Evaluation of Nurses’ Practice on Utilization of Ventilator-associated Pneumonia Care Bundle in Criticalcare Unit at Kenyatta National Hospital

Abstract

Background: Mechanical ventilation is a supportive therapy for majority of critically-ill patients in critical care unit either through an endotracheal tube or tracheostomy. This therapy causes airway contamination and micro aspiration predisposing to development of ventilator-associated pneumonia (VAP). Globally, incidence is on the rise and VAP has been linked with longer hospital stay, increased health cost, high mortality and morbidity. In order to optimize patient safety and reduce incidences of hospital- acquired infections (HAIs), care bundle modality was developed by the institute of healthcare improvement (IHI). The elements of the VAP care bundle are nursing care interventions and that, nurses are charged with the responsibility of their implementation during routine care. Implementation of VAP care bundle approach, coupled with complete adherence, has been associated with decreased cases of VAP, improved clinical outcome and quality of life. It has been observed that, in order to ensure adherence to VAP bundle, an implementation strategy such as education is paramount. Study objective: To evaluate nurses’ practice on utilization of ventilator-associated pneumonia (VAP) care bundle in critical care unit (CCU) of Kenyatta National Hospital (KNH). Significance of the study: The knowledge generated from the study will be used to improve nursing practice, to review the institutional protocol and form basis for future research. Study methodology: This was a cross-sectional descriptive study design. Systematic random sampling was employed where a total of 82 nurses were recruited. A self-administered structured questionnaire and an observation checklist were used to collect data. Statistical Package for Social Sciences (SPSS) version 26 was used to analyze data. RESULTS: The study revealed that nurses utilized the VAP bundle elements, but some elements were well practiced than others. On the part of knowledge of nurses on VAP bundles, it was realized that all of the respondents were aware of the VAP bundles, 96.3% (n=77) were aware of the elements of the VAP bundle, 88.8% (n=71) of the respondents affirmed to utilizing VAP bundle in their units while only 38.3% (n=31) stated that they are audited on the utilization of VAP bundle. The most commonly used strategy for implementing VAP care bundle was continuous practice education (CPE) 85% (n=68) of the respondents, use of bed site checklist at 68.8% (n=55), and use of training at 59% (n=47). Compliance with utilization of VAP care bundle as reported by nurses was rated at 100% compliance with oral hygiene care, head of the bed to 30 to 45 degrees

was 98.8% while DVT and PUD had 93% compliance, the least being daily assessment of readiness to extubate at 44%. Conversely, observed utilization of the VAP care bundle revealed a gap in utilization of some of bundle elements. There was no statistically significant association between reported practice of VAP care bundle by nurses and observed practice of VAP bundle utilization by the researcher, (r =-0.020 to 0.081, p=0.477 to 0.945). Conclusion Nurses at CCU-KNH utilized VAP care bundle with some of the elements being performed better than others. A few of nurses cited lack of current updates on clinical guidelines, as a factor which contributed to low utilization. There was lack of frequent audits on VAP care bundle utilization. Nurses compiled to implementation of VAP care bundle, although did not achieve the desired implementation rate recommended by IHI, due to limited resources and knowledge. There was no statistically significant relationship between reported practice of VAP care bundle by nurses and observed practice of VAP bundle utilization.