Factors Associated with Ventilator-Associated Pneumonia Guideline Adherence

描述(由申请人提供)：呼吸机相关肺炎(VAP)是危重患者常见的致命并存疾病。据估计，每1000例住院患者中约有5-10例发生VAP。已经制定了各种临床指南来预防这种情况的发生。然而，指南的可用性并不能保证遵循临床医生推荐的策略。有大量关于预防VAP的干预措施的文献。然而，缺乏关于提供者、患者、指南和系统因素如何影响VAP指南遵从率和VAP发生率的证据。本研究的目的是确定影响临床指南依从性的因素。本应用程序的具体目的是：1)描述与指南遵守相关的提供者、患者、指南和系统因素；2)探索这些因素与指南遵从率之间的关系；以及3)探索遵从率与VAP发生率之间的关系。这项研究将首次全面解决这些因素与机构指南遵守的关系。在这项研究项目中，将创建一项匿名的自我管理调查，并分发给多家医院的护士、呼吸治疗师和在成人ICU工作的医生。这项横断面调查将涉及六种常见的VAP策略：手卫生、口腔卫生、半卧位病人体位、声门下吸引术、早期脱离机械通气和维护呼吸机回路。对于每种VAP预防策略，实践频率和可能影响指南遵从性的因素将使用Lickert量表进行评级。这种方法将方便地从忙碌的临床医生那里收集坦率的意见。还将进行现场访问，以获得有关机构VAP指南、人员配置、ICU类型和VAP发病率的信息。将使用描述性分析来分析与遵守指南相关的因素。为了估计这些因素与依从率之间的关系，将进行多元Logistic回归和分层线性模型(HLM)分析。医院获得性感染尽管是可以预防的，但却是导致医疗保健发病率和死亡率的主要因素。将研究转化为现实世界的实践将涉及对提供者、患者、指南和系统因素的批判性分析。这项研究的结果将有助于通过指南质量、实践环境(包括人员配备、教育、供应可获得性、感染控制计划和跨学科合作)提高遵从性。公共卫生相关性：我的职业目标是成为一名患者安全方面的护士研究员，专注于流行病学方法、执业环境和感染。我预计，F31奖学金支持的全日制博士学习将使我能够显著提高我在患者安全领域的知识。加州大学旧金山分校(UCSF)的博士培训将为开展研究提供良好的基础，特别是在设计、方法和分析方面。在加州大学旧金山分校，我不仅将通过护理学院提供研究课程，还将通过社会学、流行病学和医学系进行研究。这是有利的，因为感染控制需要跨学科的方法。我将通过研究课程和有指导的研究实习来学习深入的研究技能。我计划了一个课程，通过博士学习来加强和扩大我在护理和组织理论方面的理论培训。此外，作为博士生和在临床研究中心工作的注册护士的双重角色，让我了解临床实践中的最新问题。在未来，我希望扩大我的国际学习，特别是在美国和日本之间，因为我有教育和临床经验，以及与这两个国家的密切联系。由于患者安全对任何国家来说都是一个至关重要的话题，我希望通过研究、教育、出版和服务为国际医疗界做出贡献。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: 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.