Knowledge and practice of intensive care nurses on prevention of ventilator associated pneumonia at Muhimbili national hospital, Dar es Salaam, Tanzania

Abstract

Background- A cross-sectional and observational study was conducted among Intensive care (ICU) nurses at Muhimbili National Hospital (MNH), to identify knowledge and practice of ICU nurses on prevention of Ventilator Associated Pneumonia (VAP). Materials and methods- Knowledge of 118 nurses working in ICU such as Main , Cardiac , Acute pediatric ICUs , emergency medicine department and highly dependent unit at MNH were tested by using a close ended questionnaire, 30 nurses among 118 were tested for knowledge and practice by using observational checklist. Information letters, consent forms and questionnaires were handed to ICU nurses by researcher assistants. Data coded and entered into SPSS version 16.0 for descriptive and inferential statistics. Results- Of ICU nurses, 95 (80.5%) were women, 64 (54.2%) had either diploma or Advanced diploma in Nursing, 105 (90%) had no ICU training, 80 (67.8%) were working in ICU for less than 10 years, knowledge scored and their levels were as follows: 64 (54.2%) scored 100% - 70% excellent, 19 (16.1%) scored between 69% - 60% very good, 23(19.5%) scored between 59% - 50% good, 10(8.5%) scored 49% - 40% average and 2 (1.7) scored between 39% - 0% poor. No association between knowledge and years of working experience (p- value 0.34), ICU training (p- value 0.64) and level of education (p- value 0.55). ICU nurses’ practice on prevention of VAP was statistically associated with education level (p- value 0.03) but not associated with ICU training (p- value 0.53) and years of work experience (p- value 0.64). On observation large proportion (100 %) of ICU nurses did not wash hands before entering ICU, 83.3% washed hands before and 66.7% after patients contact. Of ICU nurses (66.7%) observed to wash hands after contact with a source of microorganisms. During ETS large proportion of ICU nurses (83.3%) use sterile gloves, though hand washing before and after suctioning, maintaining of environment and equipment cleanness was poor. During oral care (90%) of ICU nurses use clean gloves, 80% clean mouth using toothbrush or gauze moistened with mouth wash and 73% clean equipment. vii Conclusion- ICU nurses’ knowledge on VAP prevention was adequate but their practice was found to be poor. No significant association between ICU training, level of education, years of working experience and knowledge. Practice of ICU nurses on VAP prevention was statistically associated with education level but not with ICU training and years of working experience. Hand washing, environment and equipment cleanness during ETS and oral care was inadequate therefore knowledge of ICU nurses on VAP prevention does not necessarily reflect adequate practical skills. Recommendations- ICU nurses need to be encouraged to translate knowledge into practice, ICU environment and facility should enable nurses in translation, adoption of acceptable guidelines on evidence based medicine practice is recommended. Similar studies with large sample size in other hospitals which provide critical care in Tanzania is recommended.