title: Implementing a unit-level intervention to reduce the probability of ventilator-associated pneumonia.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection and is associated with high morbidity and mortality rates for mechanically ventilated patients in the intensive care unit. Routine nursing interventions have been shown to reduce VAP rates.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the effectiveness of a unit-specific education intervention that emphasized hand hygiene, head-of-the-bed elevation, and oral care. The goals were to improve staff compliance with hand washing, head-of-the-bed elevation, and oral care; to decrease VAP rates, and to decrease number of ventilator days.
  
  
  METHODS
  Two-hour observations were conducted on a convenience sample of 100 ventilated patients not diagnosed with VAP and the clinical staff that interacted with them. Instrumentation included a compliance checklist, a demographic patient survey, and the Acute Physiology and Chronic Health Evaluation AEIV tool. Unit-specific educational interventions were designed and implemented on each participating unit.
  
  
  RESULTS
  : The VAP and the ventilator day rates did not improve significantly. There were no significant changes in clinician adherence to hand hygiene, provision of oral care, or patient positioning.
  
  
  CONCLUSIONS
  Despite implementation of both structured and creative education, team-based approach, and frequent staff reminders, patient outcomes and staff compliance did not improve significantly. Unit-based education interventions may not be the best strategy to facilitate change. Organizations with frequent changes in personnel and leadership may not have the unit-level infrastructure necessary to attain and sustain change.
authors.affiliation: U.S. Army, Nursing Research Services, Brooke Army Medical Center, Ft. Sam Houston, Texas 78234-6200, USA. Mona.bingham@us.army.mil
authors.forename: Mona
authors.initials: M
authors.lastname: Bingham
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ashley
authors.forename: Marla
authors.initials: M
authors.lastname: De Jong
authors.forename: Caren
authors.initials: C
authors.lastname: Swift
mesh_terms: D000328:Adult; D000368:Aged; D055317:Evidence-Based Practice / Q000193:education*; D005260:Female; D019983:Guideline Adherence; D006235:Hand Disinfection; D006801:Humans; D017053:Infection Control; D007318:Inservice Training / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D009910:Oral Hygiene; D056888:Patient Positioning; D010564:Personnel, Hospital / Q000193:education*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D013663:Teaching / Q000379:methods; D014481:United States