Brushing Away Ventilator Associated Pneumonia: Evidence Based Practice Supports Less is Better

Purpose:
Test an EBP oral hygiene intervention to reduce VAP in trauma pts & to measure relationships among nurse's attitudes,beliefs, training, education, & frequency of oral care in trauma ICU. Nurses cannot control the anti-inflammatory response but can be influential in preventing colonization.

Background/Significance:
VAP is the 2nd most common Nosocomial infection among mechanically ventilated patients with 22.8% in medical surgical pts, and 48% in trauma patients. Risk & prognostic factor in trauma pts is a systemic inflammatory response that is linked to a non-response to antimicrobial treatments. Bacterial growth in dental plaque provides a microhabitat for organisms & adherence on tooth surfaces. A variety of oral hygiene methods have been identified, each having a variable effect on VAP.

Methods:
Descriptive Pre and Posttest design was conducted in two ICU's in a Level One Trauma Community Hospital with a convenience sample of registered nurses who provided direct patient care.VAP was diagnosed according to CDC guidelines with cases per 1,000 ventilator days. Nurse attitudes, beliefs, adequacy of training,adequacy of supplies,and education were measured with a 27-item survey.Surveys were administered pre and post rollout of education of the EBP protocol. Descriptive & inferential statistics to evaluate relationships among variables & differences between pre & post VAP rates and evaluate differences in nurses' beliefs & attitudes was used.

Results:
There was a significant decrease in VAP with non trauma pt.'s,but no tin our trauma pt.'s.Trauma did not respond the same as non-trauma population. Beliefs regarding having adequate training (p=0.009) & attitudes of needing more information (p = 0.001) changed post intervention. Oral care education did influence nurses' attitudes, beliefs, & practice. Changes in nurses understanding of mechanism of transmission (p=0.027)& frequency of intervention (p<0.000) were instrumental in reducing VAP.There were no changes in supplies or equipment, nurses perception of facility support improved with responses of having adequate time & suitable equipment (p=0.036) & available supplies (p=0.001).

Conclusions and Implications for Practice:
Trauma pt.'s have unique characteristics.Oral care may not fall under a one protocol fits all. Using evidence to support oral care as prevention & not task may change nurses' perceptions from task to outcome orientation. Understanding nurses attitudes & beliefs may influence protocol adherence.