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Preventing ventilator-associated pneumonia-a mixed-method study to find behavioral leverage for better protocol

Aline Wolfensberger1, Marie-Theres Meier1, Lauren Clack1

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Technical solutions, not education, are key to preventing ventilator-associated pneumonia (VAP). This study found that improving healthcare environments and enabling practitioners are crucial for better VAP prevention protocol adherence in intensive care units (ICUs).

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Area of Science:

  • Infection Prevention and Control
  • Healthcare Quality Improvement
  • Behavioral Science in Medicine

Background:

  • Ventilator-associated pneumonia (VAP) remains a significant challenge in intensive care units (ICUs).
  • Optimizing adherence to VAP prevention protocols is critical for patient safety and outcomes.
  • Understanding the behavioral factors influencing protocol adherence is essential for developing effective interventions.

Purpose of the Study:

  • To identify optimal behavioral strategies for improving adherence to VAP prevention protocols.
  • To explore the facilitators and barriers to VAP prevention measure implementation among frontline healthcare practitioners (HCPs).
  • To guide the development of theory-informed interventions for VAP prevention.

Main Methods:

  • A mixed-method study combining quantitative adherence measurements with qualitative analysis of focus group interviews.
  • Assessed adherence to four key VAP prevention measures: bed elevation, oral care, sedation interruption, and subglottic suctioning.
  • Utilized a grounded theory approach for inductive analysis and the Behavior Change Wheel (BCW) framework for deductive analysis of qualitative data.

Main Results:

  • Adherence varied significantly across protocols, with low rates for bed elevation (27%) and oral care (41%), and higher rates for sedation interruption (81%) and subglottic suctioning (88%).
  • Key behavioral facilitators included perceived seriousness of VAP and self-efficacy.
  • Major barriers were related to physical capability, including lack of equipment, staffing, and side-effects of prevention measures. Technical approaches like environmental restructuring and enabling HCPs emerged as solutions.

Conclusions:

  • Technical, rather than education-based, solutions are recommended to enhance VAP prevention.
  • A theory-informed, mixed-method approach effectively guides infection prevention efforts.
  • Focusing on environmental and systemic support for HCPs is crucial for improving VAP prevention adherence.