Ventilator-Associated Pnuemonia Prevention: Barriers and Facilitators of Provider Guideline Adherence
- Author(s): Kiyoshi-Teo, Hiroko
- Advisor(s): Blegen, Mary A
- et al.
BACKGROUND: Various clinical guidelines have been developed to prevent ventilator-associated pneumonia (VAP). However, the availability of guidelines does not ensure adherence by clinicians to recommended strategies. Studies indicate prevention practices for VAP differ across settings. To date, there has been no study that comprehensively describes factors that influence VAP guideline adherence, nor the relationship between provider guideline adherence and VAP occurrence. AIM:The purpose of this study was to identify factors that influence VAP prevention guideline adherence. The specific aims were to: (a) describe guideline user-related factors, guideline qualities, and contextual factors associated with guideline adherence; (b) test the relationships among these factors and guideline adherence rates; and (c) explore the relationships between adherence rates and VAP occurrence. This study examined institution specific VAP prevention guidelines and non-pharmacologic VAP prevention interventions (oral hygiene, head of bed elevated patient positioning, spontaneous breathing trial, and hand hygiene). METHODS: A cross-sectional descriptive study was guided by a conceptual model. A survey was created to capture guideline user characteristics, qualities of the clinical guideline, and contextual factors that influence clinicians' guideline adherence RESULTS: A total of 576 critical care nurses and 15 directors of infection control, critical care educators, and nurse managers from eight hospitals participated in the study. Each hospital had unique VAP prevention guidelines. In general, nurses had positive attitudes and reported to adhere to the guidelines always to most of the time. However, there were variations among the units. Also, factors associated with guideline adherence were different by intervention. The guideline user attitude scale was the strongest and most consistent predictor of guideline adherence across interventions (OR 3.89-19.68). Guideline quality and context indicators were also significant predictors (OR 1.54-3.57). For unit level analyses, VAP rates were correlated with HOB adherence scores (-.52, p<=.05). CONCLUSION: Use of clinical guidelines has become a norm in patient care. To maximize the benefit of guideline implementation, efforts must be made to enhance nurses' attitudes, guideline quality, and environmental support.