title: Education alone is not enough in ventilator associated pneumonia care bundle compliance.
abstract: OBJECTIVE
  Ventilator-associated pneumonia (VAP) described as a secondary and preventable consequence in mechanically ventilated patients, emerges 48 h or more after patients intubation. Considering the high morbidity and mortality rate of VAP and the fact that VAP is preventable, it seemed necessary to evaluate care bundle compliance rate and effect of education on its improvement.
  
  
  METHODS
  This observational study was conducted on 10 Intensive Care Units (ICUs) of four university affiliated hospitals in three steps. In the first step, VAP care bundle compliance including head of bed (HOB) elevation, endotracheal cuff pressure (ETCP), mouthwash time, utilizing close suction systems, subglottic secretion drainage, type of suction package, and hand wash before suctioning was evaluated. In the second and third steps, ICU staffs were trained and its effect on VAP care bundle compliance was investigated. Finally, an inquiry from nurses was conducted to evaluate the obtained results.
  
  
  RESULTS
  A total of 552 checklists consisting of 294 observations in the pre-education group and 258 observations in the posteducation group were filled. Mean VAP care bundle compliance in pre-education and posteducation stages was 36.5% and 41.2%, respectively (P > 0.05). Except for patients' mouth washing, there were no improvement in HOB elevation (>30°), hand washing and ETCP after education. Based on the results of questionnaire received from nurses at the end of study, more than 90% of nurses believed that lack of rigid monitoring of VAP care bundle is a main reason of low adherence for VAP care bundle compliance.
  
  
  CONCLUSIONS
  The adherence to VAP care bundle was inappropriate. Education seems to be ineffective on improving VAP care bundle compliance. Frequent recall of the necessity of the VAP care bundle and the continuous supervision of ICU staffs is highly recommended.
authors.affiliation: Department of Clinical Pharmacy, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Hadi
authors.initials: H
authors.lastname: Hamishehkar
authors.affiliation: Iranian Evidence Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Vahidinezhad
authors.affiliation: The Liver and Gastrointestinal Research Center, Tabriz University of Medical sciences, Tabriz, Iran.
authors.forename: Simin Ozar
authors.initials: SO
authors.lastname: Mashayekhi
authors.affiliation: Student Research center committee, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Parina
authors.initials: P
authors.lastname: Asgharian
authors.affiliation: Department of Nursing, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Hadi
authors.initials: H
authors.lastname: Hassankhani
authors.affiliation: Department of Anesthesiology and critical care, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Ata
authors.initials: A
authors.lastname: Mahmoodpoor
keywords: Compliance; VAP care bundle; Ventilator-associated pneumonia (VAP); education