Evaluation of prevention of ventilator-associated infections in four Australian intensive care units.

BACKGROUND

Effective approaches to practice improvement require development of tailored interventions in collaboration with knowledge users.

OBJECTIVES

To explore critical care nurses' knowledge and adherence to best practice guidelines for management of patients with an artificial airway to minimise development of ventilator-associated pneumonia.

METHODS

A cross-sectional study was undertaken across four intensive care units that involved three phases: (1) survey of critical care nurses regarding their current practice; (2) observation of respiratory care delivery; and (3) chart audit. Key care processes evaluated were: (1) technique and adherence to standard precautions when performing endotracheal suction, cuff pressure checks and extubation; and (2) frequency of endotracheal suctioning and mouth care.

RESULTS

Observational and chart audit data on the provision and documentation of respiratory care were collected for 36 nurse/patient dyads. Forty-six nurses were surveyed and the majority responded that endotracheal suctioning and mouth care should be performed 'as required' or every 2 hours (h). During observations of practice, no patient received mouth care every 2 h, nor had documentation of such. Inconsistent adherence to standard precautions and hand hygiene during respiratory care provision was observed. Chart audit indicated that nurses varied in the frequency of suctioning consistent with documented clinical assessment findings.

CONCLUSION

Although nurses had good knowledge for the management of artificial airways, this was not consistently translated into practice. Gaps were identified in relation to respiratory related infection prevention, the prevention of micro-aspiration of oropharyngeal secretions and in the provision of mouth care.

Informations de copyright

© The Author(s) 2020.

Déclaration de conflit d'intérêts

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.