Document Type : Original Article
Authors
- . Hadi Hamishehkar 1
- . Mahdi Vahidinezhad 2
- . Simin Ozar Mashayekhi 3
- . Parina Asgharian 4
- . Hadi Hassankhani 5
- . Ata Mahmoodpoor 6
1 Department of Clinical Pharmacy, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Iranian Evidence Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
3 The Liver and Gastrointestinal Research Center, Tabriz University of Medical sciences, Tabriz, Iran
4 Student Research center committee, Tabriz University of Medical Sciences, Tabriz, Iran
5 Department of Nursing, Tabriz University of Medical Sciences, Tabriz, Iran
6 Department of Anesthesiology and critical care, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Objective: Ventilator‑associated pneumonia (VAP) described as a secondary and preventable
consequence in mechanically ventilated patients, emerges 48 h or more after patients
intubation. Considering the high morbidity and mortality rate of VAP and the fact that VAP
is preventable, it seemed necessary to evaluate care bundle compliance rate and effect of
education on its improvement.
Methods: This observational study was conducted on 10 Intensive Care Units (ICUs) of
four university affiliated hospitals in three steps. In the first step, VAP care bundle compliance
including head of bed (HOB) elevation, endotracheal cuff pressure (ETCP), mouthwash time,
utilizing close suction systems, subglottic secretion drainage, type of suction package, and
hand wash before suctioning was evaluated. In the second and third steps, ICU staffs were
trained and its effect on VAP care bundle compliance was investigated. Finally, an inquiry
from nurses was conducted to evaluate the obtained results.
Findings: A total of 552 checklists consisting of 294 observations in the pre‑education
group and 258 observations in the posteducation group were filled. Mean VAP care
bundle compliance in pre‑education and posteducation stages was 36.5% and 41.2%,
respectively (P > 0.05). Except for patients’ mouth washing, there were no improvement
in HOB elevation (>30°), hand washing and ETCP after education. Based on the results of
questionnaire received from nurses at the end of study, more than 90% of nurses believed
that lack of rigid monitoring of VAP care bundle is a main reason of low adherence for VAP
care bundle compliance.
Conclusion: The adherence to VAP care bundle was inappropriate. Education seems to be
ineffective on improving VAP care bundle compliance. Frequent recall of the necessity of
the VAP care bundle and the continuous supervision of ICU staffs is highly recommended.
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