THE PREVENTIVE STRATEGIES USED BY CRITICAL CARE NURSES REGARDING VENTILATOR ASSOCIATED PNEUMONIA AMONG PATIENTS WITH TRACHEOSTOMY TUBE

Abstract

Background: Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections in intensive care units and is linked to prolonged mechanical ventilation, increased morbidity, and higher mortality. Patients with tracheostomy tubes remain at continued risk despite potential airway management benefits. Critical care nurses are central to implementing VAP prevention bundles; however, adherence to evidence-based practices varies across clinical settings. Objective: To evaluate the preventive strategies used by critical care nurses for ventilator-associated pneumonia among patients with tracheostomy tubes in a tertiary care hospital. Study Design: Descriptive cross-sectional study. Setting: Intensive care units of a tertiary care hospital in Lahore, Pakistan. Duration of Study: January 2025 to June 2025. Methods: A total of 153 registered nurses were recruited using purposive sampling from a population of 250 nurses, with sample size calculated using Slovin’s formula. Data were collected using a structured questionnaire adopted to assess demographic characteristics and evidence-based VAP preventive practices, including humidifier care, ventilator circuit management, suctioning technique, head-of-bed elevation, cuff pressure monitoring, oral hygiene practices, sedation interruption, and spontaneous breathing trials. Data were analyzed using SPSS version 23. Descriptive statistics were presented as frequencies and percentages. Preventive practice levels were categorized as poor, moderate, or good based on composite practice scores. Results: Most participants were aged 21–25 years (47.7%), held BSN/Post-RN qualifications (63.4%), and had 1–5 years of professional experience (74.5%). High compliance was observed in infection control practices, including use of sterile water in humidifiers (98.0%), non-sharing of respiratory equipment (96.1%), aseptic tracheostomy care (96.1%), and ventilator tubing changes when indicated (96.1%). Head-of-bed elevation (89.5%), oral care every 4–8 hours (85.0%), chlorhexidine use (82.4%), and daily spontaneous breathing trials (86.9%) were also frequently reported. However, knowledge gaps were identified regarding correct suction duration (66.0%) and optimal cuff pressure range (68.0%). Overall, 42.5% of nurses demonstrated poor adherence to preventive strategies, 38.6% moderate adherence, and only 19.0% good adherence. Conclusion: While general infection control compliance was satisfactory, significant deficiencies were identified in specific technical aspects of VAP prevention among tracheostomized patients. Structured educational interventions, standardized clinical protocols, and regular competency-based evaluations are recommended to strengthen adherence to evidence-based practices and reduce VAP risk in critical care settings.