Experience of nurses in the prevention of Ventilator-Associated Pneumonia among critically ill patients at Muhimbili National Hospital in Dar Es Salaam

Abstract

  Background: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections that occur more than 48 hours after intubation and initiation of mechanical ventilation. It is associated with morbidity and mortality, increased health costs, and prolonged hospital stays. The estimated incidence of VAP globally is about 5-40% whereby in low and middle-income countries is about 47.9 per 1000 ventilator days. However, there is limited literature about VAP prevention in hospitals in Tanzania. Therefore this study aimed to explore nurses’ experience in the prevention of VAP. Methods: An exploratory descriptive study design was conducted with 15 nurses who were purposefully recruited from medical and surgical ICUs. A semi-structured interview guide consisting of main questions and probes was used to collect data. All interviews were audio-recorded and transcribed verbatim. Data were analyzed using an inductive thematic analytical approach. Results: Four main themes emerged; nurses’ roles in the prevention of VAP, nurses’ challenges toward care provision, nurses’ competency in implementing VAP prevention strategies, and enablers toward the implementation of VAP. The revealed prevention strategies were suctioning, early weaning, head of bed elevation of 30-45°, oral care, administration of medication, and implementation of IPC measures. The study has also revealed important barriers such are inadequate equipment, lack of VAP prevention protocols, shortage of staff, and inadequate knowledge. However, the major facilitators were responsible leadership, a quality control team, the availability of IPC guidelines, and individual motivation. Conclusion: This study provides insights into the experience of nurses in the prevention of VAP. Nurses face several challenges including a shortage of staff, shortage of equipment and supplies, lack of training, lack of VAP prevention protocols, and inadequate knowledge of VAP prevention. Despite these challenges nurses in their capacity are involved in VAP preventive measures.   Keywords: Ventilator-associated pneumonia, strategies, experience, nurses, critically ill patients.