Effect of Training Nurses in the Process of Weaning Premature Infants from Mechanical Ventilation on Infection Incidence in Neonatal Intensive Care Units

Document Type : Original Article

Authors

1 School of Nursing and Midwifery, Nursing Care Research Center, Iranian, Iran University of Medical Sciences, Tehran, Iran

2 Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences, Tehran, Iran

3 Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran

4 School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background: Respiratory distress syndrome and lung infection are the most common lung problems and the leading cause of mortality in preterm neonates. The prolonged use of endotracheal tubes and mechanical ventilation increases the risk of airway injury, pneumonia, and chronic lung disease. Nursing interventions can be considered a vitally important factor in the success of endotracheal intubation in premature infants. Therefore, the present study aimed to investigate the effect of training nurses in the process of weaning premature infants from mechanical ventilation on neonatal outcomes in the neonatal intensive care unit (NICU).
Methods: The present quasi-experimental study was performed on 46 nurses and 312 premature neonates admitted to the NICU of Akbarabadi Hospital in Tehran in 2020. The subjects were entered into the study using the census method; subsequently, they were examined three months before and three months after the intervention. The data collection instrument was a two-part researcher-made questionnaire encompassing demographic characteristics of nurses and preterm infants, the length of hospital stay, length of mechanical ventilation, and incidence of infection. Data were analyzed in SPSS software (version 22) using an independent t-test and chi-square test. A p-value less than 0.05 was considered statistically significant.
Results: The results demonstrated that despite a significant reduction in the number of infections after the intervention compared to before the intervention, there was no statistically significant difference between the two time periods in terms of neonatal outcomes (p=0.194). The results also indicated that nurses' training reduced the chances of neonatal infection by about 1.5 times (OR=1.498).
Conclusion: As evidenced by the results of the present study, although a reduction was observed in neonatal outcomes after nursing education, it was not statistically significant, indicating that other factors, such as nurses' adherence to hand hygiene protocols, duration of intervention, sample size, and educational content, were also involved in this regard and affected the results of this study.
 
 

Keywords


  1. Kadivar M, Safdari R, Langarizadeh M, kermani F, zarkesh M. Iranian physician attitudes toward factors in neonatal mortality: A preliminary study and review of the literature. RJMS. 2016; 23(148):64-71.
  2. Pourarian S, Vafafar A, Zareh Z. The incidence of prematurity in the Hospital of Shiraz university of medical sciences and health services, 1999. RJMS. 2002; 9(28):19-25.
  3. Behrman R, Butler A. Committee on Understanding Premature Birth and Assuring Healthy Outcomes Board on Health Sciences Policy: Preterm birth: causes, consequences, and prevention. Washington, DC: The National Academies Press; 2007.
  4. Howson C, Kinney M, Lawn JE E. Born too soon: the global action report on preterm birth. Switzerland: World Health Organization; 2012.
  5. Cheraghi F, Pakseresht M, Parsa P, Roshanaei G, Basiri B. Effect of kangaroo mother care on premature newborns' pain due to invasive procedures in neonatal intensive care unit of hospitalFatemieh, Hamadan. J Ilam Univ Med Sci. 2014; 22(1):31-40.
  6. Liu J, Shi Y, Dong JY, Zheng T, Li JY, Lu LL, et al. Clinical characteristics, diagnosis and management of respiratory distress syndrome in full-term neonates. Chin Med J (Engl). 2010; 123(19):2640.
  7. Moretti C, Giannini L, Fassi C, Gizzi C, Papoff P, Colarizi P. Nasal flow-synchronized intermittent positive pressure ventilation to facilitate weaning in very low-birthweight infants: Unmasked randomized controlled trial. Pediatr Int. 2008; 50(1):85-91.
  8. Esen S, Leblebicioglu H. Prevalence of nosocomial infections at intensive care units in Turkey: a multicentre 1-day point prevalence study. Scand J Infect Dis. 2004; 36(2):144-8.
  9. Rezaeian M, Sheikh Fathollahi F, Abdolkarimi M, Niknafs M, Bahman-Bijari M, Niknafs P, et al. Comparison of supine and prone positions on oxygen saturation in preterm neonates after weaning from mechanical ventilationin NICU of Afzalipour Hospital of Kerman in 2014. J Rafsanjan Univ Med Sci. 2015; 13(9):885-96.
  10. Omid F, Shayan K, Tabrizian NF, Tavakkoi H. A bacteriologic evaluation of tracheal cultures in incubated infants in NICU at Mashhad Bahman 22nd during 2006-2007. Iran J Med Sci. 2009; 5(2):113-8.
  11. Nateghian AR, Omrani AM, Alipour Z, Haerinejad MJ. Causes of ventilator associated pneumonia in pediatrics ICU. Iran South Med J. 2016; 19(1):98-105.
  12. Moradi M, Nili F, Nayeri F, Amini E, EsmaeilniaT. Study of Characteristics, risk factors and outcome for Ventilator Associated Pneumonia in Neonatal Intensive Care Unit patient. Tehran Univ Med J. 2013; 71(6):373-81.
  13. Goldsmith JP, Karotkin E, Suresh G, Keszler M. Assisted Ventilation of the Neonate. United States: Elsevier Health Sciences; 2016.
  14. Vandertak K. Collaborative extubation; best practice? J Neonatal Nurs. 2008; 14(5):166-9.
  15. Joseph RA. Prolonged mechanical ventilation: challenges to nurses and outcome in extremely preterm babies. Crit Care Nurse. 2015; 35(4):58-66.
  16. Raghuveer TS, Cox AJ. Neonatal resuscitation: an update. Am Fam Physician. 2011; 83(8):911-8.
  17. Salimi M, Masoumpoor A, Shirinabadi Farahani A, Shakeri N, Alaee Karharoudy F, Shiri H. Auditing nursing care related to weaning neonates from mechanical ventilation in neonatal intensive care units. Hayat. 2016; 22(2):159-74.
  18. Niknafs N, Mirlashari J, Talori P, Bahrani N. Effect of nursing care training program on outcomes of mechanically-ventilated infants. J Cardiovasc Nurs. 2015; 4(1):14-21.
  19. Ghanbari A, Mohammad Ebrahimzadeh A, Paryad E, Atrkarroshan Z, Mohammadi M. Factors affecting the duration of weaning from mechanical ventilation based on burn scale in the intensive care units. Avicenna J Nurs Midwifery Care . 2018; 26(1):33-9.
  20. Yazdannik AR, Salmani F, Irajpour AR, Abasi S. Effect of the nurse-directed weaning readiness assessment on the duration of mechanical ventilation: a randomized clinical trial. Qom Univ Med Sci J. 2013; 7(4):89-94.
  21. Rojas MA, Lozano JM, Rojas MX, Rodriguez VA, Rondon MA, Bastidas JA, et al. Prophylactic probiotics to prevent death and nosocomial infection in preterm infants. Pediatrics. 2012; 130(5):1113-20.
  22. Darmstadt GL, Ahmed ANU, Saha SK, Chowdhury MA, Alam MA, Khatun M, et al. Infection control practices reduce nosocomial infections and mortality in preterm infants in Bangladesh. J Perinatol. 2005; 25(5):331-5.
  23. Bührer C, Fischer HS, Wellmann S. Nutritional interventions to reduce rates of infection, necrotizing enterocolitis and mortality in very preterm infants. Pediatr Res. 2020; 87(2):371-7.
  24. Abou Zed SAF, Mohammed AA. Impact of nursing guidelines on nurses' knowledge and performance regarding to prevention of ventilator associated pneumonia in neonates. J Nurs Educ Pract. 2019; 9(10):15-28.
  25. Azab SF, Sherbiny HS, Saleh SH, Elsaeed WF, Elshafiey MM, Siam AG, et al. Reducing ventilator-associated pneumoniain neonatal intensive care unit using "VAP prevention Bundle": a cohort study. BMC Infect Dis. 2015; 15(1):1-7.
  26. Chadani O, Deepa W, Bimala P, Qinghua Z. Ventilator-Associated Pneumonia and Role of Nurses in Its Prevention. J Nepal Med Assoc. 2017; 56(208):461-8.
  27. Schultz C, Tautz J, Reiss I, Möller JC. Prolonged mechanical ventilation induces pulmonary inflammation in preterm infants. Biol Neonate. 2003; 84(1):64-6.
  28. Kneyber MC, van Oud-Alblas HB, van Vliet M, Uiterwaal CS, Kimpen JL, vanVught AJ. Concurrent bacterial infection and prolonged mechanical ventilation in infants with respiratory syncytial virus lower respiratory tract disease. Intensive Care Med. 2005; 31(5):680-5.
  29. Rastogi S, Rajasekhar H, Gupta A, Bhutada A, RastogiD, Wung J-T. Factors affecting the weaning from nasal CPAP in preterm neonates. Int J Pediatr. 2011; 2012:1-7.
  30. Rastogi S, Wong W, Gupta A, Bhutada A, Rastogi D. Gradual versus sudden weaning from nasal CPAP in preterm infants: a pilotrandomized controlled trial. Respir Care. 2013; 58(3):511-6.