit
CID
The practice of nursing research: appraisal, synthesis, and generation of evidence
Why don’t physicians follow clinical practice guidelines?
JAMA
Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia
Crit Care Med
Nurse's implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention
AJCC
Recommendations on prevention of ventilator-associated pneumonia
A low-sodium solution for airway care: results of a multicenter trial
Respir Care
Decreasing ventilator-associated pneumonia in a trauma ICU
J Trauma
An evaluation of the impact of the ventilator care bundle
Nurs Crit Care
Improving oral care in patients receiving mechanical ventilation
AJCC
Tracheal suctioning: an exploration of nurse's knowledge and competence in acute and high dependency ward areas
JAN
Behavioral determinants of hand hygiene compliance in intensive care units
AJCC
Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia
Ann Int Med
Critical care clinicians’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia
AJCC
The qualitative content analysis process
JAN
Cited by (61)
Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis
2023, Journal of Intensive MedicineORAL CARE TO REDUCE COSTS AND INCREASE CLINICAL EFFECTIVENESS IN PREVENTING NOSOCOMIAL PNEUMONIA: A SYSTEMATIC REVIEW
2023, Journal of Evidence-Based Dental PracticeTreatment and Management of Acinetobacter Pneumonia: Lessons Learned from Recent World Event
2024, Infection and Drug ResistanceHealthcare workers' knowledge of evidence-based guidelines for prevention of ventilator-associated pneumonia in Hodeida, Yemen
2023, Journal of Basic and Clinical Physiology and Pharmacology