ArticleBMC nursing2026
Nurses' practices and associated factors in the prevention of ventilator-associated pneumonia in adult and pediatric ICUs in Tigray, Ethiopia: a mixed-methods study.
Article in BMC nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundVentilator-associated pneumonia (VAP), which increases morbidity, mortality, and healthcare costs, is a major challenge in ICUs worldwide. Nurses are crucial in preventing VAP, but there are limited data on VAP prevention practices in Tigray's adult and pediatric ICUs. This study aims to assess practices and identify factors associated with the prevention of ventilator-associated pneumonia among nurses in Tigray.
methodsA hospital-based cross-sectional study with a sequential explanatory mixed method was conducted among 216 nurses working in adult and pediatric intensive care units from January 15 to February 15, 2025. A pretested, structured questionnaire was used to collect data from all ICU nurses in Tigray public hospitals. The data were entered into Epi-Data version 4.2 and exported to SPSS version 24 for analysis. Thematic analysis was used for the interpretation of qualitative findings. Logistic regression analyses identified factors associated with VAP prevention practices. Variables with a p-value < 0.25 in binary regression were included in the multivariable analysis. Variables with a p-value < 0.05 were considered statistically significant, and multicollinearity was assessed via tolerance and variance inflation factors.
resultsThe percentage of good practices for VAP prevention was 38.89% (95% CI: 32.35%-45.74%). Age (AOR = 3.02, 95% CI: 1.058-8.65), ICU working experience (AOR = 3.19, 95% CI:1.163-8.784), educational level (AOR = 3.205, 95% CI: 1.45-8.971), special training on VAP prevention (AOR = 4.29, 95% CI: 1.94-9.48), staffing levels in the ICU (AOR = 0.157, CI: 0.064-0.386) and knowledge of VAP prevention (AOR = 3.41, 95% CI: 1.542-7.553) were statistically significant factors associated with a good level of practice in VAP prevention. The qualitative interviews identified inadequate training, staffing shortages, high workloads, and a lack of team collaboration and management support as factors influencing nurses' VAP prevention practices.
conclusionFewer than four out of ten ICU nurses had good practices toward VAP prevention. Adherence to VAP prevention practices was significantly associated with nurses' age, ICU work experience, educational level, specialized training, and knowledge. These findings emphasize the importance of strengthening regular in-service training, continuous professional education, adequate staffing, teamwork, and managerial support to improve compliance with VAP prevention guidelines and enhance patient safety in ICU settings. CLINICAL TRIAL NUMBER: Not applicable.
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