Effects of active and passive implementation of ventilator associated pneumonia guideline on nurses' performance in critical care units: a controlled clinical trial

ABSTRACT

Ventilator associated pneumonia [VAP] is the most common infections in critical care units, which leads to more length of hospital stay, costs, and high mortality. Therefore, prevention is a priority according to clinical guidelines. The aim of this study is determine the effects of passive versus active implementation of VAP guidelines on nurses' performance in critical care units. In this controlled clinical trial, 110 nurses who working in critical care units in selected hospitals affiliated to Tehran University of Medical Sciences were enrolled to study by convenience sampling at three groups, including active intervention group [n = 40], passive intervention [n = 36], and control [n = 34]. First, nurses' performance in prevention of VAP was evaluated by an observational checklist. In passive intervention group, posters containing recommendations of prevention of VAP was installed over the wall for each bed. In active intervention group, in addition to poster installation, there were training sessions with feedback on nurses' performance. In control group without any intervention, just nurses' preventative performance was evaluated before and 1 month later. A month later the nurses' performance were observed. Data were analyzed by descriptive and inferential tests [Fisher's exact test, chi-square, ANOVA, and paired t-test] in SPSS version 16. Results showed that the nurses' mean percentage score in three groups was 46.80 +/- 5.79 and after intervention it changed from 47.76 +/- 4.61 to 63.32 +/- 6.97 [P < 0.001] in active group, from 45.24 +/- 5.72 to 55.03 +/- 10.20 [P < 0.001] in passive group and 47.33 +/- 6.86 to 47.90 +/- 6.06 in control group [P = 0.263]. Nurses' performance in active group improved significantly in comparison to passive group and in passive group, it improved significantly in comparison to control group [P < 0.001]. The results of this study showed that both active and passive methods are effective on nurses' performance in prevention of VAP. Therefore, considering the existing situation in the country and the high workload of nurses, we can offer VAP guideline as a protocol in critical care units