January 28, 2013
Nursing Research Utilization Project: Section C
Research supports that a ventilator-associated pneumonia (VAP) prevention program can decrease the incidence of VAP in patients on mechanical ventilation. Educating health care workers about the several evidence-based interventions known to reduce the incidence of VAP will enhance accountability, reduce VAP, improve patient outcomes, and decrease patient care costs. Three research reports from professional journals that support the implementation of a ventilator-associated pneumonia (VAP) prevention program are titled: Reduction of ventilator-associated pneumonia: active versus passive guideline implementation; Changes in knowledge, beliefs, and perceptions throughout a multifaceted behavioral program aimed at preventing ventilator-associated pneumonia; and An Educational intervention to reduce ventilator-associated pneumonia in an integrated health system. Article one: Reduction of ventilator-associated pneumonia
Reduction of ventilator-associated pneumonia: active versus passive guideline implementation by Hawe et al. (2009), “describes an active multifaceted implementation of a VAP prevention bundle designed to improve staff compliance with evidence-based actions and reduce the incidence of VAP” (p. 1180). A VAP prevention bundle was designed, implemented passively, and actively. The study was conducted in an adult surgical/medical intensive care unit (ICU) at an European hospital. In August 2005 the hospitals critical care development group developed a VAP prevention bundle (Hawe et al. 2009). Copies of the interventions were laminated, and placed at the patient’s bedside. Senior nursing staff gave verbal and written encouragement to staff for its use in patient care. Compliance was assessed from September 1, 2005 to February 28, 2007; this was considered the passive implementation.
The active implementation phase commenced in March 2007 when staff was educated on the evidence based interventions. Nursing staff was sent to workshops that presented the meaning of VAP, the epidemiology, pathogenesis, risk factors, and consequences of VAP (Hawe et al. 2009). Written material was distributed and staff knowledge was measured. Adherence to the bundle was promoted as in important part of the morning multi-disciplinary ward rounds. The active implementation phase was March 1, 2007 to December 31, 2007. The results of the study show that the incidence of VAP fell significantly after the active implementation. An active implementation programs increased staff compliance and reduced VAP from 19.2 to 7.5 per 1,000 ventilator days (Hawe et al. 2009).
This research report shows internal validity because “multimodal active implementation was associated with a significant improvement in VAP bundle compliance, which in turn was associated with a significant improvement in outcome (reduced VAP rate)” (Hawe et al. 2009, p. 1183). Noted limitations are that there is a possibility for bias in the results because the same individual who collected the data also performed the educational intervention. It is also possible that the reduction of VAP rates was associated with unrecognized secular trend or seasonal variation in rate. Also staff behavior could be attributed to a Hawthorne effect. Article two: Changes in knowledge, beliefs, and perceptions
Changes in knowledge, beliefs, and perceptions throughout a multifaceted behavioral program aimed at preventing ventilator-associated pneumonia, by Bouadma et al. (2010), “attempted to assess change of individual factors throughout a multifaceted program focusing on VAP prevention” (p. 1341). This study was conducted in a 20-bed medical intensive care unit, and involved all health care workers. A three-hour mandatory educational session was provided to the health care workers on recommended practices to prevent VAP. Regular reminders were...