The effectiveness of the clinical nursing practice guidelines for preventing of pneumonia caused by multidrug-resistance Acinetobacter baumannii on incidence rate of ventilator associated pneumonia in hospital
Keywords:
Pneumonia, Mechanical Ventilation, Clinical Nursing Practice Guidelines, Multidrug-Resistant Organism, Acinetobacter baumanniiAbstract
Ventilator associated pneumonia (VAP) stands out as the most prevalent nosocomial infection. This implementation research aimed to develop and assess the impact of Clinical Nursing Practice Guidelines (CNPG) designed to prevent pneumonia caused by multidrug-resistant Acinetobacter baumannii at Sawanpracharak Hospital. The study encompassed two phases: 1) the development of CNPG, involving four infection control nurses and 11 ward nurses, and 2) the implementation and evaluation of CNPG, involving 224 nurses, 40 patients with mechanical ventilation pre- and post-CNPG implementation. Research tools included VAP record forms, nurse satisfaction, and CNPG compliance questionnaires. Data collected from June 1, 2023, to July 31, 2023, underwent descriptive statistical analysis.
The CNPG, comprising eight dimensions, covered aspects such as backrest positioning, cuff pressure monitoring, daily toothbrushing, closed suction, maintaining ventilator circuits, hand hygiene practices, wearing gowns and gloves, and environmental disinfection. Validation by five experts using AGREE II revealed scores between 76 to 90 percent across all dimensions. A pilot study confirmed practicality in all dimensions. VAP rates decreased from 28.98 to 15.51 episodes per 1,000 ventilator days. Nurses demonstrated a 90.7 percent satisfaction score, with 58.0 percent regularly complying with the CNPG. These outcomes suggest that the CNPG effectively reduces VAP rates. Nurses should receive comprehensive training to enhance knowledge and skills, and organizational considerations should include standard staffing and updated guidelines to optimize CNPG implementation.
References
AGREE Next Steps Consortium (2009). The AGREE II instrumemt [Electronic version]. Retrieved from http://www.agreetrust.org.
Centers for Disease Control and Prevention (CDC). (2023). Pneumonia (Ventilator-associated [VAP] and non-ventilator associated Pneumonia [PNEU]) Event. 1-19. Retrieved from https://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf
Chusri, S., Jongsuwiwanwong, W., Silpapojakul, K., Hortiwakul, T., Charoenmak, B., & Pomwised, R. (2020). Epidemiology and infection control of carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Enterobacteriaceae (CRE) in hospital network of lower southern Thailand. 1-269. Retrieved from http://hdl.handle.net/11228/5279
Hayakawa, K., Mezaki, K., Sugiki, Y., Nagamatsu, M., Miyoshi-Akiyama, T., Kirikae, T., Kutsuna, S., Takeshita, N., Yamamoto, K., Katanami, Y., Ohmagari, N. (2016). High rate of multidrug-resistant organism colonization among patients hospitalized overseas highlights the need for preemptive infection control. American Journal of Infection Control, 44(11), e257–e259. doi.org/10.1016/j.ajic.2016.06.040
Klompas, M., Branson, R., Cawcutt, K., Crist, M., Eichenwald, E. C., Greene, L. R., Lee G., Maragakis, L. L., Powell, K., Priebe, G. P., Speck, K., Yokoe, D. S., & Berenholtz, S. M. (2022). SHEA/IDSA/APIC Practice Recommendation Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 43, 687–713. doi.org/10.1017/ice.2022.88
Inchan, T., Sornchai, N., & Yodnil, W. (2018). The effectiveness of the clinical nursing practice guidelines for preventing pneumonia associated with mechanical ventilation on incidence rate of ventilator-associated pneumonia, Sawanpracharak hospital. Journal of Bamrasnaradura Infectious Diseases Institute, 12(3), 146-156. [In Thai]
Meschiari, M., Lòpez-Lozano, J. M., Di Pilato, V., Gimenez-Esparza, C., Vecchi, E., Bacca, E., & Mussini, C. (2021). A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit. Antimicrobial Resistance and Infection Control, 10(1), 1–13. doi.org/10.1186/s13756-021-00990-z
Montoya, A., Schildhouse, R., Goyal, A., Mann, J. D., Snyder, A., Chopra, V., & Mody, L. (2019). How often are health care personnel hands colonized with multidrug- resistant organisms? A systematic review and meta-analysis. American Journal of Infection Control, 47, 693-703. doi.org/10.1016/j.ajic.2018.10.017
Nguyen, M., & Joshi, S. G. (2021). Carbapenem resistance in Acinetobacter baumannii, and their importance in hospital-acquired infections: A scientific review. Journal of Applied Microbiology, 131(6), 2715–2738. doi.org/10.1111/jam.15130
Rossi, I., Royer, S., Ferreira, M. L., Campos, P. A., Fuga, B., Melo, G. N., Machado, L. G., Resende, D. S., Batistao, D., Urzedo, J. E., Gontijo-Filho, P. P., Ribas, R. M. (2019). Incidence of infections caused by carbapenem-resistant Acinetobacter baumannii. American Journal of Infection Control, 47(12), 1431–1435. doi.org/10.1016/j.ajic.2019.07.009
Soukup, S. M. (2000). The center for advanced nursing practice evidence-based practice model: promoting the scholarship of practice. The Nursing Clinics of North America, 35(2), 301-309. doi.org/10.1016/S0029-6465(22)02468-9
Wang, H. P., Zhang, H. J., Liu, J., Dong, Q., Duan, S., Ge, J. Q., Wang, Z. H., Zhang, Z. (2017). Antimicrobial resistance of 3 types of gram-negative bacteria isolated from hospital surfaces and the hands of health care workers. American Journal of Infection Control, 45(11), e143–e147. doi.org/10.1016/j.ajic.2017.06.002
Weinberg, S. E., Villedieu, A., Bagdasarian, N., Karah, N., Teare, L., & Elamin, W. F. (2020). Control and management of multidrug resistant acinetobacter baumannii: A review of the evidence and proposal of novel approaches. Infection Prevention in Practice, 2(3), 1-9. doi.org/10.1016/j.infpip.2020.100077
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
