Evidence-based practice: Use of the ventilator bundle to prevent ventilator-associated pneumonia

Purpose To examine critical care nurses' knowledge about the use of the ventilator bundle to prevent ventilator-associated pneumonia. METHOD Published reports were reviewed for current evidence on the use of the ventilator bundle to prevent ventilator-associated pneumonia, and education sessions were held to present the findings to 61 nurses in coronary care and surgical intensive care units. Changes in the nurses' knowledge were evaluated by using a 10-item test, given both before and after the sessions. Changes in the nurses' practices related to ventilator-associated pneumonia, including elevation of the head of the bed to 30 ^o to 45 ^o, were observed in 99 intubated patients. RESULTS After the education sessions, the nurses performed better on 8 of the 10 items tested (P from .03 to <.001). The areas of most significant improvement were elevation of the head of the bed (P < .001), charting of the elevation of the head of the bed (P=.009), oral care (P=.009), checking of the nasogastric tube for residual volume (P=.008), washing of hands before contact with patients (P<.001), and limiting the wearing of rings (P<.001) and nail polish (P=.04). Even after the education sessions, the nurses' compliance with hand-washing recommendations before contact with patients was low, though statistically some improvement was apparent. Contraindications to elevation of the head of the bed did not appear to affect the nurses' practices (P=.38). CONCLUSION Education sessions designed to inform nurses about the ventilator bundle and its use to prevent ventilator-associated pneumonia have a significant effect on participants' knowledge and subsequent clinical practice.