Assessing measures for preventing ventilator associated pneumonia among nurses working in intensive care units: a case of two selected Referral Hospitals in Kigali

Abstract

Background: Ventilator associated pneumonia (VAP) is the most common hospital acquired infection in intensive care units (ICUs). This infection has been found to be associated with increased duration on mechanical ventilation, longer hospital stay, higher treatment costs as well as increased rate of morbidity and mortality. The aim of this study was to assess measures of preventing VAP among nurses working in ICUs. Methodology: A descriptive cross-sectional study design was adopted. A proportionate stratified sampling method was used to select 72 participants for the self administered questionnaire and 30 for observed practices at two selected referral hospitals in Kigali. Data were analyzed using the statistical package for the social sciences software (SPSS), version 20.0. Descriptive statistics, Pearson chi-square, Fisher’s exact test and simple logistic regressions were used in data analysis. Results: Forty two (58.3%) participants were female, 38 (52.8%) were aged between 30 to 39 years and 38 (52.8%) had advanced diploma (A1) in General Nursing. Most participants [58 (80.6%)] had no critical care nursing qualification and 31 (43.1%), had work experience from 1 year to 3years. Most of the nurses [63(87.5%)] reported that they adhere to hand washing. Only 14 (46.7%) were observed to be adhering to hand washing practices. On bivariate analysis, having critical care training course was the only variable significantly associated with adherence to endotracheal tube suctioning for both self-reported and observed data (p = 0.001 and p = 0.002, respectively). Simple logistic regression analysis showed that nurses with critical care nursing qualification were fourteen times (OR 14.1: CI 3.3 - 58.5 and OR 15.5: CI 2.6 - 92.6 respectively) more likely to adhere to endotracheal tube suctioning and to all measures for preventing ventilator associated pneumonia. Conclusion: Only 7 (9.7%) self- reported and 4 (13.3%) observed participants demonstrated acceptable levels of adherence to VAP prevention strategies. Having a critical care nursing training course was statistically significantly associated with adherence to measures for endotracheal tube suctioning as a measure for VAP prevention. The major barriers on implementing preventive measures of VAP among nurses working in ICUs were lack of material resources for endotracheal tube suctioning and oral hygiene.