Effect of Implementing Evidence-based Practice and Nurse's Behavior Change on Quality of Care in Intensive Care Unit: Focus on Ventilator Associated Pneumonia in a Tertiary Hospital in Bangladesh

Обзор

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), Central Line Bloodstream Infection (CLABSI), catheter-associated urinary tract in, Medical Device Related Pressure Ulcer (MDRPU) and Pressure Ulcer (PU). This study explores the patient outcome in ICU by examining the causes and prevalence of ICU-acquired infection. The implementation of evidence-based practice (EBP) to reduce infection and change the nurses practice (behavioral changes) to adhere with EBP based on simulation-based training. General objective: To evaluate the effect of EBP by using recent technologies-based equipment to prevent VAP and promote behavior change among nurses for better outcome of the patient in ICU. Specific Objectives: 1. To determine the incidence of adverse events (VAP rate, MDRPU rate, PU rate, CLABSI rate), length of stay and survival rate in ICU. 2. To evaluate the effectiveness of EBP education by changing nurses' behavior and determine its impact on improving patient outcomes in the ICU. 3. To evaluate the effectiveness of EBP including proper equipment use and changed nurses behavior acquired through the training for better patient outcome (VAP ratio) in the ICU. 4. To examine the feasibility of evaluation process and outcomes and successful implementation of EBP in ICU. Hypothesis: It is hypothesize that implementing EBP in ICU, including new equipment use and nurses training, will improve patient outcome. These research consist of three studies: Phase 1: Incidence of adverse events (VAP rate, MDRPU rate, PU rate, CLABSI rate), length of stay and survival rate in ICU. The patients of General ICU will be followed up after admission up to discharge or death at ICU. The investigators use the study findings for our subsequent intervention study 3 as historical data. Phase 2: A pre- and post- quasi-experimental study will be conducted for 6 months to evaluate the nurse's competency on EBP after getting 1-month EBP training. This study has 3 steps: (1) Pre-observation period to measure nurse's competency level for 2-month, (2) nurse's EBP training period with preparation for 1 month, and (3) post-implementation period to measure nurse's competency and implementation of EBP practice for 2 months. Study nurses will receive EBP training, EBP and proper equipment for patient management. The nurses will receive EBP education and training with necessary equipment, such as a close suction catheter, an endotracheal tube, a suction device, and a mouth care brush. In this study, use global standard equipment for the patients safety. Phase 3: A pre- and post- quasi-experimental study will be implemented to evaluate the efficacy of EBP implementation. The investigators use new equipment and implement EBP for patients and assess the patient outcomes. The investigators compare the findings from study 1 (as historical data) with the data from this study 3. The investigators will compare the VAP infection prevalence and patients' outcomes related to ICU-acquired infection between pre- and post- test phase.

Вмешательства

• Поведенческое This is a pre- and post- quasi-experimental study.
  We will use new equipment and implement EBP (VAP management) for patients by trained nurses (Phase 2) and check the outcome of the patients. We will compare our phase 1 findings for this study as historical data.
• Поведенческое Education with EBP
  Phase 2: Nurse's EBP training ( VAP management), 2 hours lecture and 3 hours skill training for total 4 times in 1 month. Phase 3: Introduce new equipment necessary for EBP implementation for VAP management, and EBP-trained nurses implementation for VAP management.

Первичные конечные точки

• The nurse's skill performance is related to VAP checklist [Срок оценки: Study 2: 6 months]
• Incidence rate of ventilator-associated pneumonia (VAP) [Срок оценки: 2 months]

Вторичные конечные точки (11)

• A nurse's motivation level will be measured [Срок оценки: 6 month]
• Nurses' sustained implementation measured [Срок оценки: 6 months]
• Organizational readiness measured [Срок оценки: 6 months]
• Nurses knowledge and practice related to VAP prevention measured. [Срок оценки: 6 months]
• VAP episode [Срок оценки: 2 months]
• Interval of VAP occurrence [Срок оценки: 2 months]
• Micro-organism link to VAP [Срок оценки: 2 months]
• Mortality and morbidity rate [Срок оценки: 2 months]
• Onset of VAP [Срок оценки: 2 months]
• Length of stay ICU patients [Срок оценки: 2 months]
• Survival rate in ICU [Срок оценки: 2 months]

Критерии участия

Study 2:

Критерии включения

• Who will be a registered nurse in Bangladesh.
• Who will agree to participate in this study and the EBP training.

Критерии исключения

• Who will not directly involve patient care in ICU.

Study 3:

Критерии включения

• Irrespective of age and sex, participant must be 18 years old.
• Legal guardian of a patient consents to participation in the study
• Intubated patients after admission.

Критерии исключения

• Who stays less than 2 days at the GICU.
• Who dies or is extubated within 2 days after admitted in the GICU.
• ICU readmission.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Распределение

Не применимо

Модель

Одна группа

Маскирование

Открытое

Основная цель

Организация здравоохранения

Центры проведения

Bangladesh · 1 центр

• Dhaka Medical College Hospital — Dhaka

Япония · 1 центр

• Hiroshima University — Hiroshima

Публикации

• Akhter N, Zhou X, Elhabashy S, Huq KATME, Okamoto M, Latif MA, Babaita AO, Moriyama M. Effect of evidence-based education program with mentoring system for prevention of ventilator-associated pneumonia on nurses' competency to improve quality care for patients in the intensive care unit: a quasi-experimental study in a tertiary hospital in Bangladesh. Front Public Health. 2026 Jan 9;13:1674223. do PMID 41584199

Идентификаторы

NCT: NCT06624540 · BMRC/NREC/2022-2025/338 · 584 19 05 2024 · 24K02733

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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