NR 716 Week 1 Discussion

Student Name

Chamberlain University

NR-716: Analytic Methods

Prof. Name

Date

EBP Project Practice Question

Assessment of Knowledge and Implementation Practices of the Ventilator-Associated Pneumonia (VAP) Bundle in the Intensive Care Unit of a Private Hospital

Reviewer Information

Reviewer Name(s): Not specified
Article Number: 1

Evidence Summary

The study conducted by Abad, Formalejo, and Mantaring (2021) examined the level of knowledge and practical implementation of the ventilator-associated pneumonia (VAP) bundle among healthcare providers in the intensive care unit (ICU) of a private hospital. The research aimed to assess whether nurses and infection control practitioners (ICPs) adhered to evidence-based interventions designed to reduce the incidence of VAP.

The VAP bundle, established by the Institute for Healthcare Improvement (IHI), includes several essential measures: maintaining head-of-bed elevation between 30° and 45°, conducting daily readiness-to-extubate assessments, ensuring consistent oral care, utilizing subglottic suctioning and closed suction systems, and providing deep vein thrombosis (DVT) prophylaxis.

The findings revealed that while many ICU staff members possessed adequate knowledge about the VAP bundle, consistent compliance with all its components was not achieved. Adherence was highest in head-of-bed elevation, whereas readiness-to-extubate assessments had the lowest compliance. The median compliance rate across all interventions was 84.6%, indicating room for improvement.

The researchers emphasized that ongoing professional development—through workshops, competency-based training, and refresher courses—is essential to close existing knowledge gaps. Furthermore, they highlighted the importance of nurse retention strategies, such as incentive programs and recognition initiatives, to ensure sustainable adherence to best practices over time.

Evidence Table

Author, Date, and Title	Type of Evidence	Population, Size, and Setting	Intervention	Findings that Help Answer the EBP Question	Measures Used	Limitations	Evidence Level & Quality	Notes to Team
Abad, C. L., Formalejo, C. P., & Mantaring, D. M. L. (2021). Assessment of knowledge and implementation practices of the ventilator-acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital. Antimicrobial Resistance & Infection Control, 10(1), 161. https://doi.org/10.1186/s13756-021-01027-1	Descriptive study using both qualitative and quantitative methods	60 participants (56 ICU nurses, 4 ICPs) in the ICU of a private hospital	VAP bundle interventions: head-of-bed elevation (30°–45°), closed suctioning and subglottic drainage, daily readiness-to-extubate assessments, oral hygiene, and DVT prophylaxis	Most participants were aware of the VAP bundle, but adherence was inconsistent. The highest compliance was observed in head-of-bed elevation, while readiness-to-extubate assessments had the lowest. Median compliance was 84.6%. Training, education, and retention strategies were found to be crucial for improvement.	Surveys, focus group discussions, and direct observation of 16 events across three non-consecutive day shifts	Non-randomized design limited generalizability; varying ICU settings may have influenced outcomes; Best Practice Alert (BPA) failed to activate in approximately 28% of cases	Level III, Good Quality	Continuous education and competency-based refreshers recommended. Nurse incentive and retention programs are necessary for sustainable compliance.

Key Insights

Compliance Patterns

The study found that ICU staff demonstrated substantial knowledge regarding the VAP bundle. However, consistent implementation across all interventions remained suboptimal. The lowest adherence was recorded in readiness-to-extubate assessments, a crucial component for reducing the risks associated with prolonged mechanical ventilation.

Educational Needs

To improve compliance rates, hospitals should develop and enforce structured educational programs, such as regular workshops, simulation-based training sessions, and competency validation exercises. Evidence suggests that frequent knowledge reinforcement increases the sustainability of evidence-based practices in clinical settings.

Retention Challenges

High nurse turnover rates negatively impact the long-term adoption of evidence-based interventions. To combat this, hospitals are encouraged to implement recognition programs, financial incentives, mentorship opportunities, and supportive work environments. These initiatives can enhance staff satisfaction, improve retention, and ensure the continuity of quality patient care.

References

Abad, C. L., Formalejo, C. P., & Mantaring, D. M. L. (2021). Assessment of knowledge and implementation practices of the ventilator acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital. Antimicrobial Resistance & Infection Control, 10(1), 161. https://doi.org/10.1186/s13756-021-01027-1