One evidence based protocol doesn't fit all: Brushing away ventilator associated pneumonia in trauma patients

摘要

Objectives: Evaluate change in ventilator associated pneumonia (VAP) and nurse's attitudes, beliefs post implementation of an evidence based practice (EBP) oral hygiene protocol. Methodology/design/setting: Descriptive pre and post test design in two critical care units in a Level One Trauma Community Hospital. Oral hygiene protocol data was reanalysed to examine effects in medical surgical and trauma subgroups. Outcome measures: Oral care practices, attitudes and beliefs among nurses, and VAP rates according to Centers for Disease Control and Prevention guidelines. Results: Trauma rates increased from 6.4% to 10.0% (p= 0.346), and medical/surgical rates decreased from 3.3% to 1.0% (p= 0.042). Results revealed changes in nurses' beliefs regarding pre-admission colonisation (p= 0.027) and having adequate training. Nurses' perception of facility support improved, by having suitable equipment and readily available supplies. Foam swabs with moisture agents at 4. hours or less was 88.6% and toothbrush use at 12. hours or less was 71%, with significant changes in frequency of oral care post intervention. Conclusions: Trauma patients present with unique characteristics which compromise oral care. Understanding risk and prognostic factors, mechanisms of transmission and systemic inflammatory response are important when implementing EBP protocols. Nurses' attitudes, beliefs are important, and staff adherence considered when initiating EBP changes.