ASSESSMENT OF ICU NURSES’ KNOWLEDGE, COMPLIANCE AND BARRIERS TOWARD EVIDENCE-BASED GUIDELINES FOR VENTILATOR-ASSOCIATED PNEUMONIA PREVENTION IN PALESTINE: A CROSS-SECTIONAL STUDY

Abstract

Background: In critical care units (ICUs), tracheal intubation and invasive mechanical ventilation (MV) are essential life-saving treatments for a considerable proportion of patients with severe illnesses. MV is associated with many complications, one of which is ventilator-associated pneumonia (VAP). Prevention of VAP is achieved through both non-pharmacological and pharmacological methods. Non-pharmacological measures include a set of evidence-based guidelines (EBGs) for preventing VAP. The majority of VAP prevention methods are implemented by nurses, who play a crucial role in respiratory care. Aim of study: To determine ICU nurses' knowledge and compliance with evidence-based guidelines for the prevention of VAP in hospitals in Palestine. The research also aimed to identify the primary barriers preventing ICU nurses from using EBGs to reduce VAP. Methods: A cross-sectional study was conducted by distributing a self-administered questionnaire to 240 ICU nurses in West Bank Hospitals of the Palestinian Ministry of Health and private hospitals, across three geographical sections: north, middle, and south, during March and May 2025. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 26. A P-value <0.05 was considered statistically significant. Result: This study found that a high percentage of nurses in the ICU have a good knowledge about EBGs for the prevention of VAP, which 80.4% of nurses having a good knowledge score, it was found that 68.3% of nurses have a high compliance with EBGs. However, the study found that there is no significant association between nurses' knowledge and compliance level ( p value=0.126). On the other hand, the study showed that ICU types are associated with nurses' knowledge and compliance levels regarding EBGs (p values = 0.010, 0.025, respectively). In addition to ICU type, prior training on EBGs also affects nurses' compliance level (p value=0.004). The most significant barriers that may affect nurses’ response to EBGs were a shortage of nursing staff, a limited hospital budget, a lack of ongoing education on EBGs to prevent VAP, a lack of university efforts to educate students about EBGs, and the unavailability of resources. Conclusion: nurses working in the ICU demonstrated good knowledge and high compliance with EBGs to protect patients in MV from VAP. Also, we conclude that there is no significant association between knowledge level and nurses' compliance with EBGs. Keywords: ventilated associated pneumonia, critical care unit, evidence-based guidelines, mechanical ventilator.