Effect of an educational intervention on compliance with care bundle items to prevent ventilator-associated pneumonia

Bence Mogyoródi; Dalma Skultéti; Melinda Mezőcsáti; Erzsébet Dunai; Petra Magyar; Csaba Hermann; János Gál; Balázs Hauser; Zsolt D Iványi

doi:10.1016/j.iccn.2022.103342

Effect of an educational intervention on compliance with care bundle items to prevent ventilator-associated pneumonia

Intensive Crit Care Nurs. 2023 Apr:75:103342. doi: 10.1016/j.iccn.2022.103342. Epub 2022 Dec 2.

Authors

Bence Mogyoródi¹, Dalma Skultéti², Melinda Mezőcsáti³, Erzsébet Dunai⁴, Petra Magyar⁵, Csaba Hermann⁶, János Gál⁷, Balázs Hauser⁸, Zsolt D Iványi⁹

Affiliations

¹ Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78, Budapest, Hungary. Electronic address: mogyorodi.bence@med.semmelweis-univ.hu.
² Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78, Budapest, Hungary. Electronic address: skulteti.dalma@med.semmelweis-univ.hu.
³ Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78, Budapest, Hungary. Electronic address: mezocsati.melinda@med.semmelweis-univ.hu.
⁴ Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78, Budapest, Hungary. Electronic address: dunai.erzsebet@med.semmelweis-univ.hu.
⁵ Faculty of Medicine, Semmelweis University, 1085 Üllői út 26, Budapest, Hungary. Electronic address: magyarpe@gmail.com.
⁶ Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78, Budapest, Hungary. Electronic address: hermann.csaba@semmelweis-univ.hu.
⁷ Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78, Budapest, Hungary. Electronic address: gal.janos@med.semmelweis-univ.hu.
⁸ Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78, Budapest, Hungary. Electronic address: hauser.balazs@med.semmelweis-univ.hu.
⁹ Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78, Budapest, Hungary. Electronic address: ivanyi.zsolt@med.semmelweis-univ.hu.

PMID: 36464606
DOI: 10.1016/j.iccn.2022.103342

Abstract

Objectives: We aimed to evaluate the effectiveness of our ventilator-associated pneumonia prevention bundle implemented by education of the nursing staff, and to describe the tendency of knowledge retention.

Research methodology: A prospective, before-and-after study was performed. The ventilator-associated pneumonia prevention bundle was implemented through a single educational intervention of the nursing staff. The risk of ventilator-associated pneumonia over time was estimated using a Cox proportional cause-specific hazard model. Compliance to preventive measures was assessed at three time-points: before education, at three months and 12 months after education.

Setting: A 29-bed mixed medical-surgical intensive care unit.

Main outcome measures: Ventilator-associate pneumonia incidence densities, the risk of ventilator-associated pneumonia, and compliance to preventive measures in the pre-implementation and post-implementation periods.

Results: We analyzed the data of 251 patients. The incidence density of pneumonia decreased from 29.3/1000 to 15.3/1000 ventilator-days after the implementation of the prevention program. Patients in the post-implementation period had significantly lower risk to develop pneumonia (hazard ratio 0.34, 95 % confidence interval 0.19-0.61, p = 0.001). At 3 months of implementation, a significant improvement was detected to all the individual bundle components. Complete compliance increased from 16.2 % to 62.2 % (p < 0.001). Compliance with bundle components decreased to baseline levels after 12 months of implementation apart from head-of-bed elevation.

Conclusion: This study supports existing evidence that educational interventions improve compliance. The gained knowledge was well translated into clinical practice reflected by the decreasing ventilator-associated pneumonia rate. It may be assumed that a refresher educational session within 12 months after implementation is needed.

Keywords: Health education; Nosocomial infection; Prevention and control; Protocol compliance; Ventilator-associated pneumonia.

MeSH terms

Humans
Incidence
Intensive Care Units
Patient Care Bundles*
Pneumonia, Ventilator-Associated* / epidemiology
Pneumonia, Ventilator-Associated* / prevention & control
Prospective Studies