Study On The Practice Status And Countermeasures Of Prevention And Control Of Ventilator-associated Pneumonia In ICU Nurses

Objective:To understand the current status and influencing factors of ICU nurses' VAP prevention and control in 3A-class comprehensive hospitals of Shanxi Province,and to explore the application effect of intervention scheme based on the transtheoretical model of behavior in the prevention and control practice of VAP in ICU nurses,and to provide a reference for improving the compliance of nurses' VAP prevention and control practices in the future.Methods:The survey research: From June 1,2019 to June 30,2019,self-designed ICU nurses' VAP prevention and control practice survey questionnaire and target behavior stage questionnaire were used to survey the current status of ICU nurses' VAP prevention and control in 8 3A-class comprehensive hospitals of Shanxi Province and analyze the influencing factors.A total of 330 questionnaires were distributed and 315 valid questionnaires were returned,and the effective response rate was 95.45%.The self-designed observation table for ventilator-associated pneumonia prevention and control measures was used to observe the compliance of nurses in an ICU department.The intervention study: From July 1,2019 to November 30,2019,two of 3A-class comprehensive hospitals were selected through convenient sampling in Shanxi Province.According to the principle of cluster sampling,65 nurses in one hospital's neurosurgical ICU who met the inclusion criteria were selected as the intervention group to implement the interventional program based on the transtheoretical model of behavior;60 nurses in the other hospital's neurosurgical ICU who met the inclusion criteria were selected as the control group to implement routine intervention.The ICU nurses' VAP prevention and control practice survey questionnaire,the target behavior stage questionnaire,and the self-efficacy scale were applied to measure the two groups nurses' current status of practice,behavioral stages and self-efficacy scores before the intervention,the first month and the second month after the intervention,respectively.The observation table for ventilator-associated pneumonia prevention and control measures was used to observe the compliance of the two groups of nurses before the intervention and the first month after the intervention.Through the horizontal and vertical comparison,the application effect of the transtheoretical model of behavior in the practice of VAP prevention and control was evaluated.Results:(1)The average score of 315 nurses' knowledge and behavior about VAP prevention and control measures was separately(11.36 ± 2.04)points and(78.99 ± 6.02)points;and they were positively correlated(P<0.001).The VAP prevention and control behavioral stages of 315 nurses were separately in precontemplation stage(8%),the contemplation stage(23%),the preparation stage(25%),the action stage(28%),and the maintenance stage(16%).The compliance rates of ventilator circuit replacement and oral care were the highest,reaching more than 75%;the compliance rates of Condensed water management and hand hygiene compliance were between 50% and 60%;the compliance rates of monitoring of airbag pressure was above 30%;the compliance rates of bed-head elevation,early rehabilitation training and subglottic attraction were low,less than 30%.(2)Factors influencing the practice status of ICU nurses' VAP prevention and control were: ICU specialist qualifications,professional titles,working years,education and training,cumulative lessons of VAP training in the past three months,and VAP prevention and control behavior stages.(3)After the intervention,the knowledge scores,behavior scores,self-efficacy scores,and behavior compliance of the VAP prevention and control measures of the two groups of nurses were all improved,and the stage of prevention and control behavior were undergoing positive changes.By horizontal and vertical comparison,the intervention group nurses' knowledge and behavior scores of VAP prevention and control measures,self-efficacy scores,the stages of prevention and control behavior,and the compliance rates of various measures increased better than the control group,and the difference was statistically significant(P<0.001).Conclusion:The practice status of VAP prevention and control measures of ICU nurses in the 3Aclass comprehensive hospitals of Shanxi Province have a moderate level.And the compliance of various measures is not optimistic,and there is still a gap with the guidelines.The transtheoretical model of behavior and routine intervention can improve the practice status of ICU nurses' VAP prevention and control in different ways,the former is better than the latter.The transtheoretical model of behavior has the value of clinical application.