Clinical Problem Selected: Ventilator Acquired Pneumonia

Title of the article: Use of Ventilator Bundle and Staff Education to Decrease Ventilator-Associated Pneumonia in Intensive Care Patients 

Quantitative: Yes 

Nurse author of article: Maria Parisi 

Abstract: 

Background 

Ventilator-associated pneumonia (VAP), one of the most common hospital-acquired infections, has a high mortality rate. 

Objectives 

To evaluate the incidence of VAP in a multidisciplinary intensive care unit and to examine the effects of the implementation of ventilator bundles and staff education on its incidence. 

Methods 

A 24-month-long before/after study was conducted, divided into baseline, intervention, and postintervention periods. VAP incidence and rate, the microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit were recorded and compared between the periods. 

Results 

Of 1097 patients evaluated, 362 met the inclusion criteria. The baseline VAP rate was 21.6 per 1000 ventilator days. During the postintervention period, it decreased to 11.6 per 1000 ventilator days (P = .01). Length of stay in the intensive care unit decreased from 36 to 27 days (P = .04), and duration of mechanical ventilation decreased from 26 to 21 days (P = .06). 

Conclusions 

VAP incidence was high in a general intensive care unit in a Greek hospital. However, implementation of a ventilator bundle and staff education has decreased both VAP incidence and length of stay in the unit. 

Reference in APA format 

Parisi, M., Gerovasili, V., Dimopoulos, S., Kampisiouli, E., Goga, C., Perivolioti, E., ... & Nanas, S. (2016). Use of ventilator bundle and staff education to decrease ventilator-associated pneumonia in intensive care patients.  Critical Care Nurse ,  36 (5), e1-e7. 

Citation in a sentence of your choosing 

According to Parisi et al. (2016), the incidence of ventilator associated pneumonia (VAP) in hospitals can be reduced by the educating health care workers on the use of a ventilator bundle. 

Title of the article: Nursing workload and compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia: a multicentre study 

Qualitative: Yes 

Nurse author of article: Rosa Jam 

Abstract: 

Background 

Ventilator‐associated pneumonia is common and associated with high mortality. Nurses play a fundamental role in preventing ventilator‐associated pneumonia. Evidence‐based guidelines and training interventions about preventing ventilator‐associated pneumonia do not ensure compliance with recommendations. 

Aims and objective 

To evaluate the impact of nursing workload on compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia. 

Design 

A prospective observational study in two medical‐surgical adult ICUs in Spain. 

Methods 

We measured nurses' knowledge about preventing ventilator‐associated pneumonia through a questionnaire and workload, categorized with the Nine Equivalents of Nursing Manpower Use Score. We directly observed nurses to measure compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia. 

Results 

A total of 97 nurses were studied; 76 (79%) were observed. There were 327 observations (mean 4·30 observations per nurse). The questionnaire showed good baseline knowledge of preventive measures [mean score (92% ± 16%)]. 

Nurses complied with the preventive measures in 66% ± 15% of observations; compliance ranged from 11·9% for pre‐aspiration hand washing to 99·7% for using sterile aspiration probes. Mean Nine Equivalents of Nursing Manpower Use Score for each nurse observed was 50 ± 13, without differences between centres (49 ± 14 versus 51 ± 11, p = 0·4). Overall compliance was lower in the light workload group (p = 0·02), but no significant differences in compliance between workload groups were found when each measure was analysed separately. Compliance was higher in nurses aged 31–40 years than in those aged >51 years, although workload was similar in both groups. 

Conclusions 

Compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia varies widely; non‐compliance is not because of increased workload. 

Relevance to clinical practice 

Most critical care nurses have good baseline knowledge of non‐pharmacological measures to prevent ventilator‐associated pneumonia. Failure to comply with these measures is probably more related with behavioural, structural and organizational aspects than with nursing workload. Interventions to improve compliance might be more effective if they focus on factors such as work climate and professionals' attitudes. 

Reference in APA format 

Jam, R., Mesquida, J., Hernández, Ó., Sandalinas, I., Turégano, C., Carrillo, E., ... & Salamero, M. (2018). Nursing workload and compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia: a multicentre study.  Nursing in critical care ,  23 (6), 291-298. 

Citation in a sentence of your choosing 

Non-pharmacological interventions that help reduce the incidence of ventilator associated pneumonia (VAP) should focus on critical care nurses, especially their knowledge base and compliance with existing protocols (Jam et al., 2018). 

References 

Jam, R., Mesquida, J., Hernández, Ó., Sandalinas, I., Turégano, C., Carrillo, E., ... & Salamero, M. (2018). Nursing workload and compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia: a multicentre study.  Nursing in critical care ,  23 (6), 291-298. 

Parisi, M., Gerovasili, V., Dimopoulos, S., Kampisiouli, E., Goga, C., Perivolioti, E., ... & Nanas, S. (2016). Use of ventilator bundle and staff education to decrease ventilator-associated pneumonia in intensive care patients.  Critical Care Nurse ,  36 (5), e1-e7.