Adherence to institution-specific ventilator-associated pneumonia prevention guidelines

Area of Science:

• Critical Care Medicine
• Infection Prevention
• Nursing Research

Background:

• Institution-specific guidelines exist to prevent ventilator-associated pneumonia (VAP).
• Guideline availability alone does not guarantee adherence to recommended VAP prevention strategies.
• Understanding factors influencing adherence is crucial for improving patient outcomes.

Purpose of the Study:

• To identify factors influencing adherence to VAP prevention guidelines.
• Focus on key interventions: oral hygiene, head-of-bed elevation, and spontaneous breathing trials.
• Explore user, guideline, and contextual factors impacting adherence.

Main Methods:

• Cross-sectional descriptive study involving 576 critical care nurses across 8 Northern California hospitals.
• Survey developed to assess facilitators and barriers to guideline adherence for VAP prevention.
• Analysis of user factors, guideline qualities, and contextual factors for potential relationships.

Main Results:

• Nurses generally reported positive attitudes and high adherence rates (always or most of the time).
• Adherence predictors varied by intervention, with user attitude being the strongest consistent predictor (OR, 3.49-4.75).
• Time availability (OR, 1.54) and prioritization (OR, 1.86) also significantly predicted adherence.

Conclusions:

• Nurses' positive attitude toward VAP prevention guidelines is the most consistent facilitator of adherence.
• Interventions to improve VAP prevention should focus on cultivating positive nurse attitudes.
• Addressing time and prioritization barriers may further enhance adherence to VAP prevention strategies.