Journal of Research in Pharmacy Practice

Education alone is not enough in ventilator associated pneumonia care bundle compliance

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.

Keywords

Compliance
education
Ventilator‑associated pneumonia (VAP)
VAP care bundle
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Journal of Research in Pharmacy Practice
Volume 3, Issue 2
Spring 2014
Pages 51-55

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