Educational Interventions To Reduce Ventilator Associated Pneumonia Impact Behavior Change in a Community Intensive Care Unit

Abstract

BACKGROUND/OBJECTIVES: Ventilated patients are at increased risk for the development of ventilator associated pneumonia (VAP). VAP is associated with increased mortality, increased length of stay and increased cost. A review of surveillance data in a 16 bed medical-surgical intensive care unit (ICU) revealed a 2003 VAP rate of 8.2/1000 ventilator days and a 2004 VAP rate of 7.0/1000 ventilator days. The objective was to educate ICU staff and respiratory therapists (RT) regarding VAP prevention techniques and improve infection prevention practices thereby reducing the risk of developing VAP. METHODS: An evidence based self study VAP educational module in booklet form with pre and post testing was distributed to ICU nurses, patient care technicians (PCT) and RTs. Head of bed (HOB) and covered Yankauer observations on ventilated patients were begun 1 month prior to distributing the module and continued for 6 months. Other educational interventions included fact sheets, inservices and feedback of rates and observational data to staff. Additionally, a unit based team was formed to develop weaning protocols. RESULTS: The completion rate for both the pre and post test of the module was 69% (25/36) for nursing and 86% (12/14) for RT. Nursing pre-test mean score was 82% and the post-test mean score was 93%, an increase of 11% (p < .01). The RT pre-test mean score was 83% and the post-test score was 90%, an increase of 7% (p < .01). Prior to the introduction of the module, HOB compliance was 100%. Covered Yankauer compliance was 50% although on the pretest 100% of staff correctly stated the Yankauer should be covered between uses. One month after completion of the module, HOB compliance was 100% and covered Yankauer compliance was 92% (p > .05). Six months after completion of module, HOB compliance mean was 98 % (p > .05); covered Yankauer compliance mean was 98 % (p < .05). Pre-intervention mean VAP rate was 7.0/1000 ventilator days (01/04-12/04) and post-intervention mean was 0/1000 ventilator days (06/05-12/05). CONCLUSIONS: Although staff understood the correct infection prevention practices, additional educational interventions were necessary to translate knowledge into clinical practice. Educational interventions, feedback of rates and observational data resulted in a significant increase in the compliance of covering the Yankauer and improved infection prevention practices.