Strategies to Enhance Adoption of Ventilator-Associated Pneumonia Prevention Interventions: A Systematic Literature Review

Background Ventilator-associated pneumonia (VAP) is among the most common health care associated infections in the intensive care unit, and is associated with significant morbidity and mortality. Existing VAP prevention intervention bundles vary widely on the interventions included, as well as in the approaches used to develop these bundles. Objective To develop a new VAP prevention bundle using a systematic approach that elicits clinician perceptions on which interventions are most important and feasible to implement. Methods We identified potential interventions to include through a review of current guidelines and literature. We implemented a two-step modified Delphi method to gain consensus on the final list of interventions. An interdisciplinary group of clinical experts participated in the Delphi process, which was guided by a technical expert panel. Results We identified 65 possible interventions. Through the Delphi method, we narrowed that list to 19 interventions that included 5 process and 14 structural measures. Conclusion We described a structured approach for developing a new VAP prevention bundle. Obtaining clinician input on what interventions to include increases the likelihood that providers will adhere to the bundle.

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“…Furthermore, many guidelines lack practical advice to assist readers with implementation of the recommendations. 23 …”

Section: Discussionmentioning

confidence: 99%

A systematic approach for developing a ventilator-associated pneumonia prevention bundle

Speck

Rawat

Weiner

et al. 2016

American Journal of Infection Control

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“…28 These authors also mentioned multidisciplinary teamwork, involvement of champions, and networking among peers as engagement strategies. 28 Another systematic review showed that improvement in adherence to preventive measures occurred once audit and feedback of adherence rates with or without reminder systems were introduced in addition to organizational change efforts and education of frontline healthcare practitioners (HCPs). 29 Generally, it is well accepted that theorybased implementation strategies are more effective in achieving sustained behavior changes.…”

Section: (Received 8 May 2018; Accepted 22 July 2018)mentioning

confidence: 99%

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

Wolfensberger

Meier

Clack

et al. 2018

Infect. Control Hosp. Epidemiol.

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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...

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“…[ 4 ] Respiratory care include suctioning airways, oral care, oxygen therapy, respiratory monitoring, and care related to the prevention of ventilator-associated pneumonia (VAP). [ 5 ] Many studies have indicated complications caused by improper respiratory care in ICU,[ 6 ] for instance, VAP. [ 7 ] Statistics published in Iran suggest that 10% of patients undergoing general surgery, 20% of patients with endotracheal intubation, and 70% of those with acute respiratory distress suffer pneumonia during their stay in ICU.…”

Section: Introductionmentioning

confidence: 99%

Performance of ICU nurses in providing respiratory care

Yazdannik

Atashi

Ghafari

2018

Iranian J Nursing Midwifery Res

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Background:Failure to provide proper respiratory care leads to incidence of certain complications such as ventilator-associated pneumonia. Nurses have a crucial role in providing this care. The aim of this study is to assess the performance of ICU (Intensive Care Unit) nurses in providing respiratory care.Materials and Methods:The present descriptive cross-sectional study recruited 120 nurses working in selected hospitals affiliated to Isfahan University of Medical Sciences from March to August 2016. The questionnaire used included demographic and employment details and performance observation checklist (containing 39 items in four care domains) based on recommendations in clinical guidelines. The performance of each nurse during a working shift was observed. Data were analyzed by SPSS 18, using tables of frequency, mean, and standard deviation.Results:According to the results obtained, mean (SD) total performance score of nurses in providing respiratory care was 15.46 (2.16). The highest score was obtained in preventing contamination of respiratory equipment 5 (0), and the lowest score was in oral care 0.68 (0.73).Conclusions:Considering that respiratory care is one of the main pillars of patient care in ICU and that nurses scored poorly in this area, it is imperative to pay greater attention to this area. It is essential to provide necessary training to nurses and adequate facilities for improving the quality of clinical care.

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Strategies to Enhance Adoption of Ventilator-Associated Pneumonia Prevention Interventions: A Systematic Literature Review

Cited by 14 publications

References 44 publications

A systematic approach for developing a ventilator-associated pneumonia prevention bundle

A systematic approach for developing a ventilator-associated pneumonia prevention bundle

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

Performance of ICU nurses in providing respiratory care

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