Name
Chamberlain University
NR-716: Analytic Methods
Prof. Name
Date
Assessment of knowledge and implementation practices of the ventilator-associated pneumonia (VAP) bundle in the intensive care unit of a private hospital
Reviewer Name(s): Not specified
Article Number: 1
The research conducted by Abad, Formalejo, and Mantaring (2021) explored the extent of knowledge and practical application of the ventilator-associated pneumonia (VAP) bundle in the intensive care unit (ICU) of a private hospital. This study aimed to determine whether nurses and infection control practitioners (ICPs) adhered to evidence-based measures designed to minimize VAP incidence.
The VAP bundle, developed and recommended by the Institute for Healthcare Improvement (IHI), consists of several interventions: maintaining head-of-bed elevation between 30° and 45°, performing daily readiness-to-extubate assessments, providing consistent oral care, ensuring subglottic suctioning and closed suctioning systems, and administering deep vein thrombosis (DVT) prophylaxis.
Findings revealed that although many staff members had sufficient knowledge of the VAP bundle, consistent compliance with all components was not achieved. Adherence was strongest in maintaining head-of-bed elevation but was weakest in readiness-to-extubate assessments. Median compliance across interventions was measured at 84.6%, highlighting the need for improvements. The researchers stressed that ongoing professional development through workshops, competency-based training, and refresher courses is critical to bridging knowledge gaps. Additionally, addressing high nurse turnover with retention strategies, such as incentive programs and recognition initiatives, was emphasized to promote long-term adherence to best practices.
| Author, Date, and Title | Type of Evidence | Population, Size, and Setting | Intervention | Findings that Help Answer the EBP Question | Measures Used | Limitations | Evidence Level & Quality | Notes to Team |
|---|---|---|---|---|---|---|---|---|
| Abad, C. L., Formalejo, C. P., & Mantaring, D. M. L. (2021). Assessment of knowledge and implementation practices of the ventilator-acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital. Antimicrobial Resistance & Infection Control, 10(1), 161. https://doi.org/10.1186/s13756-021-01027-1 | Descriptive study using both qualitative and quantitative approaches | 60 participants (56 ICU nurses, 4 ICPs) across ICUs in a private hospital | VAP bundle consisting of: – Head-of-bed elevation (30°–45°) – Closed suctioning and subglottic drainage – Daily readiness-to-extubate assessments – Oral hygiene – DVT prophylaxis | – Most staff were aware of the VAP bundle, but adherence was inconsistent. – Knowledge gaps existed in specific guideline details. – Highest compliance: head-of-bed elevation. – Lowest compliance: readiness-to-extubate. – Median compliance: 84.6%. – Training and education are critical for improvement. – Nurse retention strategies are necessary for sustainability. | Surveys, focus group discussions, and direct observation of 16 events across three non-consecutive day shifts | – Non-randomized design limits generalizability. – ICU settings varied, possibly influencing results. – Potential external confounding variables. – Best Practice Alert (BPA) failed to activate in ~28% of encounters. | Level III, Good Quality | Recommend continuous education and competency-based refreshers. Nurse incentive and retention programs should be prioritized to maintain compliance. |
While ICU staff demonstrated substantial knowledge of the VAP bundle, its consistent implementation remained suboptimal. The weakest adherence was noted in readiness-to-extubate assessments, which are crucial in reducing prolonged mechanical ventilation risks.
To enhance compliance, hospitals should implement structured educational programs, including recurring workshops, simulation-based training, and competency validation. Evidence suggests that regular knowledge reinforcement increases the likelihood of sustainable practice change.
High turnover among ICU nurses negatively influences the stability of evidence-based practice implementation. Incorporating recognition programs, financial incentives, mentorship opportunities, and supportive work environments may improve retention and ensure continuity of patient care.
Abad, C. L., Formalejo, C. P., & Mantaring, D. M. L. (2021). Assessment of knowledge and implementation practices of the ventilator acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital. Antimicrobial Resistance & Infection Control, 10(1), 161. https://doi.org/10.1186/s13756-021-01027-1
