الفهرس 
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Abstract
Ventilator-associated pneumonia is the second most common hospitalacquired infection in medical intensive care units. Effective nursing interventions with specific nursing care for mechanically ventilated children could decrease such complication. Furthermore, prevention of ventilator-associated pneumonia must be regarded as one of the most important issues in critical care nursing. Therefore , nursing care protocols elicit the best-practice performance for healthcare practitioners and improve patients’ outcomes A-Aims of the study: 1- To assess the occurrence of ventilator-associated pneumonia on patients receiving routine care. 2- To assess nurses’ knowledge and practices for the prevention of ventilatorassociated pneumonia 3- To design, implement & evaluate the effect of a nursing care protocol on the prevention of ventilator associated pneumonia. B-Setting: The study was conducted in the Neonatal and Pediatric Intensive Care Units (NICU & PICU) at EL Minofia University Hospital and Shebin El-Kom Teaching Hospital C-Sample: All nurses working in the two hospitals (60 nurses) were included in the study The number of nurses who shared in the study in EL Minofia University Hospital and Shebin El-Kom Teaching Hospital was 37 and 23 respectively. D-Tools of the study: Three tools were developed for data collection. 2- Tool one:- A structured interview questionnaire sheet to assess nurses knowledge about VAP. This tool contained three parts: a- Part one Biosocial characteristics of nurses. It contained six questions about nurse’s age, years of experience, place of work , name of the unit, level of education, clinical training and attendance of workshops related to mechanical ventilation b- Part two Nurse’s knowledge about VAP. It included ten questions about definition, VAP as a type of nosocomial infection, occurrence rate, time of onset, its effect on duration of ICU stay, factors that contribute to the occurrence of VAP, causative organisms, time of late onset, clinical signs and symptoms and time to begin nursing interventions to prevent VAP. c- Part three: Nurse’s knowledge about nursing interventions for the prevention of ventilator- associated pneumonia. This part was divided into six subparts: g. Subpart one: It included five questions about hand washing. h. Subpart two: It included four questions about oral care. i. Subpart three: It included two questions about endotracheal intubation. j. Subpart four: It included six questions about ventilator circuit k. Subpart five: It included three questions about suctioning. l. Subpart six: It included three questions about patient’s positioning. 2-Tool two : Nurse’s observation checklist. It included assessment of nurses practices. It was divided into six parts: G. Part one: Nurse’s observation checklist for hand washing . H. Part two: Nurse’s observation checklist for mouth care. I. Part three: Nurse’s observation checklist for suctioning. It included two subparts: 2- Subpart one: it included nurse’s observation for oral/nasopharyngeal suctioning. It included three phases d. Preparatory phase e. Performance phase f. Follow-up Phase 2- Sub part two: it included nurse’s observation for endotracheal suctioning. It included three phases: d. Preparatory phase e. Performance phase f. Follow-up Phase J. Part four: Nurse’s observation checklist for head of bed elevation. K. Part five: Nurse’s observation checklist for ventilator circuit change. L. Part six: Nurse’s observation checklist for humidifier change. 3-Tool three: Clinical pulmonary infection scoring sheet. It included two parts: 4. Part one Biosocial characteristics of children such age, sex, emergency admission to the hospital ( PICU or NICU), duration of hospitalization, diagnosis and etc 5. Part two : Criteria of ventilator- associated pneumonia. E-The main results of the study showed that: 1. The mean age and standard deviation of studied nurses was 26.62±4.19. 2. The majority of nurses didn’t get any training about mechanical ventilation (81.7%). 3. Approximately two thirds of nurses had either 1-4 years ofexperience(33.3%) or 5-10years experience (31.6%). 4. The majority of nurses had either bachelor degree ( 40.0%) or diploma degree (38.4%).5. More than half of studied children during the pre and follow up protocol implementation were female(56.6% and 53.4%) respectively.6. More than one third of studied children had respiratory distress on the pretest(40.0%), post test (45.0%), and follow up test (36.7%). 7. More than half of them were admitted to El Minofia University Hospital in the pre, post, and follow up phases (61.7%). 8. On the post test, nurses had the highest level of correct knowledge. 9. The mean scores of correct knowledge on pre test for VAP, prevention of VAP, and total mean score were 3.78±1.64, 11.83±3.48 and 15.53±4.66 respectively. 10. The mean scores of correct knowledge on post test about VAP was7.92±1.46, knowledge about prevention of VAP was21.27±2.48 andtotal score mean was 29.18 ±3.51.11. The mean scores of correct knowledge on follow up test for VAP, prevention of VAP, and total mean score were 6.12±1.12, 18.52±2.1and 27.07±3.19. 12. The majority of studied nurses had better practices on the post test. 13. The total mean score and standard deviation of studied nurses practices on post test was 148.72 ±12.69 compared to 123.18±15.68 and 145.68±11.86 on pre and follow up tests respectively.14. Total knowledge mean score and standard deviation for nurses in El Minofia University Hospital on pre, post, and follow up tests were 12.29±3.48, 21.56±1.86, and 18.92±1.42. 15. Total knowledge mean score and standard deviation for nurses in Shebin El Kom Teaching Hospital on pre, post, and follow up tests were 14.17 ±4.59, 28.52 ±4.61, and 26.26 ±4.46.