Keywords
ICU
Ventilator-associated pneumonia
Stratified intervention
Submitted : 2026-06-27
Accepted : 2026-07-12
Published : 2026-07-27
Abstract
Objective: To evaluate VAP prevention behavioral characteristics and barriers among ICU physicians, nurses, and cleaners based on the Transtheoretical Model (TTM), and to verify the application effects of a stratified intervention model. Methods: A quasi-experimental study was conducted. In June 2025, a convenience sample of 205 ICU staff from 7 ICUs of a tertiary hospital was recruited. A self-designed questionnaire was used to construct the model, which was implemented for 6 months to compare behavioral stages and VAP incidence. Results: Before the intervention, significant differences were observed in behavioral stages among the groups (p < 0.05). The maintenance stage proportions for physicians, nurses, and cleaners were 71.87%, 41.14%, and 13.33%. After intervention, they increased to 84.38%, 58.23%, and 33.33%, respectively (p < 0.05). Subglottic secretion drainage compliance among nurses increased from 41.77% to 89.24%, and environmental cleaning compliance among cleaners increased from 26.67% to 86.67% (p < 0.05). VAP incidence decreased from 3.14 to 1.21 per 1,000 ventilator-days (p < 0.05). Conclusions: The model precisely matches occupational needs, promotes positive behavioral shifts, improves compliance, and significantly reduces VAP incidence.
References
Zhang X, Lu Y, Chen J, et al., 2026, Risk Factors for Pathogens of Ventilator-Associated Pneumonia and Adverse Clinical Outcomes in ICU Patients Undergoing Mechanical Ventilation. Chinese Journal of Hospital Infection, 2026(3): 417–421.
Papazian L, Klompas M, Luyt C, 2020, Ventilator-Associated Pneumonia in Adults: A Narrative Review. Intensive Care Medicine, 46(5): 888–906.
Ladbrook E, Khaw D, Bouchoucha S, et al., 2021, A Systematic Scoping Review of the Cost-Impact of Ventilator-Associated Pneumonia (VAP) Intervention Bundles in Intensive Care. American Journal of Infection Control, 49(7): 928–936.
Klompas M, Branson R, Cawcutt K, et al., 2022, Strategies to Prevent Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nonventilator Hospital-Acquired Pneumonia in Acute-Care Hospitals: 2022 Update. Infection Control and Hospital Epidemiology, 43(6): 687–713.
Kong Y, Gao X, Dai Z, et al., 2023, Interpretation of SHEA’s Prevention Strategies for Ventilator-Associated Pneumonia and Ventilator-Associated Events in Emergency Hospitals (2022 Edition). West China Medical Journal, 38(3): 336–345.
Prochaska J, Velicer W, 1997, The Transtheoretical Model of Health Behavior Change. American Journal of Health Promotion, 12(1): 38–48.
Zhang M, Ding Y, 2022, A Review of the Development of the Transtheoretical Model and Related Research on Information Behavior. Library and Information Service, 66(20): 141–147.
Paliwal N, Bihani P, Jaju R, et al., 2024, Striving for Excellence in Ventilator Bundle Compliance Through Continuous Quality Improvement Initiative in the Intensive Care Unit of a Tertiary Care Hospital in India. Acute and Critical Care, 39(4): 535–544.