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Implementing a Unit-Level Intervention to Reduce the Probability of Ventilator-Associated Pneumonia

Bingham, Mona; Ashley, Jeffrey; De Jong, Marla; Swift, Caren

doi: 10.1097/NNR.0b013e3181c3bffc
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Background: Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection and is associated with high morbidity and mortality rates for mechanically ventilated patients in the intensive care unit. Routine nursing interventions have been shown to reduce VAP rates.

Objectives: The purpose of this study was to evaluate the effectiveness of a unit-specific education intervention that emphasized hand hygiene, head-of-the-bed elevation, and oral care. The goals were to improve staff compliance with hand washing, head-of-the-bed elevation, and oral care; to decrease VAP rates, and to decrease number of ventilator days.

Methods: Two-hour observations were conducted on a convenience sample of 100 ventilated patients not diagnosed with VAP and the clinical staff that interacted with them. Instrumentation included a compliance checklist, a demographic patient survey, and the Acute Physiology and Chronic Health Evaluation ÆIV® tool. Unit-specific educational interventions were designed and implemented on each participating unit.

Results: The VAP and the ventilator day rates did not improve significantly. There were no significant changes in clinician adherence to hand hygiene, provision of oral care, or patient positioning.

Discussion: Despite implementation of both structured and creative education, team-based approach, and frequent staff reminders, patient outcomes and staff compliance did not improve significantly. Unit-based education interventions may not be the best strategy to facilitate change. Organizations with frequent changes in personnel and leadership may not have the unit-level infrastructure necessary to attain and sustain change.

Mona Bingham, PhD, RN, is Lieutenant Colonel, U.S. Army, Chief, Nursing Research Services, Brooke Army Medical Center, Ft. Sam Houston, Texas.

Jeffrey Ashley, PhD, RN, is Colonel, U.S. Army, Chief Critical Care Nursing Services, Brooke Army Medical Center, Ft. Sam Houston, Texas.

Marla De Jong, PhD, RN, is Lieutenant Colonel, U.S. Air Force, Executive Director, Triservice Nursing Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Caren Swift, RN, BSN, is Project Director, Brooke Army Medical Center, Ft. Sam Houston, Texas.

Accepted for publication April 30, 2009.

The authors would like to acknowledge and thank the project team from the initial project for their preliminary work on this phase and findings from the initial EBP project. Our thanks to Dr. C. Abbott, Dr. T. Dremsa, Dr. D. Stewart, Dr. D. Mark, and Ms. C. Swift.

This project was funded by an award from the TriService Nursing Research Program, grant no. N03-P18 by Principal Investigator, CAPT Patricia Kelley. The Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Rd., Bethesda, MD 20814-4799, is the awarding and administering office.

The views and opinions expressed in this article are solely those of the authors and do not reflect the policy or position of the Department of the Army, the Department of Defense, or the U.S. Government. This project was sponsored by the TriService Nursing Research Program, Uniformed Services University of the Health Sciences; however, the information or content and conclusions do not necessarily represent the official position or policy of, nor should any official endorsement be inferred by, the TriService Nursing Research Program, Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government.

Corresponding author: Mona Bingham, PhD, RN, Lieutenant Colonel, U.S. Army, Chief, Nursing Research Services, Brooke Army Medical Center, Ft. Sam Houston, TX 78234-6200 (e-mail: Mona.bingham@us.army.mil).

© 2010 Lippincott Williams & Wilkins, Inc.