Knowledge and Practice of Intensive Care Unit Nurses toward Prevention of Ventilator-Associated Pneumonia at Public Hospitals in Sana'a City-Yemen

Abstract

Background of the study Ventilator-associated pneumonia (VAP) is define as a type of pneumonia in a patient receiving mechanical ventilation that was not present at the time of admission to hospital or that occurs 48 hours after intubation and mechanical ventilation. The VAP is still an important cause of mortality and morbidity in mechanically ventilated patients. This can be primarily prevent by increase knowledge and practice of ICU nurses to improve nursing care that plays important role in outcomes.

Methods A descriptive cross-sectional study was conducted among ICU nurses at public hospitals in Sana,a City-Yemen, to assess knowledge and practice of ICU nurses on prevention of Ventilator-Associated Pneumonia. The sample of the study consisted of 87 Yemeni nurses from different public hospitals were participated in this study. The sample size was determined using EpiCalc 2000. A stratified simple random sampling was applied to select the sample size from 4 major public hospitals. After official approvals were obtained from the previously selected settings, the researcher obtained lists of nurses' currently working in the study settings via random sampling methods. Data was collected using a close-ended questionnaire, 87 nurses were tested for knowledge and 50 nurses were tested for practice by using an observational checklist. Information letters, consent form, and questionnaires were handed to ICU nurses by the researcher. Data coded and entered into SPSS version 21.0 for descriptive and inferential statistics.

Results The ICU nurses, (54%) were male, (52%) were unmarried with age mean ± SD, 28.40 ± 3.9 years. About (55.2 %) had working experience from 1-3 years. Two third (65.5 %) the nurses had a diploma degree, (51.7%) had courses training in ICU and (81.6%) had no training program on the prevention of VAP. Knowledge scored and their levels were as follows: (5.7%) scored 76%-100%, good, (36.8%) scored between 50%-75% and (57.5%) scored between 0% - 49%. poor knowledge. the overall level of practice, (52%). of nurses had a poor level, (42%) had a moderate level and (6%) that were had a good level of practice. No association between knowledge and ICU training (P-value= 0.38), sex (P-value=0.41) and years of working experience (P-value= 0.37). A significant association between the knowledge toward prevention VAP and level of education (P-value=0.001). ICU nurses’ practice on prevention of VAP was statistically associated with ICU training (P-value= 0.03) and years of work experience (p-value 0.64) but not associated between practice and educational level (P-value= 0.40). On observation (28%) of nurses performed hands disinfect before oral care and before tracheal suction, before and after every patient care, most of the nurses (74%) were performed wear the gloves and gown before oral care and tracheal suction. (32%) of nurses were performed oral care with an antiseptic solution. Of ICU nurses (100%) of nurses not use the closed endotracheal suction system, (32%) performed sterilization of suctioning equipment, (42%) used the sterile technique during tracheal suction and (54%) disposed of suction catheter immediately after one single use. Most nurses (78%) kept the patient in semi-sitting position, (88%) used the kinetic bed for the ventilated patient and (62%) of nurses were done respiratory chest physiotherapy. (54%) checked the nasogastric and (36%) used of protocol for weaning from mechanical ventilation.

Conclusion ICU nurses’ knowledge of VAP prevention was inadequate and their practice was found to be poor. No association between knowledge and ICU training, sex and years of work experience but significant association between the knowledge and level of education was found. ICU nurses’ practice on prevention of VAP was statistically associated with ICU training and years of work experience but not associated with educational level.

Recommendations We recommended increasing knowledge and practice of intensive care unit nursing staff through the courses training, workshop, and curriculums. In addition to similar studies with large sample size in other hospitals that provide critical care in Yemen are recommended.