Assessment of Knowledge and Implementation Practices of the Ventilator-Acquired Pneumonia Bundle in a Private Hospital

Abstract

Background: Ventilator-acquired pneumonia (VAP) is estimated to occur in 9%–27% of patients intubated for >48 hours, and despite advances in antibiotic therapy, it remains a significant cause of morbidity and mortality. Several studies have shown that a VAP bundle significantly decreases VAP rates. In 2017, VAP rates in our institution peaked at 7.92 per 1,000 ventilator days despite perceived good adherence to the bundles of care. Methods: We performed a prospective, descriptive cross-sectional study using both quantitative (eg, validated questionnaires) and qualitative methods (eg, small group discussion and direct observation of practices) to assess the knowledge, attitudes and practices of infection control preventionists (ICPs) and intensive care unit (ICU) nurses regarding VAP prevention and the VAP bundle. Results: Of the 89 ICU nurses and 5 ICPs, we included 60 respondents, of whom 56 were ICU nurses, and 4 were ICPs. Median experience for nurses was 6 years (range, 0.67–16) and was 2 years (range, 2–4) for ICPs. Only 1 ICP had formal training on the VAP bundle, and only 1 ICU nurse had a master’s degree in nursing. Only 23 of 56 nurses (41%) reported that they had had formal training regarding the VAP bundle. Mean knowledge score regarding evidence-based VAP guidelines was 5 of 10 points (range, 3–8). Questions regarding mechanical ventilator operations had the lowest scores. Self-reported adherence to the VAP bundle ranged from 38.5% to 100%, with perfect compliance to head of bed elevation and poorest compliance with readiness to extubate and DVT prophylaxis. Overall VAP bundle compliance was 84.6%. Direct observation of nurses validated self-adherence to the VAP bundle and the institution’s compliance rates. Barriers to bundle adherence included lack of formal training, perceived lack of guidelines, inadequate resources, and fear of adverse events. Conclusions: Knowledge regarding specific components of VAP prevention is lacking. Compliance to the VAP bundle can be improved. Regular training, education, and direct feedback to assess the competency of both the medical and nursing staff are needed to improve adherence to the bundle, and ultimately decrease incidence of VAP in the ICU. Despite limitations, this is the first study to determine baseline knowledge, adherence, and implementation practices of key personnel directly involved with implementation of the VAP bundle.

Disclosures: None

Funding: None