Ventilator-Associated Pneumonia Bundle of Care Training of Nursing Officers Using Simulation and Its Impact on Their Knowledge and Incidence of Ventilator-Associated Pneumonia: A quasi-experimental Study

The objective of this study was to assess the effectiveness of simulation-based training (SBT) of a ventilator-associated pneumonia (VAP) bundle of care on the knowledge and practice of nursing officers working in the pediatric intensive care unit (PICU) and its impact on the incidence of VAP. This study was a single-center, pre- and postsimulation-based educational interventional tool conducted in a six-bed PICU located in Western Rajasthan, India. Thirty nursing officers working in the PICU participated in the study. Baseline knowledge and practice regarding VAP bundle of care were assessed using a questionnaire and practice checklist. It was followed by 1:1 SBT of the VAP bundle of care following which all participants were immediately reassessed and then again at 3 months postintervention. The incidence of VAP (events/1,000 ventilation days) was subsequently compared both at 6 months pre- and postintervention. Thirty nursing officers participated in the study of which 63% were male. Baseline knowledge and practice increased significantly immediately after the VAP bundle of care training and then again at 3 months in comparison to preintervention testing (baseline 20.27 ± 4.51, immediate postintervention 26.0 ± 3.67, 3 months postintervention 23.97 ± 4.69). The incidence of VAP showed a declining trend from 46.1 to 36.5/1,000 ventilation days; however, this finding was not statistically significant (p = 0.22). The simulation-based teaching program significantly enhanced nursing officers' knowledge and practice toward utilization of a preventive VAP bundle of care. There was decay in knowledge with time indicating that repetitive sessions are required at regular intervals to sustain this effect.

VENTILATOR ASSOCIATED PNEUMONIA-REVIEW ARTICLE

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated mortality of VAP is around 10%. There are many risk factors including host related, device related and personnel related. For prevention of VAP it is recommended to minimize the exposure to mechanical ventilation and encouraging early liberation. VAP bundle as a group of evidence-based practices that, results in decrease in the incidence of VAP should be used. Patients should be reassessed daily to conrm ongoing suspicion of disease, antibiotics should be guided by cultures reports, and clinicians should consider stopping antibiotics if cultures are 1 negative.

Assessment of knowledge and implementation practices of the ventilator acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital

Studies have shown that a ventilator associated pneumonia (VAP) bundle significantly decreases VAP rates. In this study, we evaluated existing knowledge, practices, and adherence of nurses and infection control preventionists (ICP) to the VAP bundles of care in the intensive care unit (ICU) by using qualitative and quantitative tools. Of 60 participants (56 nurses and 4 ICPs), mean knowledge score regarding specific evidence-based VAP guidelines was 5 (range 3–8) out of 10 points. Self-reported adherence to the VAP bundle ranged from 38.5 to 100%, with perfect compliance to head of bed elevation, and poorest compliance with readiness to extubate. Overall VAP median bundle compliance was 84.6%. Knowledge regarding specific components of VAP prevention is lacking. Formal training and interactive educational sessions should be performed regularly to assess the competency of key personnel regarding the VAP bundle, especially in the context of rapid nurse turnover. Incentives for retention of nurses should also be considered, so that knowledge of hospital specific initiatives such as the VAP bundles of care can be cultivated over time.

Kepatuhan Perawat dalam Melakukan Oral Hygiene di Unit Perawatan Intensif

This study aims to identify factors that influence nurse compliance and find the best solution to improve adherence to oral hygiene. The research method begins with searching scientific articles in 4 databases, namely PubMed, Wiley, science direct, and google scholar. The results of the study of 7 included articles, 42.85% (3 pieces) stated that nurses' knowledge and perceptions were the main factors that influenced nurse compliance, and 14.3% (1 article) indicated that service practices/facilities affected adherence. Other factors were found including; limited time, motivation, nurse workload, unavailability of oral hygiene procedures, and lack of interprofessional collaboration, so the best solution is to increase the knowledge and competence of nurses with training, workshops, and monitoring systems in the implementation of the VAP bundle. In conclusion, nurses' knowledge and perceptions are the main factors that affect nurse compliance in performing oral hygiene, so increasing knowledge and competence is the best solution as a joint effort to reduce the incidence of VAP. Keywords: VAP Bundle, Compliance, Intensive Care Unit, Oral Hygiene

#52: Role of Good Oral Hygiene in Reducing and Preventing Ventilator-associated Pneumonia (VAP) in the Intensive Care Unit (ICU) in a Tertiary Care Hospital

Background Ventilator-associated pneumonia (VAP) is when a patient who received mechanical ventilation for at least 48 hours develops pneumonia. According to the literature, the prevalence rate of VAP in patients experiencing mechanical ventilation is 9%–68%, its resulting mortality is 30%–70%, it also extends hospital and ICU stay by 6–7 days, raises healthcare costs by $40,000 per patient. VAP is a serious complication in the critically ill one factor causing VAP is an aspiration of oral colonization which may result from poor oral hygiene care. Oral hygiene care using either a mouth rinse or with help of forceps and gauze or combination together with the aspiration of secretion can reduce the risk of VAP in these critically ill patients. Method The main aim of this study was to evaluate the effect of strengthening oral hygiene practices and develop cost-effective and easy to use protocols of oral hygiene for ventilator-dependent patients. This study is an observational study conducted in all intensive care unit at tertiary care hospital, 41 bedded inpatient critical care area including high dependency unit (HDU)/coronary care unit (CCU), medical intensive care unit (MICU), surgical intensive care unit (SICU), neonate intensive care unit (NICU) and pediatric intensive care unit (PICU). Approximately 500 patients were admitted monthly to the intensive care unit. All ventilated patients admitted to the intensive care unit are included. Intervention is done in three phases: firstly, VAP device-associated infection (DAI’s) surveillance initiated according to the CDC guideline. HAI’s surveillance was done on daily basis. Secondly, educate staff regarding DAI’s surveillance, VAP bundle, Oral care and suction technique of ventilated patient). Ongoing training and hands-on practice on mannequin and also perform sign-off on the patient first under supervision of Nurse instructor and infection control officers. Finally, VAP bundle was initiated which include elevation of head, daily sedation vacation, and assessment of readiness to extubate, daily oral hygiene care, and assessment of stress ulcer and deep venous thrombosis prophylaxis. Result Before implementation, we just calculate all pneumonia rates together not using proper guidelines. But after we follow CDC guideline for DAI’s surveillance, we trained more than 50% of critical care staff out of 93 staffs, and 90% to 95% compliance of using chlorhexidine gluconate for oral care at least per shift and also as per patient needed observed in ventilated patients. Conclusion The implementation of these changes in practices along with using chlorhexidine gluconate products has made it possible to achieve goal and staff perform work according to the best practice guideline. Oral care hygiene using chlorhexidine gluconate (CHG) as an element of the ventilator bundle is supposed to decontaminate the mouth, avoid aspiration of contaminated secretion into the respiratory tract and prevent VAP.

Assessment of Knowledge and Implementation Practices of the Ventilator-Acquired Pneumonia Bundle in a Private Hospital

Background: Ventilator-acquired pneumonia (VAP) is estimated to occur in 9%–27% of patients intubated for >48 hours, and despite advances in antibiotic therapy, it remains a significant cause of morbidity and mortality. Several studies have shown that a VAP bundle significantly decreases VAP rates. In 2017, VAP rates in our institution peaked at 7.92 per 1,000 ventilator days despite perceived good adherence to the bundles of care. Methods: We performed a prospective, descriptive cross-sectional study using both quantitative (eg, validated questionnaires) and qualitative methods (eg, small group discussion and direct observation of practices) to assess the knowledge, attitudes and practices of infection control preventionists (ICPs) and intensive care unit (ICU) nurses regarding VAP prevention and the VAP bundle. Results: Of the 89 ICU nurses and 5 ICPs, we included 60 respondents, of whom 56 were ICU nurses, and 4 were ICPs. Median experience for nurses was 6 years (range, 0.67–16) and was 2 years (range, 2–4) for ICPs. Only 1 ICP had formal training on the VAP bundle, and only 1 ICU nurse had a master’s degree in nursing. Only 23 of 56 nurses (41%) reported that they had had formal training regarding the VAP bundle. Mean knowledge score regarding evidence-based VAP guidelines was 5 of 10 points (range, 3–8). Questions regarding mechanical ventilator operations had the lowest scores. Self-reported adherence to the VAP bundle ranged from 38.5% to 100%, with perfect compliance to head of bed elevation and poorest compliance with readiness to extubate and DVT prophylaxis. Overall VAP bundle compliance was 84.6%. Direct observation of nurses validated self-adherence to the VAP bundle and the institution’s compliance rates. Barriers to bundle adherence included lack of formal training, perceived lack of guidelines, inadequate resources, and fear of adverse events. Conclusions: Knowledge regarding specific components of VAP prevention is lacking. Compliance to the VAP bundle can be improved. Regular training, education, and direct feedback to assess the competency of both the medical and nursing staff are needed to improve adherence to the bundle, and ultimately decrease incidence of VAP in the ICU. Despite limitations, this is the first study to determine baseline knowledge, adherence, and implementation practices of key personnel directly involved with implementation of the VAP bundle.Disclosures: NoneFunding: None

Knowledge of Guideline VAP Bundle Improves Nurse Compliance Levels in Preventing Associated Pneumonia (VAP) Ventilation in the Intensive Care Unit

The use of mechanical ventilators is at risk of causing complications, Ventilator Associated Pnemonia (VAP). The Associated Pnemonia (VAP) Ventilator is a nosocomial infection that occurs in patients with Ventilator consumption from 48 hours. VAP prevention can be done with VAP bundle. The objective of this research to analyze the guidelines VAP bundle's knowledge relationship with the level of nurse compliance in VAP prevention. This type of research with cross sectional which describes the knowledge of VAP bundle of ICU-treatment. This study was conducted in March-April 2019 in the ICU Room of RS X in Semarang with a number of samples as many as 25 ICU nurses. Results indicate that there is a relationship of knowledge level to the level of nurse compliance in the implementation of VAP bundle in the ICU room of RS X in Semarang, the better the knowledge level, the better the level of compliance with P value 0.022 and r 0.456 which has the meaning there is a fairly strong relationship between levels of knowledge with the level of compliance of VAP bundle implementation. The nurses are expected to know and adhere to the VAP bundle so that the VAP does not occur against the mechanical ventilator attached patients.

GAMBARAN PENGETAHUAN PERAWAT TENTANG INTERVENSI MANDIRI VENTILATOR ASSOCIATED PNEUMONIA BUNDLE CARE PADA PASIEN DENGAN VENTILASI MEKANIK DI UNIT PERAWATAN INTENSIF

Risiko VAP pada pasien terintubasi ventilasi mekanik disebabkan oleh tabung endotrakeal yang terpasang invasive memungkinkan masuknya bakteri secara langsung ke saluran pernapasan bagian bawah. VAP Bundle Care terbukti dapat mengurangi VAP dan meningkatkan hasil positif bagi pasien. Pengetahuan perawat menjadi salah satu indikator keberhasilan VAP Bundle Care karena pengetahuan berpengaruh terhadap terbentuknya perilaku perawat. Penelitian ini bertujuan untuk mengidentifikasi tingkat pengetahuan perawat ICU tentang intervensi mandiri VAP Bundle Care. Desain penelitian ini adalah kuantitatif deskriptif dengan metode survey. Teknik sampling yang digunakan yaitu total sampling. Sebanyak 100 perawat ICU berpartisipasi. Pengambilan data menggunakan critical care nurses’ knowledge of evidence based guidelines for preventing ventilator associated pneumonia: an evaluation questionnaire. Face validity dan item validity telah dilakukan. Hasil reliabilitas kuesioner memiliki koefisien alpha 0,529. Analisis data yang digunakan yaitu analisis univariate dengan bentuk distribusi frekuensi. Hasil penelitian menunjukkan bahwa 65% perawat ICU memiliki pengetahuan sedang tentang intervensi mandiri VAP Bundle Care. Kesimpulan dari penelitian ini adalah lebih banyak perawat ICU yang memiliki pengetahuan sedang daripada perawat dengan pengetahuan kurang. Penelitian ini diharapkan dapat menjadi saran baik perawat, instansi rumah sakit, institusi pendidikan, peneliti selanjutnya untuk memaksimalkan pengetahuan tentang VAP Bundle Care. Kata kunci: Pengetahuan perawat, unit perawatan intensif, vap bundle care, ventilasi mekanik Abstract Analysis of nurse knowledge about mandiri intervention of associated pneumonia bundle care in patients with mechanical ventilation in intensive care units. Risks of ventilator-associated pneumonia (VAP) in intubated patients receiving mechanical ventilation is due to an invasive endotracheal tube that may enable bacteria to enter directly into the lower respiratory tract. VAP bundle care has been proven to reduce VAP and improve positive outcomes for patients. Nurses’ knowledge is one of the indicators of the success of VAP bundle care since it influences the formation of nurses’ behaviors. This study aimed to identify the knowledge level of ICU nurses about VAP bundle care independent intervention. This study employed a quantitative descriptive design with survey methods. A total of 100 ICU nurses recruited using total sampling participated in this study. The data were collected using the critical care nurses and ventilator-associated pneumonia: an evaluation questionnaire. The face validity and item validity tests were performed. The result of the reliability test obtained an alpha coefficient of 0.529. The collected data were analyzed using a univariate analysis in the form of frequency distribution. The results showed that 65% of the ICU nurses had a moderate level of knowledge about VAP bundle care independent intervention. This study concluded that more ICU nurses had a moderate level of knowledge than those who had an inadequate level of knowledge. This study is expected to be a suggestion for nurses, hospital agencies, educational institutions, and further researchers to optimize the knowledge of VAP bundle care Keywords: Intensive Care Unit, Nurses’ Knowledge, Mechanical Ventilation, VAP Bundle Care

Pelaksanaan Pencegahan dan Pengendalian Ventilator Associated Pneumonia (VAP) di Ruang ICU

Latar Belakang: Ventilator Associated Pneumonia (VAP) adalah salah satu infeksi yang sering ditemukan pada pasien pengguna ventilator di Intensive Care Unit (ICU). Rumah Sakit Umum Pusat (RSUP) Dr. Kariadi menetapkan beberapa indikator mutu, salah satunya adalah angka kejadian VAP. Tujuan: Penelitian ini bertujuan untuk mengeksplorasi pelaksanaan pencegahan dan pengendalian VAP di ruang ICU, RSUP Dr. Kariadi Semarang. Metode: Penelitian ini merupakan penelitian kualitatif yang dilaksanakan di ruang ICU, RSUP Dr. Kariadi, Semarang pada bulan Juni 2018 dengan pengumpulan data melalui wawancara mendalam, observasi, dan telaah dokumen. Dalam penelitian ini, dipilih 12 informan berdasarkan prinsip kesesuaian dan kecukupan dengan kriteria mengetahui dan terlibat dalam pencegahan dan pengendalian VAP di ruang ICU RSUP Dr. Kariadi, Semarang pada tahun 2018. Analisis dilakukan dengan content analysis. Hasil: Pelaksanaan pencegahan dan pengendalian VAP di ruang ICU, RSUP Dr. Kariadi Semarang mengacu pada Permenkes 27/2017 dengan beberapa inovasi dan penyesuaian. Komunikasi terkait pelaksanaan VAP bundle di ruang ICU berjalan dengan baik, perawat diberi kesempatan untuk memperbarui dan penyegaran ilmu, fasilitas sangat mendukung, serta koordinasi antar profesi berjalan lancar. Adanya SOP, daftar centang kepatuhan pelaksanaan VAP bundle , serta lomba yang sering diadakan dalam rangka pencegahan dan pengendalian infeksi mendorong pelaksana untuk terus memperbaiki diri. Walaupun demikian, masih diperlukan pengingat untuk melaksanakan VAP bundle sesuai dengan SOP, yaitu oral hygiene setiap 8 jam sekali. Kesimpulan: Pelaksanaan pencegahan dan pengendalian VAP di Ruang ICU, RSUP Dr. Kariadi Semarang tahun 2018 perlu dipertahankan bahkan ditingkatkan. Review mingguan dan penghargaan bagi pelaksana diperlukan sebagai pendorong untuk terus melaksanakan VAP bundle sesuai dengan SOP.