Evaluation of current nursing practice for the prevention and management of respiratory infection in ventilated ICU patients.

Abstract

BACKGROUND: The Australian Commission on Quality and Safety in Health Care has identified the prevention of Hospital Acquired Infections as a priority for improvement. This study explored critical care nurses' roles in respiratory-related infection prevention in the intensive care unit (ICU), with a specific focus on the prevention of ventilator associated pneumonia (VAP). METHODS: A multiple methods research project was undertaken across four ICUs that involved three components: (1) observations of respiratory care delivery, (2) a medical record audit, and (3) a survey of critical care nurses regarding their current practice. RESULTS: Medical record audits of 37 patients across four sites were conducted. Observations of respiratory care provision was undertaken for 17 general ICU patients and 9 cardiothoracic surgical patients. Forty-five critical care nurses completed the survey. Elevating the head of the bed to 30 degrees was recognised as an important preventative strategy in VAP prevention and was implemented consistently. The majority of nurses identified that endotracheal suctioning should be performed on an as needed basis. Audit data showed that the frequency of suctioning was higher for patients wit discoloured sputum (mean 3.6(SD2.3) times per 12 hour) than for those without (0.6(SD.05) (t = -6.45, df 34, p<0.001). Gastric ulcer prophylaxis was identified as an important preventative strategy and was prescribed in 91% of general ICU patients and 75% of cardiothoracic surgery patients. Nurses surveyed did not mention the importance of antimicrobial stewardship. Practice gaps were identified in the consistency of providing mouth care and adherence to infection prevention and control guidelines. CONCLUSIONS: A high standard of respiratory care was provided to patients at each of the participating study sites. Practice gaps were identified in relation to respiratory-related infection prevention that could be addressed by the implementation of a VAP prevention bundle.