Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 27 , ISSUE 4 ( April, 2023 ) > List of Articles

Original Article

Assessment of Knowledge, Barrier in Implementation, and Compliance to Ventilator Bundle among Resident Doctors and Nurses Working in Intensive Care Units of a Tertiary Care Center of Western India: A Cross-sectional Survey

Pooja Bihani, Sadik Mohammed, Sukhdev Rao, Rishabh Jaju, Sarita Janweja

Keywords : Intensive care unit, Knowledge level, Questionnaire, Ventilator bundle, Ventilator-associated pneumonia

Citation Information : Bihani P, Mohammed S, Rao S, Jaju R, Janweja S. Assessment of Knowledge, Barrier in Implementation, and Compliance to Ventilator Bundle among Resident Doctors and Nurses Working in Intensive Care Units of a Tertiary Care Center of Western India: A Cross-sectional Survey. Indian J Crit Care Med 2023; 27 (4):270-276.

DOI: 10.5005/jp-journals-10071-24434

License: CC BY-NC 4.0

Published Online: 31-03-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: Appropriate implementation of a ventilator bundle (VB) is the key step in the prevention of ventilator-associated pneumonia (VAP). However, knowledge and compliance of critical care staff for VB are inconsistent in developing countries. This cross-sectional survey was planned to evaluate critical care practitioners’ knowledge of, adherence to, and barriers toward implementation of VB in the ICUs of a tertiary care institute. Methodology: All registered nurses and resident doctors who are direct care providers to patients of the ICU were included. Two sets of questionnaires were given to access knowledge and to identify potential barriers in the implementation of VB. To determine compliance with the VB, direct observation was done for three nonconsecutive days, and mean compliance per component of the bundle and overall compliance to VB was determined. Data were analyzed using descriptive and analytic statistics. Results: Of these 75 participants, 43 (57.33%) were resident doctors and 32 (42.67%) were staff nurses. The median knowledge score of resident doctors and staff nurses for VB was 7 (range 3–10) and 6 (range 2–9), respectively, with an overall score of 7 (range 2–10). Self-reported adherence to individual components of VB ranged from 75% to 95%, among these, adherence to oral care protocol, including use of chlorhexidine oral rinse, was most, and adherence to DVT prophylaxis was least. The most common potential barriers identified were fear of potential adverse effects and unawareness of guidelines. Conclusion: Considerable gap is observed between knowledge and implementation of VB among critical care practitioners. Despite knowledge, fear of adverse events and lack of proper training are key barriers in implementation of VB.


HTML PDF Share
  1. Magill SS, Klompas M, Balk R. Developing a new, national approach to surveillance for ventilator-associated events. Am J Crit Care 2013;22(6):469–473. DOI: 10.4037/ajcc2013893.
  2. Spalding MC, Cripps MW, Minshall CT. Ventilator-associated pneumonia: New definitions. Crit Care Clin 2017;33(2):277–292. DOI: 10.1016/j.ccc.2016.12.009.
  3. Institute for health care improvement. Implement the Ventilator Bundle. Available at: http//www.ihi.org/IHI/Topics/crit care/intensive care/changes/implement the ventilator bundle.htm.
  4. Rello J, Afonso E, Lisboa T, Ricart M, Balsera B, Rovira A, et al. A care bundle approach for prevention of ventilator-associated pneumonia. Clin Microbiol Infect 2013;19(4):363–369. DOI: 10.1111/j.1469-0691. 2012.03808.x.
  5. Abad CL, Formalejo CP, Mantaring DML. Assessment of knowledge and implementation practices of the ventilator acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital. Antimicrob Resist Infect Control 2021;10(1):161. DOI: 10.1186/s13756-021-01027-1.
  6. Mannava Y, Nayak SU, Uppoor A, Naik D, Maddi A. Knowledge, attitude and oral care practices for preventing ventilator-associated pneumonia among critical care nurses – A questionnaire study. Indian J Dent Res 2020;31(3):426–432. DOI: 10.4103/ijdr.IJDR_611_16.
  7. Labeau S, Vandijck DM, Claes B, Aken PV, Blot SI. Critical care nurses’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: An evaluation questionnaire. Am J Crit Care 2007;16(4):371–377. PMID: 17595369.
  8. Jansson MM, Syrjälä HP, Talman K, Merilainen MH, Ala-Kokko TI. Critical care nurses’ knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. Am J Infect Control 2018;46(9):1051–1056. DOI: 10.1016/j.ajic.2018.02.004.
  9. Speck K, Rawat N, Weiner NC, Tujuba HG, Farley D, Berenholtz S. A systematic approach for developing a ventilator-associated pneumonia prevention bundle. Am J Infect Control 2016;44(6): 652–656. DOI: 10.1016/j.ajic.2015.12.020.
  10. Bouadma L, Mourvillier B, Deiler V, Le Corre B, Lolom I, Regnier B, et al. A multifaceted program to prevent ventilator-associated pneumonia: Impact on compliance with preventive measures. Crit Care Med 2010;38(3):789–796. DOI: 10.1097/CCM.0b013e3181ce21af.
  11. Bankanie V, Outwater AH, Wan L, Yinglan L. Assessment of knowledge and compliance to evidence-based guidelines for VAP prevention among ICU nurses in Tanzania. BMC Nurs 2021;20(1):209. DOI: 10.1186/s12912-021-00735-8.
  12. World Health Organization. Safe Surgery Saves Lives, 2008 (Last accessed on 16 October, 2015). Available from: http://www.who.int/patientsafety/safesurgery/ss_checklist/en/index.htm.
  13. Álvarez-Lerma F, Sánchez García M, Task Force of Experts for Project “Zero VAP” in Spain*. The multimodal approach for ventilator-associated pneumonia prevention - Requirements for nationwide implementation. Ann Transl Med 2018;6(21):420. DOI: 10.21037/atm.2018.08.40.
  14. Branco A, Lourencone E, Monteiro A, Fonseca J, Blatt C, Aquino R. Education to prevent ventilator-associated pneumonia in intensive care unit. Rev Bras Enferm 2020;73(6): e20190477. DOI: 10.1590/0034-7167-2019-0477.
  15. Anand T, Ponce S, Pakula A, Norville C, Kallish D, Martin M, et al. Results from a quality improvement project to decrease infection-related ventilator events in trauma patients at a community teaching hospital. Am Surg 2018;84(10):1701–1704. PMID: 30747698.
  16. Bouadma L, Mourvillier B, Deiler V, Le Corre B, Lolom I, Regnier B, et al. A multifaceted program to prevent ventilator-associated pneumonia: Impact on compliance with preventive measures. Crit Care Med 2010;38(3):789–796. DOI: 10.1097/CCM.0b013e3181ce21af.
  17. Saini V, Gandhi K, Kaur K, Yaddanapudi LN. Effect of intensive education and training of nurses on ventilator-associated pneumonia and central line-associated bloodstream infection incidence in intensive care unit at a tertiary care center in North India. Indian J Crit Care Med 2017;21(11):779–782. DOI: 10.4103/ijccm.IJCCM_259_17.
  18. Pandey R, Uniyal B. Comparing influence of intermittent subglottic secretions drainage with/without closed suction systems on the incidence of ventilator associated pneumonia. Indian J Crit Care Med 2011;15(3):168–172. DOI: 10.4103/0972-5229.84902.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.