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Updated: Jul 23, 2025
Mechanical Ventilation Boot Camp Curriculum
Published on: March 12, 2018
Identifying the barriers and facilitators to implementation of ventilator bundle in the nepalese intensive care unit:
Dejina Thapa1, Ting Liu2, Chen Yang2
1The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China.
Insights
Implementing ventilator bundles to prevent pneumonia is challenging in low-income countries. This study identified key barriers and facilitators among healthcare professionals in Nepal to improve VAP prevention strategies.
Area of Science:
- Healthcare Implementation Science
- Infectious Disease Prevention
- Critical Care Medicine
Background:
- Ventilator bundles are crucial for preventing ventilator-associated pneumonia (VAP).
- Poor implementation of ventilator bundles is a global challenge, particularly in low- and middle-income countries.
- Understanding barriers is key to developing effective VAP prevention strategies.
Purpose of the Study:
- To explore barriers and facilitators to ventilator bundle implementation in Nepalese ICUs.
- To prioritize identified barriers for targeted intervention development.
- To inform strategies for reducing VAP burden.
Main Methods:
- Qualitative study using semistructured interviews with 21 healthcare professionals (HCPs) in Nepal.
- Thematic analysis of transcribed interviews to identify barriers and facilitators.
- Barrier prioritization using a barrier identification and mitigation tool with nine participants.
Main Results:
- Five main themes emerged: provider-related, organizational, work performance, environmental, and patient-related factors.
- Common barriers included job insecurity, poor knowledge, insufficient equipment, and patient severity.
- Facilitators included training, functional equipment, adequate staffing, leadership, and organizational support.
- Eight key barriers were prioritized for intervention.
Conclusions:
- Identified barriers to ventilator bundle implementation in ICUs are crucial for improving patient care.
- Addressing prioritized barriers can enhance patient safety and reduce VAP.
- Findings can guide HCPs in developing effective VAP reduction strategies.
Background:
A ventilator bundle is an effective preventive strategy against the development of ventilator-associated pneumonia (VAP). However, in clinical practice ventilator bundle implementation is poor. Understanding the barriers to ventilator bundle implementation in low- and middle-income countries can inform the development of effective implementation strategies to reduce the burden of VAP.
Objectives:
The primary objective of this study was to explore the barriers and facilitators of ventilator bundle implementation perceived by healthcare professionals (HCPs) working in intensive care units (ICU) in Nepal. The secondary objective was to prioritise the barriers when developing implementation strategies.
Methods:
This study used a pragmatic approach comprising a series of methods to identify the implementation strategies: (i) Barriers and facilitators were explored using a qualitative study design. Twenty-one HCPs selected using the maximum variation sampling technique from a large tertiary hospital, completed semistructured interviews. All the interviews were recorded, transcribed word-by-word, and uploaded into NVivo for analysis using the thematic analysis approach. (ii) After analysis, nine participants were selecteded to determine the priority order of the barriers using a barrier identification and mitigation tool.
Results:
The data analysis revealed five main themes and 19 subthemes that affected ventilator bundle implementation. The main themes were provider-related factors, organisational and practice-related factors, performances of work, environmental conditions, and patient-related factors. The common barriers were job insecurity, poor knowledge, negative attitude, insufficient equipment, and severity of patient disease. Common facilitators were educational training, equipment functioning, adequate staff, strong leadership, and organisational support. Finally, eight main barriers were prioritised to target the change.
Conclusion:
The barriers to implementing ventilator bundles in ICUs were identified. Focussing on addressing the prioritised barriers may aid in improving patient care and safety in ICUs. Results may guide HCPs in the development of implementation strategies to reduce the burden of VAP.
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