• Hiroko Kiyoshi-Teo, Michael D Cabana, Erika S Froelicher, and Mary A Blegen.
• Hiroko Kiyoshi-Teo is a clinical assistant professor, School of Nursing, Oregon Health & Science University, Portland, Oregon. Michael Cabana is a professor of pediatrics, epidemiology and biostatistics, School of Medicine, University of California San Francisco, San Francisco, California. Erika Froelicher is a professor emerita, physiological nursing, School of Nursing, and Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California; and professor, Health Sciences, Sifa University, Izmir, Turkey. Mary Blegen is a professor emerita, School of Nursing, University of California San Francisco, San Francisco, California.
• Am. J. Crit. Care. 2014 May 1;23(3):201-14; quiz 215.

BackgroundVarious institution-specific guidelines have been developed to prevent ventilator-associated pneumonia. However, the availability of guidelines does not ensure adherence to recommended strategies.ObjectiveTo identify factors that influence adherence to guidelines for prevention of ventilator-associated pneumonia, with a focus on oral hygiene, head-of-bed elevation, and spontaneous breathing trials.MethodsA cross-sectional descriptive study of critical care nurses at 8 hospitals in Northern California was conducted. A survey was created to gather information on possible facilitators of and barriers to adherence to institution-specific guidelines for preventing ventilator-associated pneumonia. User factors, guideline qualities, and contextual factors were explored and tested for possible relationships.ResultsA total of 576 critical care nurses participated in the survey. Each hospital had unique guidelines for preventing ventilator-associated pneumonia. In general, nurses had positive attitudes and reported adhering to the guidelines always or most of the time. Factors associated with adherence differed according to the intervention implemented. The score on the user attitude scale was the strongest and most consistent predictor of adherence across interventions (odds ratio, 3.49-4.75). Time availability (odds ratio, 1.54) and the level of prioritization (odds ratio, 1.86) were also significant predictors.ConclusionThe most consistent facilitator of adherence to guidelines for prevention of ventilator-associated pneumonia was nurses' positive attitude toward the guidelines.

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