Quality of care is crucial for preventing adverse events such as infection in the intensive care units (ICUs). The most common ICU-acquired infections include pneumonia such as Ventilator Associated Pneumonia (VAP), Pressure Ulcer (PU), Medical Device Related Pressure Ulcer (MDRPU), and Central Line-Associated Bloodstream Infection (CLABSI). VAP, PU, and MDRPU are significant indicators of the quality of care, while CLABSI is a critical marker of healthcare quality in ICUs, as it is largely preventable through strict adherence to infection control protocols.
VAP is a lung infection that occurs in patients receiving mechanical ventilation for more than 48 hours. A PU is defined as localized damage to the skin or underlying tissue caused solely by pressure, while MDRPUs may also result from friction or pressure from medical devices or other objects. CLABSI is a severe infection caused by improperly inserted or maintained central venous catheters, which underscores the need for stringent catheter management protocols.
who is a registered nurse in Bangladesh.
who agrees to participate in this study and the EBP training.
who will stay at the ICU for 6 months. Patient
Irrespective of age and sex, participants must be at least 18 years old
Who will not directly involve patient care in ICU. Patient
No exclusion criteria
Single group
Education with EBP
BehavioralTrial 1: Nurse's EBP training ( VAP, PU, MDRPU, CLABSI management), online lecture, 2 hours lecture and 3 hours skill training for nurses training. Trail 1 we use advanced equipment necessary for EBP implementation for VAP, PU, MDRPU and CLABSI management, and EBP-trained nurses implementation for all this management.
This is a pre- and post- quasi-experimental study.
BehavioralWe will use advanced equipment and implement EBP (VAP, PU, MDRPU and CLABSI management) for patients by trained nurses and check the outcome of the patients. We will compare pre and post findings for this study.
The nurse's skill related to the PU, MDRPU and CLABSI total score measured by the researcher-developed checklist
1\. The nurse's skill and knowledge related to the PU, MDRPU and CLABSI checklist. Researcher developed checklist, 50 items with 0: not correct/did not do, 1: partially correct, 2: correct. Score range 0-114.
Incidence rates of PU, MDRPU and CLABSI.
The incidence rate of PU was calculated as the number of newly developed pressure ulcers after hospitalization per 1000 person-days at risk. The incidence rate of MDRPU was calculated as the number of newly developed MDRPU cases per 1000 patients assessed. The incidence rate of CLABSI was calculated as the number of CLABSI cases per 1000 central line-days. Data will be collected: Patients' demographic data (age, sex, occupation etc.) Medical past and current history (diagnosis, treatment, medication, hospitalization). Reasons and date to be admitted to ICU. Treatment in ICU. Daily laboratory data taken in ICU. Daily biological data including vital signs. Results of patients' stay during ICU. Diagnosis of PU, MDRPU and CLABSI included of this list.
Nurses' knowledge, Attitude and Practice (KAP) related to the PU, MDRPU and CLABSI prevention measured by the researcher-developed scale based on Knowledge of EBP guidelines for the PU, MDRPU and CLABSI prevention scale
Nurses attitude, practice and knowledge related PU, MDPU and CLABSI related prevention scale. The researcher makes an attitude, practice and knowledge related of EBP guideline for PU, MDPU and CLABSI question Total item 22 and validity was tested by ICU and PU specialized nurses in Japan. Knowledge was assessed using multiple-choice questions, with one correct answer among four options. Each correct response was awarded a score of 1, and incorrect or "don't know" responses were scored 0. Attitude and practice were measured using a Likert scale, with responses indicating the degree of agreement or frequency.
Rate (number of patients) of each stage of PU and MDRPU
After diagnosis of sore we measured stage of PU and MDRPU. Number of ICU patients developing PU and MDRPU categorized by stage (Stage I-IV). Unit of Measure: Number of patients per PU/MDRPU stage.
Micro-organism link to CLABSI
After diagnosis of CLABSI then identify what kind organism relate to CLABSI. Type and frequency of microorganisms identified in laboratory-confirmed CLABSI cases. Unit of Measure: Number of cases per microorganism.
Incidence and rate of VAP
Incidence rate of VAP per 1000 ventilator days. Unit of Measure: VAP cases per 1,000 ventilator days
APACHE II score
Will be collected from patient record file. Sum Acute Physiology Points + Age Points + Chronic Health Points = APACHE II total (range 0-71). APACHE II total score (integer). Optionally report distribution (mean ± SD) or stratify by score ranges.
SOFA score
Will be collected from patient record file. Sum Acute Physiology Points + Age Points + Chronic Health Points = APACHE II total (range 0-71). APACHE II total score (integer). Optionally report distribution (mean ± SD) or stratify by score ranges. Use worst values within first 24 h for baseline SOFA. For organ-dysfunction trajectory, compute daily SOFA scores。Sum component scores → SOFA total (0-24). SOFA total score (integer). Can also report number/proportion with increase ≥2 points.
GCS score
Total GCS = E + V + M (range 3-15). Record at ICU admission (worst value in first 24 h for scoring systems). Note if patient is sedated or intubated - document sedation/intubation; if intubated, record "V = T" and use local protocol for scoring (some protocols assign V=1 or use best pre-sedation score). Unit / reporting: GCS total (3-15). Report component scores if relevant.
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