الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
Abstract
Ventilator associated pneumonia is the second most common nosocomial infection in the intensive care unit (ICU) and the most common in mechanically ventilated patients. According to the Center for Disease Control and Prevention (CDC, 2012), Ventilator associated pneumonia (VAP) is that type of pneumonia developing 48 hours post intubation and connection with mechanical ventilator. It is diagnosed by the presence of a number of indicators including; manifestations of pulmonary infection as; presence of a disturbance in body temperature > 38◦C or < 36◦C, leukocytosis and purulent tracheal secretions, new or persistent infiltrates detectable on chest radiographs, and positive deep tracheal aspiration culture (Aferu, 2016).
Ventilator associated pneumonia bundle is a series of evidence-based interventions designed to reduce the prevalence of VAP in mechanically ventilated patients. The key concepts of the VAP Prevention Bundle are five concepts. These concepts include; head of bed (HOB) elevation 30-45 degrees, use of thromboembolic prophylaxis, use of peptic ulcer disease prophylaxis, daily interruption of sedative drug infusions with a constant assessment of readiness to extubate, and providing oral care (Luna, 2015).
The role of the critical care nurse in preventing VAP is crucial. Most of the measures included in VAP Prevention Bundle guidelines are largely related to the daily nursing care activities. Therefore it is important to evaluate intensive care nurse’s knowledge and practice to highlight possible contributors and barriers to the implementation of preventive measure on prevention of ventilator associated pneumonia (Ismail & Zahran, 2015).
Aim of the study:
This study aimed to assess the nurses’ perception regarding ventilator associated pneumonia bundle, through the following:
1. Assessing level of nurses’ knowledge regarding ventilator associated pneumonia bundle.
2. Assessing level of nurses’ practice regarding ventilator associated pneumonia bundle.
3. Identifying factors affecting nurses’ perception regarding ventilator associated pneumonia bundle.
Research questions:
The current study answered the following question:
1. What is nurses’ level of knowledge regarding ventilator associated pneumonia bundle?
2. What is nurses’ level of practice regarding ventilator associated pneumonia bundle?
3. What are the factors affecting nurses’ perception regarding ventilator associated pneumonia bundle?
Research design:
A descriptive explanatory design was utilized for the conduction of this study.
Setting:
The present study was conducted in critical care unit (ICU & CCU) at El Fayoum University Hospital.
Subject:
Convenience sample of all available nurses (40 nurses) who providing care for mechanically ventilated patients at previously mentioned setting.
Tools used to accomplish the aim of this study:
Five tools were used in the current study as follows:
1-Demographic data tool: It was Self-administered questionnaire filled by the studied nurses to assess their demographic characteristics of the studied nurses; age, sex, level of education, years of experience in critical care unit (ICU & CCU).
2- Nurses’ knowledge questionnaire: It was Self-administered questionnaire filled by the studied nurses to assess their level of knowledge regarding VAP bundle among mechanically ventilated patients.
3- Nurses’ Observational checklist: This tool adapted from recent and relevant literature and modified by the researcher to suite the study aim. It was used to assess the studied nurses’ level of practice regarding VAP bundle among mechanically ventilated patients.
4- Nurses’ perception questionnaire: It was Self-administered questionnaire filled by the studied nurses to assess their level of perception regarding VAP bundle among mechanically ventilated patients.
5-Factors affecting nurses’ perception questionnaire: It was Self-administered questionnaire filled by the studied nurses to assess factors affecting their perception regarding VAP bundle among mechanically ventilated patients.
Results:
The results of the study showed that:
• More than three quarters (82.5%) of the studied nurses their age ranged between 20 to <30years with a mean age of 35.09±4.87, the female group was more than two third (70%) and more than half (62.5%) of them were technical nursing diploma while the rest were nursing bachelor of them degree as well more than two third (70%) had less than 1 year of experience in critical care unit.
• Three quarter (75%) of the studied nurses their total level of knowledge regarding knowledge regarding ventilator associated pneumonia bundle were unsatisfactory.
• More than three quarters (85%) of the studied nurses their total level of practice regarding ventilator associated pneumonia bundle were incompetent.
• About two thirds (60%) of the studied nurses had negative perception regarding ventilator associated pneumonia bundle.
• Many factors affecting nurses’ perception regarding ventilator associated pneumonia bundle, the most affecting factors were nurses’ related factors (65%) followed by health setting related factors (62.5%) and then patients’ related factors (50%).
• There was highly statistically significant difference between the nurses’ level of knowledge regarding ventilator associated pneumonia bundle and their demographic characteristics; educational level and years of experience in critical care unit (X2 =10.276 & 15.873 at p <0.001&<0.001 respectively).
• There was statistically significant difference between the nurses’ level of practice regarding ventilator associated pneumonia bundle and their demographic characteristics; age & educational level (X2 =5.164 & 6.327 at p 0.023 &0.012 respectively).
• There was highly statistically significant difference between the nurses’ level of practice regarding ventilator associated pneumonia bundle and their years of experience in critical care unit with mean 24.314 and P-value= p <0.001.
• There was statistically significant difference between the nurses’ perception regarding ventilator associated pneumonia bundle and their demographic characteristics; age &educational level (X2 =7.388 & 4.000 at p 0.007&0.046 respectively).As well there was highly statistically significant difference between the nurses’ level of perception regarding VAP bundle and their years of experience in critical care unit (X2 =13.876 at p <0.001).
• There was highly statistically significant difference between the nurses’ level of knowledge regarding ventilator associated pneumonia bundle and their practice with mean 12.810 and P value= <0.001.
• There was statistically significant difference between the nurses’ perception and their level of knowledge regarding ventilator associated pneumonia bundle with mean 8.889and P-value= 0.003.
• There was highly statistically significant difference between the nurses’ perception and their level of practice regarding ventilator associated pneumonia bundle with mean 10.588 and P-value <0.001.
Conclusion:
Based on findings of the current study, it can be concluded that: three quarter of the study nurses had unsatisfactory knowledge and more than three quarters of them had incompetent level of practice regarding ventilator associated pneumonia (VAP) bundle. Meanwhile, about two thirds of the studied nurses had negative perception regarding ventilator associated pneumonia bundle. As well there were many factors affecting nurses’ perception regarding VAP bundle as; nurses’ related factors, health setting related factors and patients’ related factors. Moreover, there was statistically significant difference between the nurses’ perception, level of knowledge and practice regarding ventilator associated pneumonia bundle and their demographic characteristics; educational level& years of experience in critical care unit .Also there was statistically significant difference between the nurses’ perception regarding ventilator associated pneumonia bundle and their level of knowledge and practice.
Recommendations:
Based on the results of the present study, the following recommendations are suggested:
• On-going and regular in-service educational and training programs to improve their knowledge and practices regarding VAP bundle.
• Ventilator bundle checklist must be developed and appropriately followed by all nursing staff to prevent VAP and other complications in mechanically ventilated patients.
• The study should be replicated on large sample and in different hospitals setting in order to generalize the results.
• Future research should be conducted to examine ICU nurses’ perception, knowledge and practices before and after implementation of an educational program regarding VAP bundle in mechanically ventilated patients.