NURSES’ IMPLEMENTATION OF GUIDELINES FOR VENTILATOR-ASSOCIATED PNEUMONIA FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION

By: Carolyn L. Cason, RN, PhD, Tracy Tyner, RN, MSN, CEN, CCRN , Sue Saunders, RN, MSN, CCRN, and Lisa Broome, RN, MSN. From the School of Nursing, University of Texas at Arlington (CLC), Parkland Memorial Hospital, Dallas, Tex (TT), RHD Memorial Hospital, Dallas, Tex (SS), and Baylor Regional Hospital, Plano, Tex (LB).

BACKGROUND 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.

OBJECTIVE To evaluate the extent to which nurses working in intensive care units implement best prac­tices when managing adult patients receiving mechanical ventilation.

METHODS Nurses attending education seminars in the United States completed a 29-item question­naire about the type and frequency of care provided.

RESULTS 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.

CONCLUSIONS 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.

Selengkapnya: (American Journal of Critical Care. 2007;16:28-38)