Results of Promoting the Clinical Nurse Practice Guidelines to prevent ventilator-associated pneumonia (VAP) in Medical Intensive Care Unit at Phrae hospital
Abstract
Background: Pneumonia is caused by intubation and ventilation for more than 48 hours, resulting in higher infection and mortality rate in patients. The usage the Clinical Nurse Practice Guidelines in clinical practice by nurses to prevent ventilator-associated of pneumonia (VAP) can decrease the rate of VAP.
Objective: To compare nurses’ knowledge and practice in preventing VAP before and after using the guideline and to compare the incidence rate of VAP between patients in the usual care group and the promoted practice group.
Design: A quasi-experimental study was conducted at Phrae Hospital to investigate the effect of promoting practice guidelines for preventing VAP in the internal medicine intensive care unit from January to April 2022. The statistics analyzed were mean, percentage, and standard deviation and were compared the knowledge and practice scores of nurses using paired t-test, and Wilcoxon paired sign rank test.
Result: Nurses' knowledge of VAP was assessed before and after the promotion of practice by using the knowledge assessment of VAP by nurses. Twenty items, including a total score of 20 points were assessed. Before the study, the average knowledge score was 17.84. (SD 0.175). Following the study, the mean knowledge score increased to 18.89 (SD 0.150) average increase of 1.05 (p= 0.029). The practice of VAP was assessed before and after using the practice. The Observational Form for Pneumonia Control from Ventilation included 25 items with a total score of 25 points were assessed. In the standard of care group, the average level of knowledge was 23.66. (SD 0.236). The group using the guideline had a mean score increase of 24.4 (SD 0.113), an average increase of 0.63 points (p=0.029). The usual care group had an incidence of VAP about 13.01 infections per 1,000 days of ventilators days. In groups that promote the use of guidelines, there were fewer infections, with the incidence of VAP about 4.84 cases per 1,000 days of ventilators days.
Conclusion: The Clinical Nurse Practice Guidelines to prevent VAP cannot conclude that this guideline can actually increase the nurse’s knowledge and increase compliance of using the guideline and decrease the incidence rate of VAP. Because the study does not cover other multidisciplinary involved teams. Practice data was collected before the research. Including having the same practice guidelines in the agency, so nurses go to study and follow them before starting the research. From the results of the study, it was likely to show the reducing of VAP among patients who are followed the guideline. However, it was found that the sample group in the study did not consider the variables to be compared and the appropriate statistical method to control or adjust the influence of these variables.
Keywords: The Clinical Nurse Practice Guidelines, nurses' knowledge and practice, ventilator-associated pneumonia (VAP)
