Adoption of a ventilator-associated pneumonia clinical practice guideline.

Publisher: Blackwell Publishing Inc. for Sigma Theta Tau International Country of Publication: United States NLM ID: 101185267 Publication Model: Print Cited Medium: Print ISSN: 1545-102X (Print) Linking ISSN: 1545102X NLM ISO Abbreviation: Worldviews Evid Based Nurs Subsets: MEDLINE

Original Publication: Malden, MA : Blackwell Publishing Inc. for Sigma Theta Tau International, c2004-

Evidence-Based Medicine*/education ; Evidence-Based Medicine*/organization & administration ; Practice Guidelines as Topic*/standards; Cross Infection/*prevention & control ; Nursing Staff, Hospital/*education ; Pneumonia, Ventilator-Associated/*prevention & control; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cross Infection/epidemiology ; Diffusion of Innovation ; Education, Nursing, Continuing/organization & administration ; Female ; Humans ; Incidence ; Infection Control/organization & administration ; Inservice Training/organization & administration ; Male ; Middle Aged ; Models, Educational ; Nurse's Role ; Nursing Evaluation Research ; Nursing Staff, Hospital/organization & administration ; Pneumonia, Ventilator-Associated/epidemiology ; Program Evaluation ; Respiration, Artificial/adverse effects ; Respiration, Artificial/nursing ; Southwestern United States/epidemiology

Conceptual Framework: The Academic Center for Evidence-based Practice (ACE) Star Model was used to implement an evidence-based clinical practice guideline (CPG) in order to decrease ventilator-associated pneumonia (VAP) incidence rates and ventilator days. The goal was to interrupt person-to-person transmission of bacteria and bacterial colonization using low-cost, evidence-based strategies to prevent VAP. DISCOVERY: Two geographically proximate medical centers, inclusive of five intensive care units located in the southwestern region of the United States had significant variations in their VAP rates.
Evidence Summary: Using the U.S. Preventive Services Task Force grading criteria, the results of 69 studies were used to establish a clinical practice guideline to prevent ventilator-associated pneumonia. TRANSLATION: A clinical practice guideline was developed for the prevention of VAP and included five nursing activities: (a) head-of-bed elevation; (b) oral care; (c) ventilator tubing condensate removal; (d) hand hygiene; and (e) glove use. The effect of the CPG, inclusive of an educational intervention, was measured using an observational, prospective, quasi-experimental design. INTEGRATION: A multidisciplinary education team developed a self-learning packet, educational materials, and storyboards for the staff as dissemination strategies. Strategies also included e-mail, one-on-one teaching with clinicians, and feedback on guideline adoption and VAP rate reports.
Evaluation: Observation data were collected to evaluate adoption of the CPG while caring for 106 ventilated patients. VAP rates changed at both hospitals although the change was not statistically significant. Additionally, the ICU length of stay declined at both facilities, causing cost savings.
Discussion: These results support the idea that adoption of evidence-based practices contributes to decreased VAP rates. For a successful program, ICU leaders should emphasize strategies that routinize adoption of evidence-based CPGs.

Date Created: 20061221 Date Completed: 20070119 Latest Revision: 20191210

20240628

10.1111/j.1741-6787.2006.00066.x

17177928