Evidence-Based Nursing to Reduce Adverse Events Regarding Ventilator Associated Pneumonia, Pressure Injuries and Central Line Bloodstream Infection in Intensive Care Unit in Bangladesh

Overview

Quality of care is crucial for preventing adverse events such as infection in the intensive care units (ICUs). The most common ICU-acquired infections include pneumonia such as Ventilator Associated Pneumonia (VAP), Pressure Ulcer (PU), Medical Device Related Pressure Ulcer (MDRPU), and Central Line-Associated Bloodstream Infection (CLABSI). VAP, PU, and MDRPU are significant indicators of the quality of care, while CLABSI is a critical marker of healthcare quality in ICUs, as it is largely preventable through strict adherence to infection control protocols. VAP is a lung infection that occurs in patients receiving mechanical ventilation for more than 48 hours. A PU is defined as localized damage to the skin or underlying tissue caused solely by pressure, while MDRPUs may also result from friction or pressure from medical devices or other objects. CLABSI is a severe infection caused by improperly inserted or maintained central venous catheters, which underscores the need for stringent catheter management protocols.

General Objective: The objective of this study is to evaluate whether implementing EBP and changing nurses' competency (skill, knowledge, practice, and attitude) can reduce ICU adverse events such as VAP, PU, MDRPU, and CLABSI, and improve patient outcomes. Specific Objectives: 1. To identify insights on perceptions, barriers, and facilitators related to EBP implementation in the ICU setting. 2. To evaluate the effect of EBP training on nurses' competency (skill, knowledge, practice, and attitude) regarding EBP for CLABSI, PU, and MDRPU in an ICU setting. 3. To evaluate the effects of EBP on ICU patient incidence rates of VAP, CLABSI, PU, and MDRPU. Hypothesis: H1- Hypothesize that training on EBP and its implementation in ICU settings will improve nurses' competency (Skill, knowledge, practice and attitude). H2- Hypothesize that implementation of EBP by trained ICU nurses will reduce adverse events-such as VAP, pressure ulcers, medical device-related PU, and CLABSIs-and improve overall patient outcomes. These research consist of two studies: 1. Evaluating the effect of EBP training on ICU nurses' competency (skill, knowledge, practice, and attitude) regarding EBP for CLABSI, PU, and MDRPU in an ICU setting. A pre- and post-quasi-experimental study will be conducted over a 16-month period, with a total data collection period of 6 months, to evaluate nurses' competency. The study consists of a recruitment period (1 month), nurses' baseline data collection (1 month), nurses' EBP training with midline data collection (2 months), and nurses' endline data collection during EBP implementation (2 months). Study nurses will receive EBP training and appropriate equipment for patient management. EBP education and training will be provided with necessary equipment, such as a closed suction catheter, an endotracheal tube, a suction device, and a mouth care brush. In this study, global standard equipment will be used to ensure patient safety. 2. Evaluating the effect of EBP implementation on ICU patient incidence rates of VAP, CLABSI, PU, and MDRPU. A pre- and post-quasi-experimental design with a non-equivalent control group (Study 1, Phase 1 data used as historical data) will be applied by comparing the rate of adverse events such as VAP, CLABSI, PU, and MDRPU before and after the EBP intervention (2-month baseline data and 2-month intervention data will be collected).