Nattawipa Boonkerdram, MSN¹, Orapin Ampol, BSN², Anusara Ngoychansri, BSN², Sutthida Kaeotha, BSN¹, Thassanee Singkham, BSN¹

¹Department of Infection Control, Tertiary Care Hospital, Thailand
²Department of Critical Care Nursing, Cardiovascular-Thoracic Surgical ICU, Tertiary Care Hospital, Thailand

Corresponding Author: Nattawipa Boonkerdram, MSN, Sakon Nakhon Hospital, 1041 Charoen Mueang Road, Thart Choeng Chum, Mueang Sakon Nakhon, Sakon Nakhon, 47000, Thailand.

Citation: Nattawipa Boonkerdram, Orapin Ampol, Anusara Ngoychansri, Sutthida Kaeotha, Thassanee Singkham, (2025) Effect of a Nursing Practice Promotion Program in Prevention of Ventilator-Associated Pneumonia in Intensive Care Units of a Tertiary Care Hospital in a Middle-Income Country. World J Infect Prevent Contr, 1(1);1-6.

Copyrights: © 2025, Nattawipa Boonkerdram, et al., This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited

Key contributions of our research include:

Novel Theoretical Application: First study to apply Herzberg's Motivation Theory as a framework for VAP prevention nursing practice promotion in Southeast Asia. Practical Implementation Focus: Demonstrates the effectiveness of motivating factors (group discussions, feedback, recognition, training) combined with hygiene factors (clear guidelines, adequate equipment, supervision) in improving nursing compliance.

Real-world Healthcare Setting: Conducted in a cardiovascular-thoracic surgical ICU where VAP rates (7.41 per 1,000 ventilator-days) significantly exceed hospital averages, representing a high-risk population.

Comprehensive WHAPOS Protocol Evaluation: Systematic assessment of six key VAP prevention practices: Weaning, Hand hygiene, Aspiration precautions, Prevention of contamination, Oral care, and Suction.

Important Clinical Insights: While nursing compliance improved significantly (40% to 90%, p<0.04), VAP rates remained unchanged, highlighting the complexity of infection prevention and the importance of patient-specific risk factors.

ABSTRACT

Background: Ventilator-associated pneumonia (VAP) poses a significant healthcare challenge in intensive care units, particularly within the cardiovascular-thoracic surgical ICU (ICU-CVT), which experiences elevated rates compared to overall hospital averages. Objective: This quasi-experimental study aimed to assess the effectiveness of a nursing practice promotion program grounded in Herzberg's Motivation Theory to enhance VAP prevention practices and reduce incidence rates in the ICU-CVT of a tertiary care hospital. Methods: A one-group pretest-posttest design was implemented involving 15 registered nurses and mechanically ventilated patients (48 pre-intervention, 32 post-intervention) from November 2023 and February 2024. The intervention focused on motivating factors (group discussions, feedback, recognition, training, and role modeling) and hygiene factors (clear guidelines, adequate equipment, supportive supervision, and effective communication). Data were collected via a knowledge assessment, a practice observation form based on the WHAPOS protocol (Weaning, Hand hygiene, Aspiration precautions, Prevention of contamination, Oral care, and Suction), and VAP surveillance. Statistical analysis included descriptive statistics, chi-square tests, and VAP rates per 1,000 ventilator-days. Results: Following the intervention, compliance with VAP prevention guidelines among nurses significantly increased from 40% to 90% (p<0.04). Notable improvements were recorded in patient assessments using weaning protocols (10.70% to 100%, p=0.002), hand hygiene practices (64.50% to 100%, p=0.003), and oral care (29% to 100%, p<0.001). However, VAP incidence rates did not show a significant difference between pre- and post-intervention periods (5.18 vs. 5.78 per 1,000 ventilator-days). It is important to note that post-intervention patients had significantly higher APACHE II scores (16.71 vs. 28.22, p<0.0001), indicating greater illness severity. Conclusion: The nursing practice promotion program effectively increased adherence to VAP prevention guidelines, yet did not lead to a reduction in VAP incidence rates. This outcome may be attributed to patient-specific risk factors, including higher illness severity in the post-intervention group. These findings highlight the necessity for comprehensive VAP prevention strategies that not only enhance nursing practices but also address individual patient risk, particularly in high-risk populations with complex medical conditions.

Keywords: Ventilator-Associated Pneumonia, Nursing Practice, Prevention, Intensive Care Unit, Herzberg's Motivation Theory, Practice Promotion, WHAPOS Protocol.