Evidence-Based Practice: Use of the Ventilator Bundle to Prevent Ventilator-Associated Pneumonia

Abstract

• Purpose To examine critical care nurses’ knowledge about the use of the ventilator bundle to prevent ventilator-associated pneumonia. • Method Published reports were reviewed for current evidence on the use of the ventilator bundle to prevent ventilator-associated pneumonia, and education sessions were held to present the findings to 61 nurses in coronary care and surgical intensive care units. Changes in the nurses’ knowledge were evaluated by using a 10-item test, given both before and after the sessions. Changes in the nurses’ practices related to ventilator-associated pneumonia, including elevation of the head of the bed to 30° to 45°, were observed in 99 intubated patients. • ResultsAfter the education sessions, the nurses performed better on 8 of the 10 items tested (P from .03 to <.001). The areas of most significant improvement were elevation of the head of the bed (P < .001), charting of the elevation of the head of the bed (P= .009), oral care (P= .009), checking of the nasogastric tube for residual volume (P = .008), washing of hands before contact with patients (P < .001), and limiting the wearing of rings (P < .001) and nail polish (P = .04). Even after the education sessions, the nurses’ compliance with hand-washing recommendations before contact with patients was low, though statistically some improvement was apparent. Contraindications to elevation of the head of the bed did not appear to affect the nurses’ practices (P= .38). • Conclusion Education sessions designed to inform nurses about the ventilator bundle and its use to prevent ventilator-associated pneumonia have a significant effect on participants’ knowledge and subsequent clinical practice.

Knowledge level of nurses in Jordan on ventilator‐associated pneumonia and preventive measures

“…All nurses had good scores in the posttest. This result was congruent with the findings of Tolentino‐DelosReyes (Tolentino‐DelosReyes et al , ) who had found that after using 30‐min education sessions to educate critical care nurses on VAP prevention strategies, the nurses performed more oral care on their intubated patients and performed better hand hygiene.…”

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

“…The most common self-reported adherences were related to VB including semi-recumbent positioning (CDC, 2003;IHI, 2006), adequate hand hygiene (CDC, 2003;Rello et al, 2010), and formal infection control programs, which may be due to well-implemented guidelines. However, self-reported adherences to hand hygiene (Berhe et al, 2005;CDC, 2007;De Wandel et al, 2010;Sahay et al, 2010;Tolentino-DelosReyes et al, 2007;WHO, 2009), oral care (Cutler and Davis, 2005;Furr et al, 2004;Jones et al, 2004) and ETS practices (Day et al, 2002; were generally higher than reported in previous prospective, observational studies.…”

Using Evidence-Based Practice to Prevent Ventilator-Associated Pneumonia

“…13 Components of the 2010 bundle included elevation of the head of the bed (HOB) 30º to 45º, prophylaxis for peptic ulcer disease (PUD), prophylaxis for deep-vein thrombosis (DVT), daily interruption of sedation, daily assessment of readiness for extubation, and daily oral care with chlorhexidine. Several investigators 9,14,15 examined the efficacy of the IHI bundled practices and found that bundled practices were effective in reducing the rate of VAP.…”