Severe infections, trauma or major surgery can each cause a state of systemic inflammation. These causes for systemic inflammation often coexist and complicate each other. Mechanical ventilation is commonly used during major surgical procedures and when respiratory functions are failing in the intensive care setting. Although necessary, the use of mechanical ventilation can cause injury to the lungs and other organs especially under states of systemic inflammation. Moreover, a course of mechanical ventilator therapy can be complicated by ventilator-associated pneumonia, a factor greatly influencing mortality. The efforts to avoid additional ventilator-induced injury to patients are embodied in the expression ‘protective ventilation’. With the use of pig models we have examined the impact of protective ventilation on systemic inflammation, on organ-specific inflammation and on bacterial growth during pneumonia. Additionally, with a 30-hour ventilator-associated pneumonia model we examined the influence of mechanical ventilation and systemic inflammation on bacterial growth. Systemic inflammation was initiated with surgery and enhanced with endotoxin. The bacterium used was Pseudomonas aeruginosa. We found that protective ventilation during systemic inflammation attenuated the systemic inflammatory cytokine responses and reduced secondary organ damage. Moreover, the attenuated inflammatory responses were seen on the organ specific level, most clearly as reduced counts of inflammatory cytokines from the liver. Protective ventilation entailed lower bacterial counts in lung tissue after 6 hours of pneumonia. Mechanical ventilation for 24 h, before a bacterial challenge into the lungs, increased bacterial counts in lung tissue after 6 h. The addition of systemic inflammation by endotoxin during 24 h increased the bacterial counts even more. For comparison, these experiments used control groups with clinically common ventilator settings. Summarily, these results support the use of protective ventilation as a means to reduce systemic inflammation and organ injury, and to optimize bacterial clearance in states of systemic inflammation and pneumonia.

Ventilator-associated pneumonia (VAP) is a healthcare-associated infection (HAI), or more specifically, a healthcare-associated pneumonia (HAP) that can lead to significant morbidity and mortality in hospitalized patients that are being mechanically ventilated. There are established evidence-based guidelines in existence designed to reduce or eliminate VAP from occurring and when properly maintained have been shown to reduce the incidence of VAP. Nurses are at the frontline adhering to the VAP protocol through its integration into their workflow. It is yet unknown what elements of the protocol and workflow contribute to a successful VAP reduction in occurrence and increased patient safety. This program evaluation project, guided by an adapted Systems Engineering Initiative for Patient Safety (SEIPS) model, takes a human-factors approach towards answering these questions. It specifically examines the VAP protocol in a large urban southwestern teaching hospital to evaluate program effectiveness using a human factors approach. Building on the work of Carayon, et al. (2006) and Jansson et al. (2013), I present the findings from this program evaluation project using an adapted SEIPS model that sought to evaluate the VAP prevention program from a human factors perspective addressing the following aims: Aim 1. Determine the effectiveness of using the adapted SEIPS model to evaluate a VAP quality improvement (QI) project; Aim 2. Evaluate a VAP QI program taking a human factors approach; and Aim 3. Using the adapted SEIPS model, identify elements of the VAP bundle that nurses perceive as strength and weaknesses. The project was completed with the following findings: Based on this work the adapted SEIPS model demonstrates usefulness for evaluating QI projects. It would be interesting to continue this work with QI projects to see how well it performs.

Respiratory assistance devices bypass essential host defenses and allow these pathogens direct access to the lower respiratory tract and hinder these defense systems to effectively clear respiratory pathogens (1). Mechanical ventilation in the presence of dental plaque with respiratory pathogens has the potential to lead to ventilator-associated pneumonia (VAP). Ventilator-associated pneumonia is the leading cause of morbidity and mortality in intensive care units. VAP influences increasing need for medical treatment and hospital length of stay (LOS) (2-4). Lower respiratory tract infections (LRTI) have been found to be the most expensive site per infection with 13% of all infections accounting for 29% of the total recorded cost (5). The purpose of this systematic review is to perform a comprehensive literature search to identify published randomized clinical trials relating to the efficacy of chlorhexidine gluconate (CHX) oral rinse in preventing VAP. CHX has been identified as the "gold standard" to reduce the number of microorganisms. This review also addresses the importance of oral health and the increased risk of respiratory infections from colonization by harmful pathogens within the oral mucosa. Clinical trials relating to the hypothesis in question were evaluated using Consolidated Standards of Reporting Trials (CONSORT) checklist for validity. Quality and strength of each randomized clinical trial were evaluated based on the requirements of the Agency for Healthcare Research and Quality (AHRQ). Nine bibliographic databases, from 1965-2012 were used to conduct the literature inquiry. Ten studies included populations greater than or equal to 18 years of age and admitted to the intensive care unit receiving mechanical ventilation. The patients were, ventilated due to either trauma, undergoing elective cardiothoracic surgery, or from some other form of surgery, at risk for VAP. In one study, CHX oral rinse decreased microbial colonization of the respiratory tract and hospital-acquired pneumonia (HAP) in patients who underwent open-heart surgery and were intubated less than 24 hours. Yet the difference was not significant in patients intubated more than 24 hours who had a higher amount of bacterial colonization (6). Modulation of oropharyngeal colonization by the use of oral chlorhexidine has reduced the number of ICU-acquired HAP in selected patient populations such as those undergoing coronary bypass grafting, but its routine use is not recommended until more data become available (7). Findings from several studies suggest a significant decrease in the incidence of total nosocomial respiratory infections and systemic antibiotic use in patients who underwent open heart and used a CHX oral rinse as compared with ventilator patients who did not use the rinse; there was also a 65% decrease (13% vs. 4%) in the overall nosocomial infection rate in the chlorhexidine group (7,8,9). Using 2% chlorhexidine solution presents the strongest evidence for decreasing VAP (10,11). From Scannapieco and colleagues' study we can conclude that twice daily is not necessarily better than once daily, but maybe a four times daily regimen with 2% instead of 0.12% CHX does make a difference in reducing the incidence of VAP (12).

Ventilator-associated events (VAEs) are patients' complications of respiratory conditions including ventilator-associated pneumonia (VAP). Research shows that VAP is the most common hospital-acquired infection among ventilated patients and a leading source of mortality. With greater risk for complications among ventilated- supported patients, nurses working in the ICU must keep abreast of new knowledge and update expertise to develop technical and clinical skills in daily practice. The purpose of this project was to assess whether an educational intervention would increase the ICU nurses' level of knowledge of the evidence-based intervention. Knowles' adult learning theory was chosen for this project. A paired-samples t-test was conducted to examine nurses' knowledge of VAE/VAP using a questionnaire measuring knowledge of VAP; 58 ICU nurses participated an educational intervention. Findings showed that nurses had an increase in knowledge following the education (M = 11.43, SD = .775) compared to nurses prior to education (M = 9.55, SD = .976), t(57) = -26.884, p < .001. Results of this project may guide the use of an evidence-based practice educational intervention to improve the quality and safety of ventilated patients. The implications for positive social change include preventing VAEs/VAP among patients, thus decreasing the length of hospital stay, cost, and deaths related to ventilator infections.

No description available.

Thesis (MCur)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Ventilator-Associated Pneumonia (VAP) is a hospital acquired infection, not present or incubating at the time of admission and developing in patients during the process of care within the hospital setting. Between nine and twenty-seven percent of patients who are mechanically ventilated will develop ventilator-associated pneumonia. Mortality rates for ventilated patients who develop ventilator-associated pneumonia are estimated to be between 33-50%. The Institute for Healthcare Improvements (IHI) in 2006 recommended the use of ‘care bundles’ to reduce VAP but no statistically significant decline has been noted. Despite the completion of an extensive literature search for purposes of this review, no statistical data on nosocomial infections or nosocomial pneumonia relevant to South Africa was found. Mechanical ventilation, a support therapy used in approximately one third of patients, significantly increases the patient’s risk of developing this nosocomial pneumonia. Critically ill patients are by virtue of their critical illness more prone to the development of infections, especially ventilator-associated pneumonia. Consistent evidence suggests that oropharyngeal colonization can be associated with the development of VAP. Studies focusing on standard oral care, with or without the concurrent use of chlorhexidine, have not provided sufficient evidence for the use of chlorhexidine in VAP prevention. Chlorhexidine is an antiseptic agent, which when tested, proved to reduce total respiratory tract infections by up to 69% (DeRiso et al, 1996:1558). Objective: The aim of this study was to systematically appraise and review evidence on the effectiveness of chlorhexidine in reducing the incidence of ventilator-associated pneumonia in adult patients. The secondary aim was to systematically summarize evidence on the use of chlorhexidine in reducing mortality. Methodology: An extensive literature search of studies published in English was undertaken. Electronic databases searched were CENTRAL, CINAHL, EMBASE and MEDLINE. Reference lists of articles, textbooks and conference summaries were examined. Literature searches were conducted using Medical Subject Headings (MeSH). These included: Ventilator-associated pneumonia, chlorhexidine, VAP and oral care. Eight randomized controlled trials, investigating the efficacy of Chlorhexidine in ventilator-associated pneumonia prevention in adults met the inclusion criteria. The effect measure of choice was Risk ratio with 95% confidence intervals for dichotomous data using the random effects (Mantel-Haenszel) model; (p=value of 0.05). Heterogeneity was assessed using the Cochrane Q statistic and I². Results: Eight randomized controlled trials met the inclusion criteria for this review. Pooled risk ratio for the incidence of ventilator-associated pneumonia was 0.64 (95% CI; 0.44-0.91; p =0.18). Treatment with chlorhexidine decreased the risk of ventilator-associated pneumonia by 36%. There was no evidence of Chlorhexidine reducing mortality. Conclusions: Chlorhexidine is a cost effective safe treatment in the prevention of VAP. The use of 2% chlorhexidine may be more effective in reducing the incidence of VAP. No studies were found conducted in developing countries. More rigorously designed trials using 2% chlorhexidine are recommended. / AFRIKAANSE OPSOMMING: Agtergrond Ventilator-Geassosieerde Longontsteking (VAP) is 'n hospitaal verkry infeksie, nie teenwoordig met toelating nie. Ventilator-geassosieerde longontsteking word ontwikkel in pasiënte tydens die proses van sorg in die hospitaal. Tussen nege en sewe en twintig persent van pasiënte wat meganies geventileer word kry ventilator-geassosieerde pneumonie. Sterftesyfers vir geventileerde pasiënte wat ventilator-geassosieerde pneumonie ontwikkel is na raming tussen 33- 50%. Die Institute for Healthcare Improvements (IHI) het in 2006 die gebruik van 'sorg bundels' aanbeveel om VAP te verminder, maar geen statisties beduidende daling is aangeteken nie. Ten spyte van 'n uitgebreide literatuur soek, is geen statistiese data op nosokomiale infeksies of nosokomiale longontsteking toepaslik tot Suid-Afrika gevind nie. Meganiese ventilasie, 'n ondersteuningsterapie wat gebruik word in ongeveer een derde van die pasiënte, verhoog aansienlik die pasiënt se risiko vir die ontwikkeling van hierdie nosokomiale longontsteking. Kritiek siek pasiënte is op gronde van hul kritieke toestand meer geneig tot die ontwikkeling van infeksies, veral ventilator-geassosieerde pneumonie. Konsekwente bewyse dui daarop dat orofaringeale kolonisasie kan met die ontwikkeling van VAP geassosieer word. Studies wat fokus op standaard mond sorg, met of sonder die gelyktydige gebruik van chlorhexidine, het nie voldoende bewyse vir die gebruik van chlorhexidine in VAP voorkoming nie. Chlorhexidine is 'n antiseptiese agent, wat wanneer in een verewekansigde gekontroleerde studies (VGS) getoets was die totale respiratoriese kanaal infeksies verminder deur tot 69%. Doel: Die doel van hierdie sistematiese literatuuroorsig was om stelselmatig te evalueer en bewyse oor die effektiwiteit van chlorhexidine in die vermindering en voorkoms van ventilatorgeassosieerde pneumonie in volwasse pasiënte te hersien. Die sekondêre doel was om stelselmatig bewyse op te som op die gebruik van chlorhexidine in die vermindering van sterfte. Metodiek: 'n Uitgebreide literatuursoektog van studies wat in Engels gepubliseer is was onderneem. CENTRAL, CINAHL, EMBASE en MEDLINE was deursoek. Naslaanlyste van artikels, handboeke en konferensie opsommings is ondersoek. Die literatuur soektog is uitgevoer met behulp van Medical Subject Headings (MeSH). Dit sluit in: ventilator-geassosieerde pneumonie, chlorhexidine, VAP en mond sorg. Agt verewekansigde gekontroleerde studies (VGS), wat die doeltreffendheid van Chlorhexidine in ventilator-geassosieerde pneumonie voorkoming in volwassenes ondersoek, was ingesluit vir hierdie studie. Die effek mate van keuse was risiko ratio (RR) met 95% vertrouensintervalle met behulp van die ewekansige effekte (Mantel-Haenszel) model; (p = 0.05). Heterogeniteit is bepaal deur gebruik te maak van die Cochrane Q- statistiek en I². Hoof resultate: Agt verewekansigde gekontroleerde studies (VGS) het die insluiting kriteria vir hierdie oorsig gepas. Gepoelde risiko ratio vir die voorkoms van ventilator-geassosieerde pneumonie: Risiko Ratio (RR) was 0.64 (95% CI; 0.44-0.91; p=0.18). Gevolgtrekkings: Behandeling met chlorhexidine het die risiko van ventilator-geassosieerde pneumonie met 36% gedaal. Daar was geen bewyse van Chlorhexidine op die vermindering van mortaliteit nie. Chlorhexidine is 'n koste-effektiewe veilige behandeling in die voorkoming van VAP. Die gebruik van 2% chlorhexidine kan moontlik meer effektief wees in die vermindering van die voorkoms van VAP. Meer streng ontwerp studies met 2% chlorhexidine word aanbeveel.

The thesis is focused on ventilator-associated pneumonia and its possible preventive measures during nursing care. In the theoretical part of the work we have included chapters on nosocomial infections emphasizing on the etiology and epidemiology of ventilator-associated pneumonia and its clinical manifestations. We have analyzed the issues of artificial airway management with a detailed focus on the peculiarities of nursing care of the ventilated patients. There, we focus primarily on the care of the patients oral cavity, respiratory tract and the ventilation circuit. A big chapter is dedicated to preventive measures and to the possibilities of prevention in the nursing practice. The empirical part includes research on preventive measures that are implemented in practice and comparative analysis of the measures between different facilities as well as their compliance to the guidelines. We have also determined the level of VAP awareness and its prevention among the nurses. KEYWORDS nosocomials infections, nursing care, prevention, ventilator-associated pneumonia

A pneumonia associada à ventilação mecânica (PAVM) é uma condição inflamatória infecciosa cuja etiopatogenia ainda está mal definida. Embora a principal via de infecção do trato respiratório inferior permaneça desconhecida, a colonização do trato orofaríngeo é geralmente considerada como a principal via de infecção para PAVM. Desta forma, o objetivo deste estudo foi avaliar a presença de microrganismos periodontopatogênicos em amostras subglóticas de pacientes intubados e mecanicamente ventilados, submetidos a cirurgias eletivas. Adicionalmente, este estudo avaliou o impacto do estado de saúde periodontal e da descontaminação bucal com clorexidina (CHX) na quantificação destes microrganismos. Foram incluídos 43 pacientes programados para cirurgia eletiva sob anestesia geral com intubação orotraqueal. Um exame periodontal de boca toda foi realizado anteriormente a cirurgia. A periodontite foi definida como: i) dois ou mais sítios interproximais com nível clínico de inserção (NIC) >=4 mm ou dois ou mais sítios interproximais com profundidade clínica de sondagem (PCS) >= 5 mm (Definição 1); ii) NCI >= 4 mm ou PCS >= 5 mm em pelo menos seis sítios interproximais (Definição 2); e iii) NCI >= 4 mm ou PCS >= 5 mm em pelo menos dois sítios interproximais em cada quadrante (Definição 3). No dia da cirurgia, os pacientes foram randomizados em dois grupos que fizeram um enxague intraoral com 15 ml de CHX 0,12% (teste) ou solução salina (controle) por 30 segundos. Após 3h de intubação orotraqueal, o conteúdo da região subglótica foi aspirado e armazenado a -80ºC. A quantificação de Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis) e Tannerella forsythia (T. forsythia) foi feita pela reação em cadeia da polimerase quantitativa em tempo real. As contagens de P. gingivalis, T. forsythia e A. actinomycetemcomitans não diferiram entre pacientes periodontalmente saudáveis e aqueles diagnosticados com periodontite, independentemente da definição de periodontite (p> 0,05). De forma análoga, nenhum dos parâmetros periodontais avaliados tiveram impacto nas contagens subglóticas de P. gingivalis, T. forsythia e A. actinomycetemcomitans (p> 0,05). Por fim, o grupo que recebeu um enxague intraoral único pré-intubação com CHX 0,12% apresentou níveis reduzidos de P. gingivalis e A. actinomycetemcomitans em amostras do conteúdo subglótico. Em resumo, este estudo demonstrou presença de microrganismos periodontopatogênicos na região subglótica de pacientes intubados e mecanicamente ventilados. Enquanto a descontaminação intraoral em dose única com CHX foi associada com níveis reduzidos de A. actinomycetemcomitans e P. gingivalis, o estado de saúde periodontal não interferiu nos níveis de A. actinomycetemcomitans, P. gingivalis e T. forsythia na região subglótica. / Ventilator-associated pneumonia (VAP) is an infectious inflammatory condition whose etiopathogenesis is still poorly defined. Although the main route of infection to the lower respiratory tract remains unknown, colonization of the oropharyngeal tract is generally considered the main route of infection for VAP. Thus, the objective of this study was to evaluate the presence of periodontopathogenic microorganisms in subglottic samples of intubated and mechanically ventilated patients submitted to elective surgeries. Furthermore, this study evaluated the impact of periodontal health status and oral decontamination with chlorhexidine (CHX) on the quantification of these microorganisms. 43 patients scheduled for elective surgery under general anesthesia with orotracheal intubation were included. Full-mouth periodontal examination was performed prior to surgery. Periodontitis was defined as: i) two or more interproximal sites with clinical attachment level (CAL) >=4 mm or two or more interproximal sites with clinical probing depth (CPD) >= 5 mm (Definition 1); ii) CAL >= 4 mm or CPD >= 5 mm in at least six interproximal sites (Definition 2); and iii) CAL >= 4 mm or CPD >= 5 mm in at least two interproximal sites in each quadrant (Definition 3). On the day of surgery, patients were randomized into two groups that rinsed preoperatively with 15 ml CHX 0.12% (test) or saline (control) for 30 seconds. After 3h of orotracheal intubation, the contents of the subglottic region were aspirated and stored at -80°C. Quantification of Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) was done by quantitative real-time polymerase chain reaction. P. gingivalis, T. forsythia, and A. actinomycetemcomitans counts did not differ between periodontally healthy patients and those diagnosed with periodontitis, regardless of the definition of periodontitis (p> 0.05). Similarly, none of the periodontal parameters evaluated had an impact on the subglottic counts of P. gingivalis, T. forsythia and A. actinomycetemcomitans (p> 0.05). Finally, the group receiving a single pre-intubation intraoral rinse with CHX 0.12% presented reduced levels of P. gingivalis and A. actinomycetemcomitans in samples of the subglottic content. In summary, this study demonstrated the presence of periodontopathogenic microorganisms in the subglottic region of intubated and mechanically ventilated patients. While a single dose intraoral decontamination with CHX was associated with reduced levels of A. actinomycetemcomitans and P. gingivalis, the periodontal health status did not affect the levels of A. actinomycetemcomitans, P. gingivalis and T. forsythia in the subglottic region.

Ventilator associated pneumonia (VAP) and acute respiratory distress syndrome (ARDS) are two respiratory conditions unique to mechanically ventilated patients. The diagnosis of these conditions, and therefore any subsequent treatment, are befuddled by uncertainty. VAP rates vary considerably according to the diagnostic or surveillance criteria used. The pathogenesis of ARDS is well understood but when the internationally agreed consensus criteria are employed, the histological hallmarks are absent about half the time, indicating a disconnection between the clinical diagnosis and what is known about the biology of this condition. It is argued that tests of biological function should be considered in addition to clinical characteristics in order to improve the utility of diagnosis. Given that the pathological sequelae of both VAP and ARDS are driven by an over exuberant host neutrophil response, the activated neutrophil was selected as a potential biological imaging target. Optical molecular imaging uses visible and near visible wavelengths from the electromagnetic spectrum to derive or visualize information based on the optical properties of the target tissue. Optical wavelengths are safe and cheap to work with, producing much higher resolution images than those relying on x-rays or gamma radiation. The imaging modality can be coupled with exogenously applied chemistry to identify specific biological targets or processes. The hypothesis that optical molecular imaging could be used to detect activated neutrophils in real time in the alveolar region of patients was tested. A bespoke optical molecular imaging agent called Neutrophil Activation Probe (NAP), designed in-house, was used to test the hypothesis. NAP is a dendrimeric compound delivered to the alveolar region of a patient in microdoses (≤100 micrograms), becoming fluorescent only on contact with activated neutrophils, and can be detected by optical endomicroscopy. Both the imaging agent and the endomicroscope are delivered to the distal lung via routine bronchoscopy. The agent was tested extensively in the laboratory to demonstrate function, specificity, and safety. Ex vivo testing took place using human and ovine lungs. A regulated dose escalation Phase I clinical trial of investigational medicinal product (CTIMP) in healthy volunteers, patients with bronchiectasis, and mechanically ventilated patients with a pulmonary infiltrate on chest radiography (NCT01532024) was designed and conducted. The aim of the Phase I study was to demonstrate the safety of the technique and to confirm proof of concept. In order to support the requirement for a technique that interrogates alveolar neutrophils two supplementary clinical studies were performed. Firstly, two VAP surveillance techniques (CDC surveillance and HELICS European VAP surveillance) were compared with clinically diagnosed VAP across consecutive admissions in two large tertiary centres for one year. Secondly, the utility of circulating neutrophils to permit discrimination between acute respiratory illnesses was examined. Blood samples from mechanically ventilated patients with and without ARDS underwent flow cytometric assessment using eight clusters of differentiation and internal markers of activation to determine neutrophil phenotype. All clinical studies received the appropriate regulatory, ethical, and/or Caldicott guardian approval prior to commencement. NAP became fluorescent only in the presence of three processes specific to neutrophil activation: active pinocytosis, progressive alkalinization of the phagolysosome, and the activity of human neutrophil elastase. High optical signal was detected following the application of NAP in the alveolar regions of explanted lungs from patients with cystic fibrosis, known to be rich in activated neutrophils. Using an ex vivo ovine lung ventilation and perfusion model optical signal was demonstrated following segmental lung injury. The safety and specificity of the technique in a small cohort of healthy volunteers and mechanically ventilated patients was demonstrated. The technique was tested on a small cohort of patients with bronchiectasis, which provided the first opportunity to obtain broncho-alveolar lavage samples for laboratory correlation. Fluorescent signal was shown in the lavaged neutrophils, labeling that could only have taken place in the alveolar region. The supportive clinical studies found the concordance between actual VAP events was virtually zero even though the reported VAP rates were similar. Furthermore, the rate at which clinicians initiate antibiotics for VAP was approximately five times higher than either surveillance VAP rate. The study of circulating neutrophils from the blood of healthy volunteers and mechanically ventilated patients with and without ARDS indicated circulating neutrophil activation phenotype was not capable of discriminating between clinically diagnosed ARDS and other acute respiratory illnesses. In summary, an ambitious programme of work was completed to develop and support an optical molecular imaging technique that meets the rigorous requirements for human application and can be applied at the bedside to yield immediate visual results. The spatiotemporal relationship of neutrophil activation in real time both in the laboratory and in volunteers and patients was visualized. The visualization of neutrophil activation at such a resolution has never been achieved before in humans, healthy or unhealthy. The Phase I study was not powered to determine utility but recruitment has begun to a Phase II CTIMP (NCT02804854) to investigate the utility, accuracy, and precision of the imaging technique in a large cohort of mechanically ventilated patients. Ultimately, it is proposed that the technique will facilitate diagnosis, stratify patients for treatment and monitor treatment response using this technique.

<p>Ventilator-associerad pneumoni (VAP) är den vanligaste infektionen på intensivvårdsavdelningar. Det är en komplikation som orsakar stort lidande, ökad mortalitet och medför höga vårdkostnader. Det finns många evidensbaserade riktlinjer för att förhindra att VAP uppstår, där sjuksköterskan har en betydande roll. Flera studier har visat att det finns brister i sjuksköterskans kunskap att tillämpa de evidensbaserade riktlinjerna för att förhindra uppkomsten av VAP. Syftet med studien var att beskriva intensivvårdsjuksköterskors tillämpning av de evidensbaserade riktlinjerna för att förhindra uppkomsten av ventilatorassocierad pneumoni hos intensivvårdspatienter samt att jämföra tillämpningen av riktlinjer mellan subgrupper. En strukturerad enkät delades ut till alla intensivvårdsjuksköterskor (N=40) på en intensivvårdsavdelning i mellansverige, varav 30 besvarade enkäten. Resultatet visade att intensivvårdsjuksköterskorna tillämpar de evidensbaserade riktlinjerna i hög utsträckning utifrån självskattningar. Det framkom inga signifikanta skillnader mellan de med kort (0-5 år) och lång (>5 år) erfarenhet som intensivvårdsjuksköterska, vad gäller i vilken utsträckning de använder de evidensbaserade riktlinjerna för att förhindra uppkomsten av VAP. Kunskapen och tillämpningen av de evidensbaserade riktlinjerna kan anses vara god hos respondenterna i föreliggande studie utifrån självskattningar. I det närmaste alla respondenter hade fått utbildning/information om VAP vilket kan vara orsaken till det resultat som framkom. Många tidigare studier har visat att utbildning ökar tillämpningen av de evidensbaserade riktlinjerna.</p> / <p>Ventilator-associated pneumonia is the most common infection in the intensive care unit. It is a complication that causes major morbidity, increased mortality and growing healthcare costs. There are many evidence-based clinical practice guidelines in order to prevent that VAP arises, where the nurse has a significant role. Several studies have established that there is deficiencies in the nurse's knowledge to apply to the evidence-based guidelines in order to prevent the origin of VAP. The aim with the study was to describe intensive care unit nurses' application of the evidence-based guidelines in order to prevent the origin of VAP at intensive care patients and to compare the application of the evidence-based guidelines between subgroups. A structured questionnaire was distributed out to all intensive care nurses (N=40) on an intensive care unit in the middle of Sweden, of which 30 responded to the questionnaire. The result showed that the intensive care nurses apply to the evidence-based guidelines in a high extent on the basis of self-reports. There were no significant differences between they with short (0-5 year) and long (> 5 year) experience as an intensive care nurse, as regards in what extent they use the evidence-based guidelines in order to prevent the origin of VAP. The respondents knowledge and application of the evidence-based guidelines can be considered to be good in this study, on the basis of self-reports. Most of the respondents had got education/information about VAP, what can have caused the result that appeared. Many previous studies have shown that education increases the application of the evidence-based guidelines.</p>