Knowledge of evidence‐based guidelines in ventilator‐associated pneumonia prevention

Yeganeh, Mohammad Reza; Yekta, Hamid; Farmanbar, Rabiollah; Khalili, Malahat; Khaleghdoost, Tahereh; Roushan, Zahra Atrkar

doi:10.1111/jebm.12188

Cited by 25 publications

(27 citation statements)

References 17 publications

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“…Generally, reasonable and stable P cuff can not only ensure enough supply of tidal volume but can also effectively prevent the aspiration of secretions into the lung, thereby reducing the incidence of VAP. Currently, the guidelines for VAP prevention (Torres et al, ; Klompas et al, ; Yeganeh et al, ) recommend maintaining the P cuff around 25 cmH 2 0 and monitoring and adjusting the P cuff thrice a day but make no recommendation on the use of continuous or intermittent endotracheal tube P cuff control system; however, it still warrants more studies to evaluate the role of continuous and intermittent control of P cuff . It is noteworthy that a patient's breathing, cough and medical operation characteristics, such as suction and body position, the drug use of sedations and muscle relaxants and the changes in body temperature, can also disturb the stability of P cuff (Vyas et al, ; Nseir et al, ; Nseir et al, ; Yang et al, ) .…”

Section: Discussionmentioning

confidence: 99%

Is continuous better than intermittent control of tracheal cuff pressure? A meta‐analysis

Wen

Chen

et al. 2018

Nursing in Critical Care

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Aim To compare and evaluate the efficacy and safety of continuous and intermittent control of cuff pressure. Methods We performed a comprehensive and systematic meta‐analysis of randomized controlled trials (RCTs) assessing the continuous and intermittent control of Pcuff by searching PUBMED, EMBASE and other such databases (from inception to 31 March 2018). Summary odds ratios or mean differences with 95% confidence intervals were calculated using a fixed‐ or random‐effects model. Measurements and Main Results Seven randomised controlled trials with 970 mechanically ventilated patients were included in this study. The continuous control of cuff pressure significantly reduced the incidence of cuff pressure < 20 cm H2O (0.03 (OR) (95% CI: 0.01–0.07)), Pcuff > 30 cm H2O (0.06 (95% CI: 0.03–0.15)) and VAP (0.39 (95% CI: 0.28–0.55)) when compared with intermittent control of cuff pressure. No significant differences in duration of MV (‐1.94 (95% CI: ‐4.06 to ‐0.17)), length of ICU stay (‐3.88 (95% CI: ‐9.00 to ‐1.23)) and mortality (0.99 (95% CI: 0.73–1.35)) were found between the two groups. Conclusions Continuous control of cuff pressure offers more benefits in stabilizing the cuff pressure and reducing the incidence of VAP, and more studies are warranted to further evaluate the role of continuous control of cuff pressure. Relevance to practice The continuous control of cuff pressure should be conducted whenever possible as it is the most ideal for the prognosis of MV patients.

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Section: Discussionmentioning

confidence: 99%

Is continuous better than intermittent control of tracheal cuff pressure? A meta‐analysis

Wen

Chen

et al. 2018

Nursing in Critical Care

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“…Adherence to and knowledge about VAP prevention measures were shown to be poor in several studies 19 25 , 26 Adherence can be raised through different implementation programs 19 27 A systematic review identified education (eg, training sessions or development of concise summaries of the evidence) and execution strategies (eg, standardization of care processes and building redundancies into routine care) as strategies to enhance the adoption of VAP prevention measures 28 .…”

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confidence: 99%

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

Wolfensberger

Meier

Clack

et al. 2018

Infect. Control Hosp. Epidemiol.

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OBJECTIVE Preventing ventilator-associated pneumonia (VAP) is an important goal for intensive care units (ICUs). We aimed to identify the optimal behavior leverage to improve VAP prevention protocol adherence. DESIGN Mixed-method study using adherence measurements to assess 4 VAP prevention measures and qualitative analysis of semi-structured focus group interviews with frontline healthcare practitioners (HCPs). SETTING The 6 ICUs in the 900-bed University Hospital Zurich in Zurich, Switzerland.Patients and participantsAdherence to VAP prevention measures were assessed in patients with a device for invasive ventilation (ie, endotracheal tube, tracheostomy tube). Participants in focus group interviews included a convenience samples of ICU nurses and physicians. RESULTS Between February 2015 and July 2017, we measured adherence to 4 protocols: bed elevation showed adherence at 27% (95% confidence intervals [CI], 23%-31%); oral care at 41% (95% CI, 36%-45%); sedation interruption at 81% (95% CI, 74%-85%); and subglottic suctioning at 88% (95% CI, 83%-92%). Interviews were analyzed first inductively according a grounded theory approach then deductively against the behavior change wheel (BCW) framework. Main behavioral facilitators belonged to the BCW component 'reflective motivation' (ie, perceived seriousness of VAP and self-efficacy to prevent VAP). The main barriers belonged to 'physical capability' (ie, lack of equipment and staffing and side-effects of prevention measures). Furthermore, 2 primarily technical approaches (ie, 'restructuring environment' and 'enabling HCP') emerged as means to overcome these barriers. CONCLUSIONS Our findings suggest that technical, rather than education-based, solutions should be promoted to improve VAP prevention. This theory-informed mixed-method approach is an effective means of guiding infection prevention efforts. Abstract Objective: Preventing ventilator-associated pneumonia (VAP) is an important goal for intensive care units (ICUs). We aimed to identify the optimal behavior leverage to improve VAP prevention protocol adherence. Design: Mixed-method study using adherence measurements to assess 4 VAP prevention measures and qualitative analysis of semi-structured focus group interviews with frontline healthcare practitioners (HCPs). Setting: The 6 ICUs in the 900-bed University Hospital Zurich in Zurich, Switzerland. Patients and participants: Adherence to VAP prevention measures were assessed in patients with a device for invasive ventilation (ie, endotracheal tube, tracheostomy tube). Participants in focus group interviews included a convenience samples of ICU nurses and physicians. Results: Between February 2015 and July 2017, we measured adherence to 4 protocols: bed elevation showed adherence at 27% (95% confidence intervals [CI], 23%-31%); oral care at 41% (95% CI, 36%-45%); sedation interruption at 81% (95% CI, 74%-85%); and subglottic suctioning at 88% (95% CI, 83%-92%). Interviews were analyzed first inductively according a grounded theory approach then de...

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“…Shin and Lee (2017) showed the social and organizational factors such as greater opportunities to exchange nurses' ideas and the communication skills as facilitators of EBP in nursing (12). Yeganeh et al (2016) resulted application of guidelines in nursing practice was a facilitator and lack of knowledge of nurses about it was a barrier in EBP (13). Black et al (2015) confirmed studies about knowledge, skills, facilitators, and barriers bridged the gap between practice and knowledge (14).…”

Section: Introductionmentioning

confidence: 89%

Psychometric Evaluation of Iranian Version of the Evidence-Based Practice Questionnaire (EBPQ): A Methodological Study

Yeganeh

Pouralizadeh

Ebadi

2017

Iran Red Crescent Med J

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Knowledge of evidence‐based guidelines in ventilator‐associated pneumonia prevention

Cited by 25 publications

References 17 publications

Is continuous better than intermittent control of tracheal cuff pressure? A meta‐analysis

Is continuous better than intermittent control of tracheal cuff pressure? A meta‐analysis

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

Psychometric Evaluation of Iranian Version of the Evidence-Based Practice Questionnaire (EBPQ): A Methodological Study

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