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Most of critically ill patients need mechanical ventilator (MV) which assists or replaces spontaneous breathing. Mechanically ventilated patients are more likely to develop pulmonary infection and ventilated associated pneumonia (VAP). Intubation bypasses the normal airway protective mechanisms and acts as a direct route for bacterial invasion to the airway. VAP has been associated with increased morbidity, longer hospital stay, increased health care costs, and higher mortality rates. Critical care nurse has an important and crucial role in preventing VAP. Evidence indicates that training of critical care nurses about the implementation of VAP Prevention Bundle had a great effect on decreasing the incidence of VAP. Therefore, this study was conducted to determine the effect of nurses training on VAP Prevention Bundle on VAP incidence Rate at a Critical Care Unit.

Objective: To compare physiologic measures and the incidence of ventilator associated pneumonia (VAP) using different modalities of endotrachael tube (ETT) suctioning. Methods: A Quasi-experimental design was used with 80 adults in an intensive care unit. Two modalities of suctioning were compared: 1) not instilling normal saline (NS) into the ETT before suctioning, and 2) instilling NS into the ETT tube before suctioning. The outcome variables were: physiologic measures (heart rate, respiratory rate and blood pressure and oxygen saturation), the incidence of Ventilator Associated Condition (VAC) and Possible Ventilator Associated Pneumonia (PVAP) at day 5 after mechanical ventilation. Results: There were no differences in the physiologic measures assessed at day 5 and a significantly higher rate of VAC in patients who had NS installed (p = .009). Four patients developed PVAP compared to 10 patients in group 2 where NS was installed but that did to reach significance (p = .077). Factors associated with VAC were age, WBC > 12,000, antibiotic use, amount of secretions, and NS installation. The same factors were associated with the development of PVAP with the exception of NS installation which did not reach significance. Conclusions: Installing NS in the ETT tube did not result in significant physiologic changes at day 5, and more rates of VAC and PVAP were noted. Therefore, the use of this procedure is questionable and further studies are needed to provide conclusive evidence.