Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based guidelines for the prevention of ventilator-associated pneumonia – A survey study

Summary

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.

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:

• What do critical care nurses know about EBGs for prevention of VAP?

• To what extent do critical care nurses adhere to EBGs for prevention of VAP?

• What are the barriers towards EBGs for prevention of VAP?