Nurses' implementation of ventilator-associated pneumonia prevention guidelines: an observational study in Jordan

Abstract

Background: Ventilator-associated pneumonia prevention guidelines from the Center for Disease Control and Prevention, the American Thoracic Society, and the Institute for Health Care and Improvement have been published to reduce the rate of ventilator-associated pneumonia in the clinical settings; however, nurses' compliance with these guidelines is still questionable.

Aims: The purpose of this study was to assess nurses' compliance with ventilator-associated pneumonia prevention guidelines and the factors that influence their compliance.

Design: A structured observational design with a non-participant approach.

Method: One hundred nurses were observed during their care for patients on mechanical ventilator. The observers documented nurses' implementation of ventilator-associated pneumonia prevention guidelines using a structured observational sheet.

Results: Compliance of nurses was found to be unsatisfactory. Of the participants, 63% showed 'insufficient compliance'. Nurses working in units with a 1:1 nurse:patient ratio and lower beds' capacity demonstrated higher compliance and their intensive care units had a lower rate of ventilator-associated pneumonia and shorter intensive care unit stay in comparison with their counterparts working with a 1:2 nurse:patient ratio and higher beds' capacity.

Conclusion: Nurses' compliance with ventilator-associated pneumonia prevention guidelines was insufficient. Low nurse-patient ratio and large intensive care unit beds capacity were found to affect nurses' compliance and patients' outcomes. This study expanded knowledge about important aspects of nursing care; nurses' compliance with ventilator-associated pneumonia prevention guidelines and the factors that affect their compliance. This knowledge can be used by health professional to guide the clinical practice and to improve the quality of care.

Keywords: Mechanical ventilation; Nurse-patient ratio.