Changes in knowledge, beliefs, and perceptions throughout a multifaceted behavioral program aimed at preventing ventilator-associated pneumonia.

PURPOSE: Prevention of ventilator-associated pneumonia (VAP) requires a complex approach that should include factors affecting healthcare workers' (HCWs) behavior. This study attempted to assess change of individual factors throughout a multifaceted program focusing on VAP prevention. METHODS: The prevention program involved all HCWs in a 20-bed medical intensive care unit (ICU) and included a multidisciplinary task force, an educational session, direct observations and performance feedback, technical improvements, and reminders. Knowledge, beliefs, and perceptions (cognitive factors) were assessed with a test and a self-reporting questionnaire based on social-cognitive theories. They were completed before and 1 and 12 months after the educational session. RESULTS: Of the 100 HCWs initially evaluated, 84 were present 1 year later. Overall, individual factors (knowledge and cognitive factors) changed positively and significantly, immediately after the educational session. Five cognitive factors were significantly associated with knowledge: perceived susceptibility, seriousness, knowledge, benefits, and self-efficacy (P < 0.05). The other factors, i.e., perceived barriers, subjective and behavioral norm, intention to perform action, and motivation, were not. The positive cognitive change was significantly reinforced at 1 year. Three distinct cognitive profiles derived from answers to the baseline questionnaire were individualized. The positive impact of our behavioral approach was highest for the HCW group with the lowest baseline cognitive profiles. CONCLUSIONS: Behavior changed gradually throughout the program and was especially pronounced for HCWs with the lowest baseline cognitive profiles.

A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures.

OBJECTIVE: To determine the effect of a 2-yr multifaceted program aimed at preventing ventilator-acquired pneumonia on compliance with eight targeted preventive measures. DESIGN: Pre- and postintervention observational study. SETTING: A 20-bed medical intensive care unit in a teaching hospital. PATIENTS: A total of 1649 ventilator-days were observed. INTERVENTIONS: The program involved all healthcare workers and included a multidisciplinary task force, an educational session, direct observations with performance feedback, technical improvements, and reminders. It focused on eight targeted measures based on well-recognized published guidelines, easily and precisely defined acts, and directly concerned healthcare workers' bedside behavior. Compliance assessment consisted of five 4-wk periods (before the intervention and 1 month, 6 months, 12 months, and 24 months thereafter). MEASUREMENTS AND MAIN RESULTS: Hand-hygiene and glove-and-gown use compliances were initially high (68% and 80%) and remained stable over time. Compliance with all other preventive measures was initially low and increased steadily over time (before 2-yr level, p < .0001): backrest elevation (5% to 58%) and tracheal cuff pressure maintenance (40% to 89%), which improved after simple technical equipment implementation; orogastric tube use (52% to 96%); gastric overdistension avoidance (20% to 68%); good oral hygiene (47% to 90%); and nonessential tracheal suction elimination (41% to 92%). To assess overall performance of the last six preventive measures, using ventilator-days as the unit of analysis, a composite score for preventive measures applied (range, 0-6) was developed. The median (interquartile range) composite scores for the five successive assessments were 2 (1-3), 4 (3-5), 4 (4-5), 5 (4-6), and 5 (4-6) points; they increased significantly over time (p < .0001). Ventilator-acquired pneumonia prevalence rate decreased by 51% after intervention (p < .0001). CONCLUSIONS: Our active, long-lasting program for preventing ventilator-acquired pneumonia successfully increased compliance with preventive measures directly dependent on healthcare workers' bedside performance. The multidimensional framework was critical for this marked, progressive, and sustained change.