Centers for Disease Control and Prevention. Nurses' implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention

The School of Nursing, University of Texas at Arlington, TX 76109-0407, USA.
American Journal of Critical Care (Impact Factor: 2.12). 02/2007; 16(1):28-36; discussion 37; quiz 38.
Source: PubMed


Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia.
To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation.
Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided.
Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols.
The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

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Available from: Carolyn L Cason
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    • "Studies have shown that VAP is common among trauma patients in ICUs and dramatically increases the mortality rate of these patients (5). VAP accounts for over 47% of all infections in ICUs (6), and 8% to 28% of patients under ventilators; VAP increases fatality by approximately 24% to 70% (7-9). It also leads to more prolonged use of ventilators, increases length of stay in the ICU as well as the costs of treatment (10). "
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    ABSTRACT: Many patients with severe traumatic injuries are admitted to intensive care units (ICU). These patients usually require prolonged mechanical ventilation. These interventions require oral intubation and leave the mouth open which consequently impairs the natural antimicrobial activity in the mouth and airways. These patients are also prone to ventilator-associated pneumonia (VAP). Evidence shows that paying attention to oral hygiene in patients under mechanical ventilation is important in helping to prevent VAP.
    Full-text · Article · Apr 2014 · Trauma Monthly
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    • "As observed in other studies, although oral hygiene procedures were performed more than once a day before the training programme, most nurses did not use chlorhexidine solution (DeRiso et al., 1996; Tablan et al., 2004; Koeman et al., 2006). Cason et al. (2007) also found that only 26% of nurses used chlorhexidine. Compliance with recommendations for oropharyngeal hygiene improved after the training programme. "
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    ABSTRACT: Background: Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICUs). Most published studies have analysed nurses' theoretical knowledge about a specific procedure; however, the transfer of this knowledge to the practice has received little attention. Aim: To assess the impact of training session on nurses' knowledge regarding VAP, compliance with VAP preventive measures, VAP incidence and determining whether nursing workload affects compliance. Method: A prospective, quasiexperimental, pre- and post-study of the nursing team in a 16-bed medical/surgical ICU. Pre-intervention phase: a questionnaire to assess nurses' knowledge of VAP prevention measures, direct observation and review of clinical records to assess compliance. Intervention phase: eight training sessions for nurses. The post-intervention phase mirrored the pre-intervention phase. Findings: Nurses answered more questions correctly on the post-intervention questionnaire than on the pre-intervention (17·87 ± 2·69 versus 15·91 ± 2·68, p = 0·002). Compliance with the following measures was better during the post-intervention period (p = 0·001): use of the smallest possible nasogastric tube, controlled aspiration of subglottic secretions and endotracheal tube cuff pressure, use of oral chlorhexidine and recording the endotracheal tube fixation number. VAP incidence remained unchanged throughout the study. However, a trend towards lower incidence of late (>4 days after intubation) VAP was observed (4·6 versus 3·1 episodes/1000 ventilation days, p = 0·37). Conclusion: The programme improved both knowledge of and compliance with VAP preventive measures, although improved knowledge did not always result in improved compliance.
    Full-text · Article · Nov 2012 · Nursing in Critical Care
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    • "More recently, the literature emphasises the assignment of new nursing work of guideline implementation including education and audit. Cason et al. (2007) highlighted the CDC recommendation for intensive care unit staff education in VAP epidemiology and infection control. Unit-based implementation projects following this guidance report multifaceted implementation methods including the creation and distribution of educational materials with accompanying practice audits (Babcock et al., 2004; Cutler and Davis, 2005). "
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    ABSTRACT: Objectives: The aim of this critical ethnographic literature review was to explore the evolution of nursing discourse in oral hygiene for intubated and mechanically ventilated patients. Methods: The online databases CINAHL and MEDLINE were searched for nurse-authored English language articles published between 1960 and 2011 in peer-reviewed journals. Articles that did not discuss oral problems or related care for intubated adult patients were excluded. Articles that met the inclusion criteria were chronologically reviewed to trace changes in language and focus over time. Results: A total of 469 articles were identified, and 84 papers met all of the inclusion criteria. These articles presented an increasingly scientific and evaluative nursing discourse. Oral care originally focused on patient comfort within the literature; now it is emphasized as an infection control practice for the prevention of ventilator-associated pneumonia (VAP). Despite concern for its neglected application, the literature does not sufficiently address mouth care's practical accomplishment. Conclusions: Mouth care for orally intubated patients is both a science and practice. However, the nursing literature now emphasises a scientific discourse of infection prevention. Inattention to the social and technical complexities of practice may inhibit how nurses learn, discuss and effectively perform this critical aspect of patient care.
    Full-text · Article · Oct 2012 · Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses
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