Preventing ventilator-associated pneumonia—a mixed-method study to find behavioral leverage for better protocol adherence

Abstract

OBJECTIVE Preventing ventilator-associated pneumonia (VAP) is an important goal for intensive care units (ICUs). We aimed to identify the optimal behavior leverage to improve VAP prevention protocol adherence. DESIGN Mixed-method study using adherence measurements to assess 4 VAP prevention measures and qualitative analysis of semi-structured focus group interviews with frontline healthcare practitioners (HCPs). SETTING The 6 ICUs in the 900-bed University Hospital Zurich in Zurich, Switzerland.Patients and participantsAdherence to VAP prevention measures were assessed in patients with a device for invasive ventilation (ie, endotracheal tube, tracheostomy tube). Participants in focus group interviews included a convenience samples of ICU nurses and physicians. RESULTS Between February 2015 and July 2017, we measured adherence to 4 protocols: bed elevation showed adherence at 27% (95% confidence intervals [CI], 23%-31%); oral care at 41% (95% CI, 36%-45%); sedation interruption at 81% (95% CI, 74%-85%); and subglottic suctioning at 88% (95% CI, 83%-92%). Interviews were analyzed first inductively according a grounded theory approach then deductively against the behavior change wheel (BCW) framework. Main behavioral facilitators belonged to the BCW component 'reflective motivation' (ie, perceived seriousness of VAP and self-efficacy to prevent VAP). The main barriers belonged to 'physical capability' (ie, lack of equipment and staffing and side-effects of prevention measures). Furthermore, 2 primarily technical approaches (ie, 'restructuring environment' and 'enabling HCP') emerged as means to overcome these barriers. CONCLUSIONS Our findings suggest that technical, rather than education-based, solutions should be promoted to improve VAP prevention. This theory-informed mixed-method approach is an effective means of guiding infection prevention efforts. Abstract Objective: Preventing ventilator-associated pneumonia (VAP) is an important goal for intensive care units (ICUs). We aimed to identify the optimal behavior leverage to improve VAP prevention protocol adherence. Design: Mixed-method study using adherence measurements to assess 4 VAP prevention measures and qualitative analysis of semi-structured focus group interviews with frontline healthcare practitioners (HCPs). Setting: The 6 ICUs in the 900-bed University Hospital Zurich in Zurich, Switzerland. Patients and participants: Adherence to VAP prevention measures were assessed in patients with a device for invasive ventilation (ie, endotracheal tube, tracheostomy tube). Participants in focus group interviews included a convenience samples of ICU nurses and physicians. Results: Between February 2015 and July 2017, we measured adherence to 4 protocols: bed elevation showed adherence at 27% (95% confidence intervals [CI], 23%-31%); oral care at 41% (95% CI, 36%-45%); sedation interruption at 81% (95% CI, 74%-85%); and subglottic suctioning at 88% (95% CI, 83%-92%). Interviews were analyzed first inductively according a grounded theory approach then de...

Probiotics for the Prevention of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Controlled Trials

“…Ventilator-associated pneumonia (VAP) is defined as an infectious inflammatory reaction of the lung parenchyma that occurs after mechanical ventilation for >48 h. VAP is a common and severe complication in mechanically ventilated patients and can lead to a prolonged hospital stay, increased medical costs, and a higher mortality risk. 1,2 The incidence of VAP in the United States is $4.4 cases per 1,000 mechanical ventilation days, 3 and it has become an important cause of death in patients who receive mechanical ventilation. The pathogenesis of VAP is mainly due to bacterial colonization of the upper respiratory tract and inhalation of contaminated secretions into the lower respiratory tract.…”

“…6 They can selectively stimulate the growth of some bacteria and improve the microecological balance of the host. 9 The positive effects of probiotics on VAP may include (1) strengthening the gut barrier function, (2) reducing the overgrowth of potential pathogens, and (3) stimulating immune responses. 10,11 However, whether probiotics can effectively prevent VAP remains controversial.…”

Documentation of Adherence To Infection Prevention Best Practice in Patient Records – A Mixed-Methods Investigation

“…An exception to the described pattern is noteworthy, regarding the rule of 30° headrest elevation. At the time of the study this was part of an intervention to reduce VAP and was monitored through established documentation [14]. Forth, it was sometimes impossible to infer IP standard adherence from EMR data due lacking detail in the description of a speci c process, e.g., the use of sterile gloves and gowns during surgery, the insertion of drains through a separate incision, and the performance of hand hygiene before and after insertion of a catheter, etc.…”

Conocimientos Sobre Infecciones Asociadas a La Atención De Salud Y Su Prevención en Estudiantes De Enfermería De Séptimo Y Octavo Semestre De La Universidad Técnica De Ambato

“…Los principales factores predisponentes de las IAAS son los procedimientos médicos invasivos que producen disrupción de las defensas naturales del hospedador, por el uso de un dispositivo o una incisión que permiten que los microorganismos de la microbiota normal del paciente (flora endógena) invadan los tejidos, como las intervenciones quirúrgicas, los catéteres vasculares centrales y periféricos, que se utilizan frecuentemente para la administración de medicamentos, nutrición parenteral, monitorización hemodinámica, hemodiálisis, los catéteres vesicales de los pacientes hospitalizados para el control de la diuresis (6), traqueostomías y la ventilación mecánica que conlleva a la perdida de mecanismos de defensas como la tos produciendo microaspiraciones y neumonía asociada a la ventilación mecánica (7)(8)(9).…”