NR 716 Week 1 Discussion

Student Name

Chamberlain University

NR-716: Analytic Methods

Prof. Name:

Date

EBP Project Practice Question

What is the level of knowledge and adherence to ventilator-associated pneumonia (VAP) bundle practices among healthcare professionals in an intensive care unit of a private hospital?

The clinical focus of this evidence-based practice (EBP) project is to assess how effectively healthcare providers apply the ventilator-associated pneumonia (VAP) bundle. VAP remains a significant complication in critically ill patients, and bundle adherence is essential for reducing infection rates. The project aims to evaluate whether ICU nurses and infection control practitioners (ICPs) understand and consistently implement evidence-based preventive measures.

Reviewer Information

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

Evidence Summary

The study conducted by Abad, Formalejo, and Mantaring (2021) investigated healthcare providers’ knowledge and actual implementation of the VAP bundle within private hospital intensive care units. The bundle, recommended by the Institute for Healthcare Improvement (IHI), consists of multiple interventions such as maintaining the head of the bed at 30°–45°, performing daily readiness-to-extubate assessments, practicing regular oral care, subglottic suctioning, and providing deep vein thrombosis (DVT) prophylaxis.

Findings showed that although most staff were knowledgeable about the VAP bundle, compliance was inconsistent. The highest adherence was noted in head-of-bed elevation, while daily readiness-to-extubate checks were poorly executed. Median bundle compliance was 84.6%. The study highlighted persistent knowledge gaps and stressed the necessity of ongoing education, competency-based workshops, and regular reinforcement of guidelines. Additionally, retention of nursing staff was identified as a challenge, emphasizing the importance of strategies that support long-term commitment and skill sustainability.

Evidence Table

Author, Date, and Title	Type of Evidence	Population, Size, and Setting	Intervention	Findings that 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 utilizing both qualitative and quantitative methods	60 participants (56 ICU nurses and 4 ICPs) across private hospital ICUs	VAP bundle including: – Head-of-bed elevation (30°–45°) – Closed suctioning & subglottic drainage – Daily readiness-to-extubate checks – Oral hygiene protocols – DVT prophylaxis	– Staff had awareness of the VAP bundle, but adherence varied. – Head-of-bed elevation showed highest compliance. – Readiness-to-extubate had lowest compliance. – Median compliance was 84.6%. – Knowledge gaps and inconsistent practices were noted. – Ongoing education, training, and retention strategies are critical.	Surveys, structured group discussions, and direct observation (16 events over three non-consecutive days during day shifts)	– Non-randomized design. – Variability across ICU settings. – Risk of external confounders. – Best Practice Alert (BPA) failed to activate in ~28% of cases due to system lockouts.	Level III evidence, Good quality	Reinforce routine education and training. Consider retention incentives for nurses to sustain VAP prevention practices.

Key Insights

Compliance Patterns

While ICU staff demonstrated strong theoretical understanding of the VAP bundle, actual practice revealed inconsistencies. The readiness-to-extubate element was the least implemented, suggesting gaps in workflow integration and prioritization.

Educational Needs

Regular educational sessions, simulation-based training, and refresher workshops are recommended to improve guideline adherence. Competency-based evaluations could strengthen long-term performance and ensure consistent care delivery.

Retention Challenges

High turnover among ICU nurses undermines sustainability of VAP bundle adherence. Nurse retention incentives, such as professional development opportunities, recognition programs, and supportive work environments, may enhance consistency in infection control practices.

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