title: One evidence based protocol doesn't fit all: brushing away ventilator associated pneumonia in trauma patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 4hours or less was 88.6% and toothbrush use at 12hours 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.
authors.affiliation: Critical Care Services, John C. Lincoln North Mountain Hospital, Phoenix, AZ 85020, USA. Kari.Johnson@jcl.com
authors.forename: Kari
authors.initials: K
authors.lastname: Johnson
authors.forename: Alisa
authors.initials: A
authors.lastname: Domb
authors.forename: Roberta
authors.initials: R
authors.lastname: Johnson
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D055318:Evidence-Based Nursing / Q000193:education; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009741:Nursing Staff, Hospital / Q000193:education; D009910:Oral Hygiene / Q000451:nursing*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D014099:Toothbrushing; D014481:United States; D014947:Wounds and Injuries / Q000451:nursing*