Table 6. Outline of Self-Reported Versus Measured Adherence Rates, Mapped Barriers and Facilitators, and Intervention Opportunities
Observed Overall Adherence, % (95% CI)
UHZ VAP prevention bundle overall
Continuous application of a sedation and weaning protocol
Head of the bed elevation of ≥30°
N.A. BCW Proposed Barriers
- Physical opportunity (staffing/time) - Social opportunity (hierarchical structures)
81 (74–87)
- Psychological capability (forgetfulness) - Physical opportunity (staffing/time)
Facilitators
- Psychological capability (comprehension and reasoning)
- Reflective motivation (relevance of VAP, belief in preventability)
- Social opportunity (coworkers)
- Enablement (checklists) - Restrictions (protocols)
Proposed Interventions
- Enablement (checklists) - Restrictions (protocols)
Intervention Functions
- Restriction - Environmental restructuring - Enablement
- Restriction - Environmental restructuring - Enablement - Education - Training
27 (23–31)
- Physical capability (inability to estimate angle)
- Psychological capability (forgetfulness) - Reflective motivation (lack of evidence) - Automatic motivation (conflict with patient’s well-being)
- Physical opportunity (side effects, infrastructure/equipment)
Oral decontamination with chlorhexidine mouth wash
41 (36–45)
- Automatic motivation (conflict with patient well-being)
- Physical opportunity (infrastructure/ equipment, feasibility)
- Automatic motivation (habit) - Reflective motivation (belief in prevention measure)
- Environmental restructuring (eg, providing mouth wash in gel form)
- Social opportunity (champions)
- Environmental restructuring (eg, bed with angle indicator)
- Enablement (alarm system) - Enablement (checklists) - Restrictions (protocols)
- Restriction - Environmental restructuring - Enablement - Education - Training - Persuasion - Incentivisation - Coercion - Modelling
- Restriction - Environmental restructuring - Enablement - Persuasion - Incentivization - Coercion - Modelling
Use of endotracheal tubes with continuous subglottic secretion drainage
Hand hygiene according to the WHO 5 moments concept
Use of non-invasive ventilation (NIV) whenever feasible
Periodic changes of ventilator tubing and filters
Use of closed suction systems
Daily evaluation of stress ulcer prophylaxis to limit its use
88 (83–92)
- Physical opportunity (infrastructure/ equipment)
N.A. N.A. - Physical opportunity (staffing/time)
- Reflective motivation (lack of evidence, disbelief in prevention measure)
- Physical opportunity (competing priorities, staffing/time)
N.A. N.A. N.A. N.A.
- Physical opportunity (infrastructure equipment)
N.A. N.A.
- Physical opportunity (infrastructure equipment)
N.A. N.A. N.A. N.A.
- Restriction - Environmental restructuring - Enablement
- Physical opportunity (infrastructure/equipment)
N.A. N.A.
- Environmental restructuring (eg, tracheal tubes with suction port)
N.A. N.A.
- Restriction - Environmental restructuring - Enablement
- Restriction - Environmental restructuring - Enablement
- Restriction - Environmental restructuring - Enablement
Note. BCW, behavior change wheel; N.A., not applicable. This table summarizes the adherence rates assessed by observation and reported barriers, facilitators, and proposed interventions mapped according to intervention functions of the BCW framework.32
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