IMPLEMENTING VENTILATOR-ASSOCIATED PNEUMONIA PREVENTION GUIDELINES IN CRITICAL CARE: NURSE COMPLIANCE AND OBSTACLES

Abstract

Background: Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality among critically ill patients, especially in low- and middle-income countries (LMICs), where healthcare resources are often limited. Despite the availability of evidence-based guidelines for VAP prevention, critical care nurses’ compliance remains inconsistent, and several barriers hinder effective implementation. Objective: This systematic review aimed to evaluate the compliance of critical care nurses with VAP prevention guidelines and to identify the major barriers affecting the implementation of these practices in intensive care settings. Methods: A systematic search was conducted following PRISMA guidelines across five databases (PubMed, CINAHL, Scopus, Cochrane Library, and Google Scholar), focusing on studies published between 2021 and 2024. Studies included were those assessing nurse adherence to VAP guidelines and exploring associated barriers. A total of eight studies met the inclusion criteria and were analyzed for knowledge levels, compliance rates, and institutional or personal challenges to guideline adherence. Results: The review revealed varying levels of nurse compliance with VAP prevention strategies, with several studies reporting suboptimal adherence to specific components of the care bundle, such as oral care, cuff pressure monitoring, and humidification. Key barriers included inadequate training, staff shortages, lack of resources, limited institutional support, and poor interprofessional collaboration. Educational interventions were effective in increasing knowledge, but their impact on sustained clinical practice remained limited without systemic support. Conclusion: Although critical care nurses generally demonstrate moderate to high awareness of VAP prevention guidelines, actual adherence remains inconsistent due to a range of individual and organizational barriers. To improve compliance and reduce VAP rates, a multifaceted approach is needed—one that combines ongoing nurse education with robust institutional support, policy reinforcement, and context-specific adaptations of VAP bundles.