Ventilator-associated pneumonia (VAP) is a common and deadly co-morbidity for critically ill patients. It is estimated that VAP occurs in approximately 5-10 cases per 1,000 hospitalizations. Various clinical guidelines have been developed to prevent occurrence. However, the availability of guidelines does not assure adherence to recommended strategies by clinicians. There is substantial literature on interventions to prevent VAP. Nevertheless, there is a lack of evidence of how provider, patient, guideline, and system factors influence VAP guideline adherence rates and VAP incidence. The purpose of this research is to identify factors that influence clinical guideline adherence.
The specific aims of this application are to: 1) describe provider, patient, guideline, and system factors associated with guideline adherence;2) explore the relationships among these factors and guideline adherence rates;and 3) explore the relationships between adherence rates and VAP incidence. This research will be the first to comprehensively address these factors in relationship to institutional guideline adherence. In this research project, an anonymous self-administered survey will be created and distributed to nurses, respiratory therapists, and physicians working in adult ICUs in multiple hospitals. This cross-sectional survey will address six common VAP strategies: hand hygiene, oral hygiene, semi-recumbent patient positioning, subglottic suctioning, early weaning from mechanical ventilation, and maintenance of a ventilator circuit. For each VAP prevention strategy, frequency of practice and factors that could influence guideline adherence will be rated using a Lickert-scale. This methodology will conveniently gather candid opinions from busy clinicians. Site visits will also be conducted to obtain information on institutional VAP guidelines, staffing, type of ICU, and VAP incidence. Factors associated with guideline adherence will be analyzed using descriptive analyses. To estimate the relationships between these factors and adherence rates, multiple logistic regression and hierarchical linear model (HLM) analysis will be performed. Hospital-acquired infections, despite being preventable, are a major contributor to healthcare morbidity and mortality. Translating research into real world practice would involve critical analysis of provider, patient, guideline, and system factors. Findings from this study will contribute to enhancing adherence through guideline quality, practice environment including staffing, education, supply availability, infection control programs, and interdisciplinary collaboration.
My career goal is to become a nurse researcher in patient safety with a focus on epidemiologic methods, practice environment, and infection. I anticipate that full-time doctoral study supported by a F31 fellowship will allow me to significantly advance my knowledge in the patient safety field. Doctoral training at the University of California San Francisco (UCSF) will provide an excellent foundation to conduct research especially in design, methodology, and analysis. At UCSF, I will take not only research courses offered through the School of Nursing but through the sociology, epidemiology, and medicine departments as well. This is advantageous as infection control requires interdisciplinary approach. I will learn in-depth research skills through research classes as well as through the mentored research residencies. I have planned a curriculum that will enhance and expand my theoretical training in nursing and organizational theories through doctoral study. Further, holding a dual role as a doctoral student and a registered nurse working at a clinical research center keeps me updated with issues in clinical practice. In the future, I hope to expand my studies internationally especially between the US and Japan as 1 have both the educational and clinical experience, as well as strong connections with both countries. As patient safety is a critically important topic for any country, I hope to contribute to the international healthcare communities through research, education, publication, and service.
