Developing Nursing Practice Guidelines for Ventilator Associated Pneumonia Prevention in Neonates at Samutsakhon Hospital

Abstract

Background: Ventilator associated pneumonia (VAP) is the highest incidence among neonates infection at Samutsakhon hospital. VAP increases risk of mortality and cost of treatment. Therefore it is necessary to develop nursing practice guidelines for VAP prevention in neonates in which appropriate to context and achievement in nursing practice.
Objective: To develop nursing practice guidelines for ventilator associated pneumonia (VAP) prevention in neonates and implement the effective guidelines to the Pediatric 1 department at Samutsakhon hospital.
Methods: A research and development study was used and consists of 3 phases; 1) preparing phase; situation analysis of VAP, 2) development of practice guidelines phase; guideline implementation and improvement, 3) outcome evaluation. The development of practice guidelines had 4 circled-processes of planning, acting, observing and reflection including continuous improvement of the guidelines to meet the consensus between researchers and participants. The sample included 13 registered nurses who had been worked at Pediatric1 department and 43 neonates who underwent mechanical ventilator during July 2012 to January 2013. The quantitative data were collected by using observation record and questionnaire whereas qualitative data was collected through focus group interview. Statistics analysis using frequency, percentage and paired t-test was used to compare the average of opinion before and after using this guideline.
Results: Guidelines for VAP prevention in neonates were classified into 6 categories; 1) hands washing 2) intubation and care 3) oral cavity care 4) suction, 5) tube feeding and aspirated prevention 6) ventilator and circuit care. In comparison, the average of compliance to nursing practice guideline after guideline implementation was higher than before implementation. The average level of opinion to nursing practice before and after guidelines development were statistically different (significant level of p=.001). The incidence of VAP rate was reduced in evaluation period.
Conclusions: Although the result of this study was better but evidence was not strong according to limited duration of study. Suggestion for further guideline development is to include the policy development, weaning protocol consultation, education, training and project supervision to lower incidence of VAP.