Associated Factors with Performance of Infection Control for the Prevention of Ventilator-associated Pneumonia among Some Intensive Care Unit Nurses

Abstract

Objectives: Ventilator-associated pneumonia (VAP) is the most common form of nosocomial infections in intensive care units. The purpose of this study was to measure infection control knowledge and practice for VAP, and investigate the factors associated with them among staff nurses in intensive care units. Methods: The 232 staff nurses working in three university hospitals were surveyed by closed ended questionnaires using scoring system about infection control knowledge, practice for VAP and general characteristics. Practice scores for VAP were compared in groups of nurse. The factors associated to practice for VAP were analyzed with multiple linear regression using a SPSS version 16.0 statistical program. Results: The score of knowledge and performance of infection control were 4.85 ± 1.18 and 1.82 ± 0.13, respectively. In multiple regression analysis, the level of performance of infection control was significantly higher in nurses who cared for less than 3 patients compared to nurses who cared for more than 4 patients (β = 0.04, p = 0.067). And nurses with experience of education for the VAP prevention within 2 years had higher performance for the VAP prevention (β = 0.05, p = 0.009). The level of knowledge was higher, performance of infection control better. Conclusions: Performance for the VAP prevention was associated with the number of patients in charge, experience of education and the level of knowledge for the VAP prevention. So the level of performance of the VAP prevention will be improved by the reasonable nurse-to-patient ratio in intensive care unit and supplying of education and increasing of the level of knowledge for the VAP prevention.

Development of a Tool for Measuring Ventilator-Associated Pneumonia Prevention Behaviors of Intensive Care Unit Nurses

“…Existing tools in Korea do not mention ventilator circuit replacement [ 38 , 40 ] and measure regular replacement after using the circuit for a certain period of time (7–14 days) [ 27 , 29 ]. This study reflected the latest guidelines related to ventilator management, including the items “The ventilator circuit is not replaced regularly, and it is only replaced when there is visible contamination or functional disorders” [ 8 , 34 , 35 ] and “The humidifier inside the ventilator circuit uses sterile distilled water”.…”

“…With regard to the “oral care” factor, the IHI in the United States [ 6 ] and the KDCA in Korea [ 8 ] both strongly recommend providing oral care using chlorhexidine for patients on mechanical ventilation; however, most existing tools do not include an item on oral care [ 23 , 43 ] nor present oral care solutions [ 27 , 28 , 29 ]. The Betsy Lehman Center [ 44 ] and ICSI [ 36 ] recommend that medical personnel carry out oral care every 4 and 6–8 h, respectively.…”

“…The Betsy Lehman Center [ 44 ] and ICSI [ 36 ] recommend that medical personnel carry out oral care every 4 and 6–8 h, respectively. In regard to the daily routine and intervals, existing tools did not provide suggestions on the number of times or intervals for oral care [ 27 , 28 , 29 , 30 , 45 ]. This study considered the current manpower status in ICUs in Korea through interviews with ICU nurses and widened the interval of oral care to 4–8 h. It is necessary to re-examine the frequency of oral care when the manpower problem is resolved in the future.…”

“…Previous tools [ 27 , 28 , 29 , 30 , 45 ] had only been developed through a literature review without a conceptual identification process through fieldwork in the clinical field; thus, they were limited in that only the content validity test and the reliability test were performed by experts. The tool developed in this study identified the concept through fieldwork and focus group interviews with ICU nurses and infection control unit nurses.…”

“…In addition, intensive care nurses needed to evaluate a total of 43 items daily, which was found to be too many for them; there are limitations because the items were developed only through content validity and reliability measured by experts. Most of the tools [ 28 , 29 , 30 , 31 ] developed after Ban’s tool [ 27 ] only added revisions and supplements to Ban’s tool [ 27 ] or only evaluated content validity or reliability after revisions. In addition, almost no tools have been developed according to the systematic methodological procedure of tool development.…”