Nurses’ Knowledge Regarding Ventilator-Associated Pneumonia Prevention Bundle in Adult Cardiac Care Unit- A cross-sectional study

Nurses’ Knowledge Regarding Ventilator-Associated Pneumonia Prevention Bundle in Adult Cardiac Care Unit- A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nurses’ Knowledge Regarding Ventilator-Associated Pneumonia Prevention Bundle in Adult Cardiac Care Unit- A cross-sectional study Innocent mwiseneza, Mohamed Ibrahim Ismail Kandil, Mohamed El-Khatib, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7696169/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Ventilator-associated pneumonia is the most serious acquired infection in intensive care units for patients undergoing mechanical ventilation following urinary tract infections. The mortality associated with VAP ranges from 20% to 50%, and the attributable mortality is estimated at 13%. And the knowledge of nurses working in critical areas regarding the VAP prevention bundle is not well established. This study determined the knowledge level of the VAP bundle among nurses working in cardiac critical areas. Methods A cross-sectional study design with a quantitative approach was used. A convenient sampling method was used in selecting study participants and was conducted in the adult cardiac intensive care unit and the Cardiac care unit. Participation was voluntary, and a sample of 67 nurses was selected. A structured questionnaire was used in data collection, and SPSS version 21 was used in data analysis. The data was collected in the first week of September 2025. Results Regarding the sociodemographic characteristics of the study participants, most of the study participants were aged below 24 years (58.2%), and the mean age of 25.2687. The majority of the participants were working in ACICU (85.1%). The Overall knowledge level, about 80.6% of the studied subjects had a satisfactory knowledge level (61–100% score). Computed multivariate binary logistic regression analysis, the result showed a significant relationship between the workplace, not attending the VAP or IPC training and frequency of ventilator circuit change were statistically significant with nurses’ VAP knowledge level with OR: 0.032 (C.I:0.01–0.200), p value 0.000; OR: 0.040(C.I:0-0.33), p value 0.003, and OR: 0.043 (C.I:0.000-0.660), P value 0.024 respectively Conclusion The overall nurses’ knowledge level towards VAP was satisfactory, especially for those working in ACICU. And the factors associated with nurses’ VAP knowledge level, workplace, having attended or not VAP/IPC training, and changing ventilator circuit frequency were statistically significant. Nurses Knowledge Ventilator-associated pneumonia Bundle Adult Cardiac Care Units Figures Figure 1 BACKGROUND Ventilator-associated pneumonia is a specific lung parenchymal infection that occurs 2–3 days after admission to intensive care units (ICUs) of critically ill patients requiring artificial intubation[ 1 ]. Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection (HCAI) occurring in 10–20% of patients mechanically ventilated in the ICU[ 2 ]. Ventilator-associated pneumonia (VAP) carries a mortality rate as high as 74% and the International Nosocomial Infection Control Consortium (INICC) reports the incidence of VAP is about 13.6/1000 mechanical ventilation days[ 3 ]. According to the World Health Organization (WHO), the incidences vary extensively from 5% to 40%, depending on the diagnostic criteria and setting[ 4 ]. Worldwide, the prevalence of VAP is 12.6%, 13.5% in the US, 19.4% in Europe, 13.8% in Latin America, and 16% in South Asia. While in Pakistan VAP rate among children was observed as 17% and 30.5% in adults[ 3 ]. The utilization of evidence-based practice (EBP) and guidelines increases patient care quality while also closing the gap between research findings and practice. EBP can improve the processes, outcomes, and costs of clinical treatment[ 5 ]. In developed countries, like Australia, Findings confirmed that using a care bundle provided a structured approach to nursing care of a ventilated patient and that the use of checklist reminders at the bedside was useful in a busy practice environment[ 6 ]. A bundle is ‘‘a systematized way of humanizing the processes of care and improving patient outcomes that, when performed collectively and reliably, have proven to improve patient outcomes by assisting, promoting changes in patient care, and supporting guideline compliance. The ventilator care bundle consists but is not limited to, the following items: elevating the head of the bed to 30 to 45 degrees; daily "sedation vacation" to determine readiness for extubating, DVT prophylaxis[ 1 ]. Though the knowledge level of nurses towards VAP varies from country to country and hospital to hospital, in Cyprus, the findings of the previously conducted study revealed that nurses’ overall mean of knowledge on VAP prevention was an adequate level (19 out of 30) with low-level knowledge regarding prevention strategies of VAP[ 7 ]. In developing countries, VAP varies from 10 to 41.7 cases per 1000 ventilator days(Weheida, Omran, and Taha, 2022). Some measures were established to decrease this incidence, which include VAP prevention bundles and studies conducted in these countries, like in India, indicated that the knowledge of critical care nurses about VAP prevention bundles was inadequate[ 1 ]. In Palestine, the study revealed that the mean knowledge score for critical care nurses was 50.8% [ 9 ]. Nurses can significantly enhance patient outcomes by implementing evidence-based practices for VAP through ongoing education[ 9 ]. In Sudan, the nurse’s knowledge was improved by the training program, and the result of assessing nurses’ knowledge was good by 55% before intervention, and this result was improved to be as good as 80% in posttest II[ 10 ]. In Egypt, Most healthcare professionals are nurses, referred to as the "center of the health care system." Their adherence to the bundle protocol appears to be more important in preventing disease complications since they spend more time with patients than other healthcare professionals[ 8 , 10 ]. The study by Osti et al. (2017) documented that implementing a ventilator bundle was linked to a significant decrease rates of VAP[ 8 ]. In another study it was revealed that being trained and having sufficient knowledge of VAP prevention bundles differentiates the outcome of patients admitted, shorter length of stay in the intensive care unit, less duration on mechanical ventilation[ 8 ]. Identifying knowledge of VAP prevention bundles among Critical care Registered nurses (CCRNs) working in critical care areas in Aswan Heart Center will highlight the milestones of this hospital in managing and preventing VAP among patients admitted in ICU, as this had a tremendous impact on how patients have to be cared especially towards the prevention of VAP and management of intubated cardiac patients in general. RESEARCH METHODS RESEARCH DESIGN A prospective cross-sectional study design with a quantitative approach was used in this research. A Cross-sectional study design is a type of observational study design. In a cross-sectional study, the investigator measures the outcome and the exposures in the study participants at the same time[11]. STUDY SETTING This study was conducted in one of the hospitals located in this governorate, called Aswan Heart Center- Magdy Yacoub Foundation. At inception in 2009, the facility had two surgical suites, one cath suite, and 12 ICU beds. AHC has 20 ICU beds, 50 ward beds, two modern surgical suites, two modern catheterization suites, 9 outpatient exam rooms, and a state-of-the-art imaging center. This study was conducted in critical care areas, which included the adult cardiac intensive care unit (ACICU) and cardiac care unit (CCU), both of which are from the Aswan Heart Center- Magdy Yacoub Foundation. RESEARCH SUBJECTS A convenient sampling method was used in selecting study participants from the critical care departments, which are the adult cardiac intensive care unit (AICU) and the Cardiac care unit (CCU) and who consented to participate in the research voluntarily. The sampling procedure is important for improving sample representativeness and the generalizability of study findings. Convenience sampling is a non-probability sampling strategy that involves selecting participants from the target population based on their ease of access (Sullivan, 2022). STUDY POPULATION All Nurses working in critical care areas, which included, Adult cardiac intensive care unit(ACICU) and cardiac care unit(CCU) made a total of 66 Registered Nurses(RNs) from ACICU and 17 RNs from CCU, this makes a total population of 83 Registered Nurses. The target population was RNs aged 18 years and above who spent at least 6-month periods working in the above-mentioned critical care areas (ACICU and CCU). Exclusion criteria All nursing staff who were unwilling to participate in the research, and those with working experience of less than 6 months from the time of data collection. Newly recruited nurses in the ACICU and CCU, unpaid voluntary nurses, and the head nurses were also excluded from the current study to eliminate any possibility of bias. SAMPLE SIZE A convenient sample of 67 nurses, who met the inclusion and exclusion criteria, was selected for this descriptive study. It was conducted in two critical care departments at AHC-Magdy Yacoub Foundation. A convenient Non-probability purposive sampling technique was used. The sample was calculated using a convenience sampling technique, and an online sample size was calculated using a Raosoft sample size calculator (Raosoft, Inc. 2004, http://www.raosoft.com/samplesize.html), which determined a confidence level of 95%, an accepted margin of error of 5%, and a response distribution of 50%[1]. Consequently, the response rate to the questionnaire was 100% among CCNs because the Source of support was nil, Conflict of interest, the sample was collected through convenient techniques, which excluded any nurse who refused to participate in the study at the beginning of the data collection[1]. DATA COLLECTION METHODS Data Collection Instruments (Tools) One tool was utilized to collect data pertinent to this study. A structured questionnaire aimed to assess the level of knowledge among nurses regarding the prevention of VAP for critically ill patients. The questionnaire was adapted from a reliable source, developed by Labeau et al[1]. Some questions were also obtained from another study done in southern Taiwan, and finally, the questions were extended to correspond to the context of the Aswan Heart Center in Egypt. In addition to this, the questionnaire will be contextualized and validated with this research by the main researcher and other research experts, including the research supervisor (Aziz et al. , 2020). It consists of two parts; Part A: Nurse’s demographic data, e.g., age, professional qualification, and clinical experience. Part B: VAP bundle prevention Knowledge questionnaire It was created by the multiple-choice questions (MCQs) to assess the knowledge of nurses regarding the VAP prevention bundle Table 1 :Scoring system for the knowledge level Each question had four options, out of which one option was correct and given one mark, whereas the rest of the three options were incorrect and marked zero (0). Based upon the scoring system utilized and the overall mean score earned, the knowledge level was categorized into four categories RELIABILITY AND VALIDITY OF THE RESEARCH TOOLS Reliability of the Tool The items or questions on the questionnaire had a logical connection with the study objectives since the questions were about the knowledge of nurses working in adult critical care areas regarding VAP prevention bundles and were described as related to other previously conducted research on the same topic. Validity of the instrument The instrument used was adopted from the previously developed questionnaire and used in different studies to evaluate the knowledge of nurses working in adult cardiac critical care areas regarding VAP prevention bundles (Aziz et al. , 2020). The questionnaire that used in data collection was enough and appropriate to measure the knowledge of nurses working in adult cardiac critical care areas regarding VAP prevention bundles at Aswan Heart Center-Magdy Yacoub Foundation. The items or structured questionnaire was more appropriate and have adequate representation in each section. This instrument was checked with deep analysis by various experts in research including the research supervisor for content validity. This tool justified the face validity of this study. A pilot study was conducted on the participants' nurses at least 7 (10% of the total number of sample), to test the instrument for validity and feasibility purposes to contextualize it with the study setting (Aswan Heart Centre). The internal consistency was measured and Cronbach’s alpha coefficient is 0.755. Files selected in the pilot study were not included in the main results of the study. PROCEDURES OF DATA COLLECTION Data collection was conducted after getting permission from the British University in Egypt (BUE) Research Ethical Committee with the approval reference No: P.015, and the Ethical Committee of Aswan Heart Center. Permission from the respective departments was granted verbally after presenting approval from the hospital administration. A structured questionnaire was used in data collection. A structured questionnaire, was administered to the study participants who were critical care nurses (CCNs) working in the Adult Cardiac Intensive Care Unit and Coronary Cardiac Unit (CCU) who were willing to be part of the research. Prior to administering the questionnaires to the study participants, the investigator explained the purpose of the research to the participants and clarified that participation is entirely voluntary. After the participants consented to participate, they were requested to sign a consent form for participation. After consenting verbally and signing written consent, the participant were given a structured personal questionnaire for assessing the knowledge level on the VAP prevention bundle. The participants were requested to complete it and ask questions if there is an unclear or difficult term, and were given enough time to complete it as it pleases them. After completing the questionnaire, the participant were requested to hand it back to the principal investigator (PI) for data processing. The filled questionnaire was then be kept by the principal investigator for further analysis. Each structured questionnaire was given a code, and the researcher made a list of participants' names to the code to avoid using the same name or code twice and for ensuring the anonymity of the study participants. Data collection took place in September 2025, and data was collected after the approval was granted by the Aswan Heart Center administration and respective departments. DATA ANALYSIS The researcher analyzed the knowledge of nurses working in adult cardiac critical care areas regarding ventilator-associated pneumonia prevention bundles at Aswan Heart Center using SPSS version 24. Sociodemographic characteristics were presented in frequencies and percentages, and the knowledge level of the study participants towards the VAP prevention bundle was presented in frequency and proportion. To determine the relationships between different factors and the CCNs knowledge level of VAP prevention bundles, a bivariate and multivariate binary logistic regression model will be computed, and OR, p value will be reported. A variable with a p value that is equal to or less than 0.05 will be considered significant. Data will be presented using tables, and graphs. RESULTS PRESENTATION AND INTERPRETATION Table 2: Frequency distribution of studied participants according to demographic characteristics (N=67) Regarding the sociodemographic characteristics of the study participants, most of the study participants were aged below 24 years, with 58.2% (N.39), and the mean age of 25.2687. According to gender, the majority were female 53.7% (N.36). Regarding the marital status, the majority were unmarried with 82.6% (N.54), versus married, while the working experience, the majority were having the experience of 2 to 5 years with 56.7% (N.38), On the other hand, the education level, the majority had completed the college/university with 77.6% (N.52). And regarding the place of work, the majority of the participants were working in ACICU, with 85.1% (N.57). Finally, regarding the previously attended training on VAP or IPC, the majority of the participants attended one or both training sessions, with 91% (N.61) ( Table 2 ). Table 3 VAP knowledge assessment parameters (N = 67) Variables N % What is VAP Bundle Correct answer 60 89.6 Incorrect answer 7 10.4 No compliance with the VAP bundle is associated with Correct answer 57 85.1 Incorrect answer 10 14.9 VAP occurs in a patient who has received mechanical ventilation for Correct answer 52 77.6 Incorrect answer 15 22.4 Which Component is not included in the VAP bundle for the prevention of VAP Correct answer 62 92.5 Incorrect answer 5 7.5 Which is the recommended position for a ventilator patient for the prevention of VAP Correct answer 61 91 Incorrect answer 6 9 The head of the bed elevation should range from Correct answer 61 91 Incorrect answer 6 9 What is the effect of kinetic beds for the prevention of VAP Correct answer 63 94 Incorrect answer 4 6 Which route is best recommended when intubating a patient Correct answer 67 100 Incorrect answer 0 0 How frequently should the ventilator circuit be changed Correct answer 55 82.1 Incorrect answer 12 17.9 A nurse caring for a ventilated patient is required to wash their hands(Frequency) Correct answer 67 100 Incorrect answer 0 0 It is recommended to perform Oral care by using a swab moistened with Chlorhexidine 1% Correct answer 49 73.1 Incorrect answer 19 26.9 One of the components of VAP Bundle is Correct answer 66 98.5 Incorrect answer 1 1.5 Early weaning from the ventilator Correct answer 66 98.5 Incorrect answer 1 1.5 What is your opinion regarding respiratory physiotherapy for the prevention of VAP Correct answer 40 59.7 Incorrect answer 27 40.3 Contraindications for DVT prophylaxis include Correct answer 43 64.2 Incorrect answer 24 35.8 Regarding the definition of VAP bundle, the majority of the studied participants answered the question knowledgeably at about 89.6% (N.60). None compliance to VAP bundle the majority answered correctly the question with 85.1% (N.57) and VAP occur in patient with mechanical ventilation for how long in hours, the majority answered correctly with 77.6%(N.52). Regarding the component not included in VAP bundle, the majority of nurses reported correctly with 92.5% (N.62), while the recommended position in degree centigrade for VAP prevention, nurses reported the question correctly with 91% (N.61). About the head of the bed elevation 91% (N.61) answered correctly the question, and on the effect of kinetic bed on VAP prevention, 94% (N.64) answered correctly the question. Regarding the recommended route for intubation, the nurses answered the question with 100% (N.67), while on how frequently the ventilator circuit should be changed, the study participants answered the question correctly with 82.1% (N.55). Regarding how frequently the nurse should wash hands when handling a patient, the nurses answered the question correctly with the proportion of 100%(N.67), while the recommended frequency to perform oral care by using a swab moistened with Chlorhexidine 1% frequency, the participants answered correctly with 73.1%(N.49), and on the identifying the component of VAP, responded correctly the question with 98.5%(N.66). The impact of early weaning from the ventilator, the study participant answered correctly the question with 98.5% (N.67), and if the respiratory physiotherapy for VAP is recommended was answered correctly with 59.75% (N.40), and in addition to this the contraindication for DVT prevention the study participants responded correctly with 64.2%(N.43) ( Table 3 ). Table (4) illustrates computed bivariate binary logistic regression analysis of sociodemographic characteristics of the knowledge variables against the overall nurses’ knowledge level towards VAP prevention bundle and the result showed that there was a significant relationship between the sociodemographic characteristics, nurses’ knowledge variables, and nurses’ knowledge level as follows: attending the training session on either VAP or IPC was significantly associated with nurses’ knowledge with OR:11.556 (C.I:1.837–72.685) and p value 0.009 compared to those who did not attend the training session. Workplace; working in CCU was significantly associated with knowledge level with OR: 0.050 (C.I:0.010–0.249) and p value 0.000, compared to working in ACICU. The head of the bed elevation in the prevention of VAP, the correct answer was significant with OR: 8.556(C.I:0.821–36.019) and p value 0.002 compared to those wrongly answered the question. Kinetic bed effect on VAP prevention, the correctly answered response was associated with nurses’ knowledge with OR: 15.900 (C.I:1.498-168.716) and p value 0.003 compared to incorrect answer responses. The correct answer about how frequently the ventilator circuit should be changed was significantly associated with knowledge level, with OR: 38.250 (7.300-200.406) and p value 0.000 compared to incorrectly answered questions. And finally, regarding the correctly answered response on the component of VAP, it was significantly associated with nurses’ knowledge level with OR: 69 (7.849-606.604) and p value 0.000 compared to incorrectly answered questions. Table 5 Relationship between nurses' demographic characteristics, knowledge variables, against nurses’ knowledge level regarding VAP prevention bundle (Multivariate logistic regression analysis). Variable Knowledge Level OR 95%CI.For OR P Value Satisfactory knowledge Unsatisfactory knowledge Lower Upper N % N % Workplace ACICU 51 76.12 6 8.96 1 CCU 3 4.47 7 10.45 0.032 0.01 0.2 0.000 Attended Training on VAP or IPC Yes 52 77.61 9 13.43 1 No 2 2.98 4 5.98 0.040 0 0.33 0.003 How frequently should the ventilator circuit be changed Correct answer 51 76.12 4 5.98 1 Incorrect answer 3 4.47 9 13.43 0.043 0 0.66 0.024 Total 54 80.59 13 19.41 - - - - Table (5). Illustrates computed multivariate binary logistic regression analysis of variables statistically significant in the bivariate model with nurses’ knowledge level towards VAP prevention bundle, and the result showed that there was a significant relationship between the workplace, where working in CCU was significant with OR:0.032(0.01–0.200) and p value 0.000 compared to working in ACICU. Not attending the training session on VAP or IPC was statistically significant with OR: 0.040 (C.I:0-0.33) and p value 0.003 compared to attending the training session on VAP or IPC. Finally, an incorrect answer on how frequently the ventilator circuit should be changed was significantly associated with the knowledge level, with OR: 0.043 (C.I:0.000-0.660) and P value 0.024. DISCUSSION On computing the sociodemographic characteristics of the study participants, most of the study participants were aged below 24 years (58.2%), and the mean age of 25.2687. According to gender, the majority were female (53.7%). On the other hand, the education level, the majority had completed the college/university (77.6%), contrary to this study, the results from a study conducted in Nepal on the same topic in adult critical care setting, the mean age was 26.8 years and the majority of the participated nurses had university education and were having the experience of more than one year[ 12 ]. Regarding marital status, the majority were unmarried (82.6%), versus married. Contrary to this study, the results from Egypt, at Mansoura University teaching Hospital, most of the study participants were married, and similarly, the majority were female[ 13 ]. On the working experience, the majority had experience of 2 to 5 years (56.7%), similarly to this, results were reported in a study conducted in Cairo Military hospital, the work experience, the majority were having between 6 months to 4 years[ 5 ]. Regarding the place of work, the majority of the participants were working in ACICU, with (85.1%). On the previously attended training on VAP or IPC, the majority of the participants attended one or both training sessions, with 91%. In contrast to this, in Nepal, the majority did not attend the above-mentioned training session on VAP[ 12 ]. Regarding the definition of VAP bundle, the majority of the studied participants answered the question knowledgeably at about 89.6%). Non-compliance to the VAP bundle, the majority answered the question correctly (85.1%), and VAP occurs in patients with mechanical ventilation for how long in hours, the majority answered correctly (77.6%). And the component not included in the VAP bundle, the majority of nurses reported correctly (92.5%), similar results were reported in a study conducted in a governmental hospital in Gaza, Palestine [ 14 ]. The recommended position in degrees centigrade for VAP prevention, most nurses reported the question correctly (91%), the head of the bed elevation, most of them (91%) answered the question correctly, and on the effect of kinetic bed on VAP prevention, most nurses (94%) answered correctly. the question. Regarding the recommended route for intubation, the nurses answered the question (100%), while on how frequently the ventilator circuit should be changed, the study participants answered the question correctly (82.1%), Similarly to the study participants on the study conducted in Ethiopia, reported to have sufficient knowledge on the patient position, ventilator circuit change and oropharyngeal intubation[ 1 , 15 ]. Regarding how frequently the nurse should wash hands when handling a patient, most of nurses answered the question correctly with the proportion of 100%, while the recommended frequency to perform oral care by using a swab moistened with Chlorhexidine 1% frequency, the participants answered correctly with (73.1%), and on the identifying the component of VAP, most of nurses responded correctly the question (98.5%). The impact of early weaning from the ventilator, the study participant answered correctly the question (98.5%), and if the respiratory physiotherapy for VAP is recommended for VAP prevention, nurses answered correctly at 59.75%, and finally, the contraindication for DVT prevention, most of the study participants responded correctly (64.2%), similarly results was found in a study conducted in Gaza, Palestine and Spain on the same variables used in the assessment of nurses’ VAP knowledge level[ 1 , 14 ]. In Spain, the most reported component of the ventilator bundle was head-of-bed elevation, followed by oral care[ 16 ]. And finally to what was reported in the Philippines, knowledge regarding specific components of VAP prevention is lacking[ 17 ]. By computing the overall knowledge level of nurses towards VAP prevention bundle; The majority of the evaluated nurses (80.6%) had a satisfactory knowledge level(61–100%) regarding the VAP bundle, similar to the study conducted in Nepal, the study participants had satisfactory knowledge towards VAP bundle prevention at around 97.4%%[ 12 ]. And in another study conducted in Cairo University Hospital in Egypt, the nurses’ knowledge level was good in at around 52.4% of the overall knowledge score[ 5 ]. Contrary to this, a study conducted in Egypt at Mansoura University teaching hospital, where the study participants reported having poor knowledge level towards the VAP bundle at around 90% of the study participants[ 13 ].And in another study conducted in Egypt in a Governmental hospital, In Egypt, the results of 20- items questionnaire revealed unsatisfactory knowledge scores (mean 7.46 + 2.37), and most of the nurses were not compliant with ventilator-associated pneumonia bundle practices (average mean = 8.62 + 7.9 out of 29)[ 1 ]. In Ethiopia, the overall knowledge of nurses on VAP evidence-based guidelines was inadequate[ 15 ]. And in another study conducted in Palestine, the nurses’ knowledge was moderate on the VAP prevention bundle[ 18 ]. While the results from the study conducted in the neonatal intensive care Unit at Port Said University reported insufficient knowledge of nurses towards VAP bundle[ 19 ]. And another study conducted in Saudi Arabia, at King Fahad general hospital, revealed that the nurses' overall knowledge towards VAP bundle was insignificant, which was reported to be a big concern[ 20 ]. And finally, in Sri Lanka, the majority of nurses reported having insufficient knowledge of the VAP prevention bundle[ 21 ]. While in Rwanda, only 9.7% self-reported and 13.3% observed participants demonstrated acceptable levels of adherence to the ventilator-associated pneumonia prevention bundle[ 22 ]. Computed multivariate binary logistic regression analysis of sociodemographic characteristics variables against the overall nurses’ knowledge level towards VAP prevention bundle showed that there was a significant relationship between the sociodemographic characteristics, and nurses’ knowledge level as follows: There was a significant relationship between the workplace and nurses’ knowledge level, where working in CCU was significant with OR:0.032(C.I:0.01–0.200) and p value 0.000 compared to working in ACICU, similarly to this study, the results from the study conducted in China, reported that the work place like ICU was significantly associated with VAP bundle knowledge, in addition to this had attended the VAP training also was significantly associated with nurses’ knowledge on VAP bundle[ 23 ]. Contrary to this, a study conducted in KSA, revealed that there was a significant relationship between nurses' knowledge and age, experience in nursing, and having training on the VAP bundle[ 24 ]. In addition to this, the reported results in a study conducted in a governmental hospital in Gaza, Palestine, the age, gender, and work experience were statistically significantly associated with critical care nurses’ knowledge[ 1 ]. And in another study conducted in Saudi Arabia, revealed that the nurses’ knowledge was associated with nationality, level of education, and work experience among critical care nurses[ 25 ]. Not attending the training session on VAP or IPC was statistically significant with OR:0.040 ( C.I:0-0.33) and p value 0.003 compared to attending the training session on VAP or IPC, Similarly results was reported in a study conducted in Benha University hospital in Egypt, where the results showed that, attending VAP prevention bundle training was statistically associated with nurses’ knowledge on VAP bundle compared to those who did not attend the training[ 8 ]. Finally, on the evaluating the association between the knowledge variables and nurses’ knowledge level; how frequently the ventilator circuit should be changed was significantly associated with the knowledge level, with OR: 0.043 (C.I:0.000-0.660) and P value 0.024, contrary to this study, the results from a conducted at Port Said University hospital, they reported no significant association between the nurses’ knowledge level and other parameters involved in the assessment of evaluating knowledge[ 19 ]. Whereby, in another study conducted in Finland, quite similar results to this study, a systematic analysis was conducted, the results showed that the factor associated with VAP prevention bundle were the head of the bed elevation and oral care[ 26 ]. CONCLUSION AND RECOMMENDATIONS Conclusion On sociodemographic characteristics of the cardiac critical care nurses who participated in this study, the results showed that the majority were single females and had an age below 24 years old, with a mean age of 25 years old, who attended university/college. And most of them had the work experience of about 2 to 5 years working in ACICU, and also had attended VAP/IPC training course or both. The overall nurses’ knowledge level towards VAP was satisfactory, especially to those working in ACICU. And finally, to the factors associated with nurses’ VAP knowledge level: workplace, having attended or not VAP/IPC training, and changing ventilator circuit frequency were statistically significant in multivariate binary logistic regression analysis. Recommendations It is therefore recommended that nurses working in cardiac critical care areas, as it is very sensitive to determining the outcome of post-operative patients, nurses working in those areas should keep updating their knowledge on VAP prevention bundle and IPC in general, and be aware of VAP prevention methods for further improving the quality of care and outcome of patients admitted there. Study limitations This study was conducted in one cardiac center in Egypt; therefore, the results generated may not represent the whole of Egypt towards the cardiac critical care nurses’ VAP knowledge level and its associated factors. Abbreviations ACICU: Adult cardiac Intensive care Unit; CCU: Cardiac care Unit; VAP: Ventilator Associated pneumonia; IPC: Infection Prevention and control; OR: odds ratio; C.I: Confidence interval; INICC: International Nosocomial Infection Control Consortium; EBP: Evidence-based Practice Declarations Acknowledgements The research team is thankful to the help provided by Madgy Yacoub foundation-Aswan Heart Centre management, its education department, and most importantly, our gratitude goes to the nurses who participated in this research for their efforts and willingness. Author affiliation 1 British University in Egypt, Faculty of Nursing, Cairo, Egypt 2 Magdy-Yacoub Foundation, Aswan Heart Center, Aswan, Egypt 3 The Heart Care and Research Foundation, Rwanda- Egypt Heart Centre, Kigali, Rwanda 4 University of Rwanda, School of Nursing and Midwifery, Huye Campus, Rwanda Author contributions IM, MF contributed to the study conception, design, data collection, data analysis, and manuscript refinement. MIIK, MEK, JU, JRVM, JBM, AU , and MMMA contributed to the data collection, data analysis, and manuscript refinement. Declarations Conflict of interest The authors declare no conflict of interest Ethical Approval and consent to participate Ethical approval to conduct the study was granted by the British University in Egypt (BUE) Institutional Review Board (IRB) with the reference number: P.015, and permission to collect data was granted by the Aswan Heart Centre- Magdy Yacoub Foundation administration. Participants` privacy and confidentiality were considered by using patient codes instead of names. Privacy during data collection was ensured by identifying the private area before starting data collection. Filled questionnaires were kept in a closed cupboard to maintain confidentiality. The data was stored electronically, and password-locked file software was used according to the BUE IRB rules and regulations regarding research projects. This research involved human subjects and therefore followed the Declaration of Helsinki for research involving human subjects. All research participants were explicitly informed in detail about the objective and benefits of the study, and they consented verbally after asking questions and getting answers. Finally, the study participants signed a consent form before participating in the research. The individuals volunteered to participate in the study, and they were free to withdraw at any time without penalty. The use of participant numbers rather than names protected the participants' privacy and confidentiality. There was no risk in participating in this research. Collected data were stored in a password-protected computer, computer was only accessed by the research team; nobody else had access to that computer. The data was entered into a computer protected with a personal computer password. Consent to publish Not Applicable Funding Not applicable Availability of data and materials All data relevant to this study are included in the article References El-Kass SM, Alruwili HA, Alrowily MA, Ellayan OM, El-Kass LM, Hijo EE, et al. Critical Care Nurses’ Knowledge on Prevention of Ventilator-associated Pneumonia: A Cross-sectional Study. Indian J Crit Care Med. 2024;28(12):1122–9. Hellyer TP, Ewan V, Wilson P, Simpson AJ. The Intensive Care Society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. J Intensive Care Soc. 2016;17(3):238–43. Aziz Z, Kausar S, Zahid S, Farooqi S, Aziz Z, Ahmad RA. Knowledge and practice of ventilator care bundle for preventing ventilator associated pneumonia by ICU nurses of tertiary care hospitals of Lahore. Anaesthesia, Pain Intensive Care. 2020;24(4):426–34. Alreshidi MS, AlRashidi FA, Tuppal CP, Prudencio DAM, Alrashidi N, Villagracia RWA, et al. Nurses’ Knowledge on the Prevention of Ventilator-Associated Pneumonia (VAP) among Critically Ill Patients. Nurse Media J Nurs. 2024;14(1):65–73. Aboul-fotouh AM, Megahed LA mawala, Elnakib MM, Madany MH, Abd H, Abd E haleem A. Assessment of nurses ’ knowledge and compliance to evidence based guidelines regarding bundle of ventilator associated pneumonia in a military hospital. 2022; Ladbrook E, Bouchoucha SL, Hutchinson A. Lessons learned from a rapid implementation of a ventilator-associated pneumonia prevention bundle. J Infect Prev. 2019;20(6):274–80. Alkhazali MN, Bayraktar N, Al-Mugheed KA. Knowledge and Barriers of Critical Care Nurses Regarding Evidence-Based Practices in Ventilator-Associated Pneumonia Prevention. Cyprus J Med Sci. 2021;6(3):185–91. Weheida SM, Omran ES, Taha AS. Effect of Designed Bundle Protocol about Ventilator Associated Pneumonia on Nurses’ Performance, Compliance, and Patient Outcomes. Evidence-Based Nurs Res. 2022;4(3):71–85. Ahmad Al-Nawaja’a I, Salameh B, Toqan D, Hammad BM, Fashafsheh I. Assessing Critical Care Nurse’s Knowledge and Adherence to Evidence-Base Guidelines for Ventilator-Associated Pneumonia Prevention in Palestinian Hospitals. Nurs Res Pract [Internet]. 2024;2024:1434479. Available from: http://www.ncbi.nlm.nih.gov/pubmed/39758455%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC11698611 Abdelazeem E, Fashafsheh I, Fadllalah H. Effect of Training Program on Nurses Knowledge and Competence Regarding Endotracheal Tube and Tracheostomy Care in Mechanically Ventilated Patients. Int J Nurs. 2019;6(1). Setia MS. MODULE ON BIOSTATISTICS AND RESEARCH METHODOLOGY FOR THE DERMATOLOGIST. Indian J Dermatol [Internet]. 2016;61(3):261–4. Available from: http://www.e-ijd.org Bhandari S, Medha S, Gentle S. Knowledge of Nurses Working in Critical Care Areas Regarding Ventilator Associated Pneumonia Prevention Bundles in a Tertiary Level Cardiac Centre. J Inst Med Nepal [Internet]. 2021;43(1):36–42. Available from: www.jiomnepal.com.np Gerida AA, Youssef O, Abdelraouf E sheikh E, Abdallah A. Nurses ’ knowledge and Performance regarding Infection Preventive Measures for Ventilators Associated Pneumonia. 2022;9(2):291–7. Martinez-reviejo R, Tejada S, Jansson M, Ruiz-spinelli A, Ramirez-estrada S, Ege D, et al. Prevention of ventilator-associated pneumonia through care bundles : A systematic review and meta-analysis. J Intensive Med [Internet]. 2023;3(4):352–64. Available from: https://doi.org/10.1016/j.jointm.2023.04.004 Zones WG, Misganaw A, Ayenew NT. Intensive care unit nurses ’ knowledge and compliance with ventilator associated pneumonia bundle at a resource limited setting in East Gojam and West Gojam Zones , Ethiopia . a cross-sectional. 2025;(April). Martinez-Reviejo R, Tejada S, Jansson M, Ruiz-Spinelli A, Ramirez-Estrada S, Ege D, et al. Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis. J Intensive Med [Internet]. 2023;3(4):352–64. Available from: https://doi.org/10.1016/j.jointm.2023.04.004 Abad CL, Formalejo CP, Mantaring DML. Assessment of knowledge and implementation practices of the ventilator acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital. Antimicrob Resist Infect Control [Internet]. 2021;10(1):1–6. Available from: https://doi.org/10.1186/s13756-021-01027-1 Alqaissi N, Qtait M. Knowledge and Practices of Intensive Care Unit Nurses Related to Prevention of Ventilator-Associated Pneumonia Cross-Sectional Study. 2025; Abd El-Sattar El-Sayed El-Sayed S, Amal Ahmed Khalil P, Rehab Hanie EL-kazaz A. Assessment of Nurses’ Knowledge and Practice Regarding Prevention of Ventilator Associated Pneumonia In Neonates. Port Said Sci J Nurs. 2023;10(3):207–35. Barnawi FAJ, Barnawi Y, Al-Modallal H. Enhancing Patient Safety: Assessing ICU Nurses’ Knowledge and Compliance in Ventilator-Associated Pneumonia Prevention at King Fahad General Hospital, Saudi Arabia. Saudi J Nurs Heal Care. 2025;8(01):20–30. Muralitharan P., Seneviratne S.M.K.S. Knowledge Regarding Ventilator-associated Pneumonia and its Prevention Among Nurses Working at Intensive Care Units of Two Teaching Hospitals in Sri Lanka. J Heal Sci Innov Res. 2022;3(01):28–38. Ruririmbwa E, Bhengu BR, Teshome GS. Assessing Measures for Preventing Ventilator Associated Pneumonia among Nurses Working in Intensive Care Units : A Case of Two Selected Referral and Teaching Hospitals in Kigali. 2025;1–9. Li X, Zhang X, Feng Y, Yao Z, Sun Y, Zhang L, et al. of nurses in ICU on preventing ventilator-associated pneumonia : a cross-sectional study in Gansu. 2025;(July):1–10. Alhamad N, Elsayed W. Nursing Knowledge and Preventive Practices of Ventilator-Associated Pneumonia as Perceived by Intensive Care Nurses in Hail City, KSA. Evidence-Based Nurs Res. 2024;6(4):1–11. Mohmmad A, Bokhary H, Salem AH, Al-Qahtani FM. Critical Care Nurses’ Knowledge Regarding Evidence-Based Guidelines for Preventing of Ventilator-Associated Pneumonia in the Intensive Care Units: A cross-sectional study. Int J Healthc Sci [Internet]. 2021;9(2):139–49. Available from: www.researchpublish.com Martinez-reviejo R, Tejada S, Jansson M, Ruiz-spinelli A, Ramirez-estrada S, Ege D, et al. Prevention of ventilator-associated pneumonia through care bundles : A systematic review and meta-analysis. 2023;3(March):352–64. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7696169","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522050850,"identity":"c4dd02dc-dd88-4645-ab16-b4dbc46e18b9","order_by":0,"name":"Innocent mwiseneza","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYBACNgSTsQFCs4NoAwuCWiQQWngOgLRIELQNSYVEApoAGuCT7j344EfFnTrdGcnNHz7usLHnn/n86oYfBRIM/O3dCVgdJnMu2bDnzDMJsxuJbZIzz6QxS9zOKbvZA3SYxJmzG7Bqkcgxk2ZsOyxhdjuxjZm37TAbw+2ctBs8QC0GErl4tPwDa2n+/LftP4/8zTNpN/8Q1NIA1tIAtO6AhMEN9mO3CdhibNhz7LDktvsP2yR725INDM/ksN2WMZDgweUX+Rk5hg9+1BzmNztz/PGHn2129nLHjz+7+eaPjRx/ey9WLdgAjwGYJFY5CLA/IEX1KBgFo2AUDH8AAJBUYsjAi4woAAAAAElFTkSuQmCC","orcid":"","institution":"British University in Egypt","correspondingAuthor":true,"prefix":"","firstName":"Innocent","middleName":"","lastName":"mwiseneza","suffix":""},{"id":522050853,"identity":"96482f67-1e02-4d8c-a8ac-d6e6f994c0e9","order_by":1,"name":"Mohamed Ibrahim Ismail Kandil","email":"","orcid":"","institution":"Magdy-Yacoub Foundation, Aswan Heart Center","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Ibrahim Ismail","lastName":"Kandil","suffix":""},{"id":522050854,"identity":"8742b210-975e-4e5f-b577-395928151a57","order_by":2,"name":"Mohamed El-Khatib","email":"","orcid":"","institution":"Magdy-Yacoub Foundation, Aswan Heart Center","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"","lastName":"El-Khatib","suffix":""},{"id":522050855,"identity":"6622170b-a033-4b80-b62a-9ad663443731","order_by":3,"name":"Josephine Uwingabire","email":"","orcid":"","institution":"The Heart Care and Research Foundation, Rwanda-Egypt Heart centre","correspondingAuthor":false,"prefix":"","firstName":"Josephine","middleName":"","lastName":"Uwingabire","suffix":""},{"id":522050862,"identity":"338a3835-42a9-42d1-bb5f-91b0af2c8e16","order_by":4,"name":"Jean Rene Victor Muhirwa","email":"","orcid":"","institution":"The Heart Care and Research Foundation, Rwanda-Egypt Heart centre","correspondingAuthor":false,"prefix":"","firstName":"Jean","middleName":"Rene 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Mohamed","lastName":"Ali","suffix":""},{"id":522050868,"identity":"6eb48a5c-dcc0-4d8d-8a04-6edace4c80de","order_by":8,"name":"Marwa Fathallah","email":"","orcid":"","institution":"British University in Egypt","correspondingAuthor":false,"prefix":"","firstName":"Marwa","middleName":"","lastName":"Fathallah","suffix":""}],"badges":[],"createdAt":"2025-09-23 15:53:10","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7696169/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7696169/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92575459,"identity":"d73b5acf-75c4-4126-8e13-02d01fad8694","added_by":"auto","created_at":"2025-10-01 08:21:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":78814,"visible":true,"origin":"","legend":"","description":"","filename":"VAPmanuscriptInnocentM25.09.2025TobesubmittedtoBMCNursingJournal.docx","url":"https://assets-eu.researchsquare.com/files/rs-7696169/v1/f1e56ab62a1ab117b4b7ffef.docx"},{"id":92574723,"identity":"b84aff36-af59-454e-9cfb-89fe7a9b14d1","added_by":"auto","created_at":"2025-10-01 08:13:19","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10371,"visible":true,"origin":"","legend":"","description":"","filename":"fa4a2f9a16cc4b9297a75e4dd593aca5.json","url":"https://assets-eu.researchsquare.com/files/rs-7696169/v1/7d0d85d19d5eed5ca6d0d7d7.json"},{"id":92574726,"identity":"1704b217-d5eb-4064-8b8d-a5946dfaf6f0","added_by":"auto","created_at":"2025-10-01 08:13:19","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":124300,"visible":true,"origin":"","legend":"","description":"","filename":"fa4a2f9a16cc4b9297a75e4dd593aca51enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7696169/v1/7cb4a6e39187444adddf909a.xml"},{"id":92575460,"identity":"3941b529-59a7-494d-b760-d59c59d0e4e8","added_by":"auto","created_at":"2025-10-01 08:21:19","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":122065,"visible":true,"origin":"","legend":"","description":"","filename":"fa4a2f9a16cc4b9297a75e4dd593aca51structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7696169/v1/05d46724ea43e889dd1ebce5.xml"},{"id":92574728,"identity":"4dcfaa83-4ac8-450b-a8e1-4f660b93c1eb","added_by":"auto","created_at":"2025-10-01 08:13:19","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":135437,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7696169/v1/966799ef2ed70e505f3492d5.html"},{"id":92574721,"identity":"92b0a9a5-714b-49f9-adc3-7710bdd9a469","added_by":"auto","created_at":"2025-10-01 08:13:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48898,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePercentage distribution of the studied subjects concerning knowledge about the VAP bundle (N=67)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClarifies that the majority of about 80.6 % of the studied subjects had a satisfactory knowledge level (61-100% Score) regarding the VAP bundle.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7696169/v1/d05e0aa567a5f568766337be.png"},{"id":95654383,"identity":"0b719cf5-0218-46e1-b097-c0f6dd20206a","added_by":"auto","created_at":"2025-11-11 16:11:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1366883,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7696169/v1/af5c0611-0cd5-4dd0-affc-288b4e67a5ea.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nurses’ Knowledge Regarding Ventilator-Associated Pneumonia Prevention Bundle in Adult Cardiac Care Unit- A cross-sectional study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eVentilator-associated pneumonia is a specific lung parenchymal infection that occurs 2\u0026ndash;3 days after admission to intensive care units (ICUs) of critically ill patients requiring artificial intubation[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection (HCAI) occurring in 10\u0026ndash;20% of patients mechanically ventilated in the ICU[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Ventilator-associated pneumonia (VAP) carries a mortality rate as high as 74% and the International Nosocomial Infection Control Consortium (INICC) reports the incidence of VAP is about 13.6/1000 mechanical ventilation days[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to the World Health Organization (WHO), the incidences vary extensively from 5% to 40%, depending on the diagnostic criteria and setting[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Worldwide, the prevalence of VAP is 12.6%, 13.5% in the US, 19.4% in Europe, 13.8% in Latin America, and 16% in South Asia. While in Pakistan VAP rate among children was observed as 17% and 30.5% in adults[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e The utilization of evidence-based practice (EBP) and guidelines increases patient care quality while also closing the gap between research findings and practice. EBP can improve the processes, outcomes, and costs of clinical treatment[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In developed countries, like Australia, Findings confirmed that using a care bundle provided a structured approach to nursing care of a ventilated patient and that the use of checklist reminders at the bedside was useful in a busy practice environment[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A bundle is \u0026lsquo;\u0026lsquo;a systematized way of humanizing the processes of care and improving patient outcomes that, when performed collectively and reliably, have proven to improve patient outcomes by assisting, promoting changes in patient care, and supporting guideline compliance. The ventilator care bundle consists but is not limited to, the following items: elevating the head of the bed to 30 to 45 degrees; daily \"sedation vacation\" to determine readiness for extubating, DVT prophylaxis[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Though the knowledge level of nurses towards VAP varies from country to country and hospital to hospital, in Cyprus, the findings of the previously conducted study revealed that nurses\u0026rsquo; overall mean of knowledge on VAP prevention was an adequate level (19 out of 30) with low-level knowledge regarding prevention strategies of VAP[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn developing countries, VAP varies from 10 to 41.7 cases per 1000 ventilator days(Weheida, Omran, and Taha, 2022). Some measures were established to decrease this incidence, which include VAP prevention bundles and studies conducted in these countries, like in India, indicated that the knowledge of critical care nurses about VAP prevention bundles was inadequate[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Palestine, the study revealed that the mean knowledge score for critical care nurses was 50.8% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Nurses can significantly enhance patient outcomes by implementing evidence-based practices for VAP through ongoing education[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In Sudan, the nurse\u0026rsquo;s knowledge was improved by the training program, and the result of assessing nurses\u0026rsquo; knowledge was good by 55% before intervention, and this result was improved to be as good as 80% in posttest II[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Egypt, Most healthcare professionals are nurses, referred to as the \"center of the health care system.\" Their adherence to the bundle protocol appears to be more important in preventing disease complications since they spend more time with patients than other healthcare professionals[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The study by Osti et al. (2017) documented that implementing a ventilator bundle was linked to a significant decrease rates of VAP[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In another study it was revealed that being trained and having sufficient knowledge of VAP prevention bundles differentiates the outcome of patients admitted, shorter length of stay in the intensive care unit, less duration on mechanical ventilation[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Identifying knowledge of VAP prevention bundles among Critical care Registered nurses (CCRNs) working in critical care areas in Aswan Heart Center will highlight the milestones of this hospital in managing and preventing VAP among patients admitted in ICU, as this had a tremendous impact on how patients have to be cared especially towards the prevention of VAP and management of intubated cardiac patients in general.\u003c/p\u003e"},{"header":"RESEARCH METHODS","content":"\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eRESEARCH DESIGN\u003c/h2\u003e\n \u003cp\u003eA prospective cross-sectional study design with a quantitative approach was used in this research.\u003c/p\u003e\n \u003cp\u003eA Cross-sectional study design is a type of observational study design. In a cross-sectional study, the investigator measures the outcome and the exposures in the study participants at the same time[11].\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSTUDY SETTING\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in one of the hospitals located in this governorate, called Aswan Heart Center- Magdy Yacoub Foundation. At inception in 2009, the facility had two surgical suites, one cath suite, and 12 ICU beds. AHC has 20 ICU beds, 50 ward beds, two modern surgical suites, two modern catheterization suites, 9 outpatient exam rooms, and a state-of-the-art imaging center. This study was conducted in critical care areas, which included the adult cardiac intensive care unit (ACICU) and cardiac care unit (CCU), both of which are from the Aswan Heart Center- Magdy Yacoub Foundation.\u003c/p\u003e\n\u003ch3\u003eRESEARCH SUBJECTS\u003c/h3\u003e\n\u003cp\u003eA convenient sampling method was used in selecting study participants from the critical care departments, which are the adult cardiac intensive care unit (AICU) and the Cardiac care unit (CCU) and who consented to participate in the research voluntarily. The sampling procedure is important for improving sample representativeness and the generalizability of study findings. Convenience sampling is a non-probability sampling strategy that involves selecting participants from the target population based on their ease of access (Sullivan, 2022).\u003c/p\u003e\n\u003ch3\u003eSTUDY POPULATION\u003c/h3\u003e\n\u003cp\u003eAll Nurses working in critical care areas, which included, Adult cardiac intensive care unit(ACICU) and cardiac care unit(CCU) made a total of 66 Registered Nurses(RNs) from ACICU and 17 RNs from CCU, this makes a total population of 83 Registered Nurses. The target population was RNs aged 18 years and above who spent at least 6-month periods working in the above-mentioned critical care areas (ACICU and CCU).\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eAll nursing staff who were unwilling to participate in the research, and those with working experience of less than 6 months from the time of data collection. Newly recruited nurses in the ACICU and CCU, unpaid voluntary nurses, and the head nurses were also excluded from the current study to eliminate any possibility of bias.\u003c/p\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003eSAMPLE SIZE\u003c/h2\u003e\n \u003cp\u003eA convenient sample of 67 nurses, who met the inclusion and exclusion criteria, was selected for this descriptive study. It was conducted in two critical care departments at AHC-Magdy Yacoub Foundation. A convenient Non-probability purposive sampling technique was used. The sample was calculated using a convenience sampling technique, and an online sample size was calculated using a Raosoft sample size calculator (Raosoft, Inc. 2004, http://www.raosoft.com/samplesize.html), which determined a confidence level of 95%, an accepted margin of error of 5%, and a response distribution of 50%[1]. Consequently, the response rate to the questionnaire was 100% among CCNs because the Source of support was nil, Conflict of interest, the sample was collected through convenient techniques, which excluded any nurse who refused to participate in the study at the beginning of the data collection[1].\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eDATA COLLECTION METHODS\u003c/h3\u003e\n\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003eData Collection Instruments (Tools)\u003c/h2\u003e\n \u003cp\u003eOne tool was utilized to collect data pertinent to this study. A structured questionnaire aimed to assess the level of knowledge among nurses regarding the prevention of VAP for critically ill patients. The questionnaire was adapted from a reliable source, developed by Labeau et al[1]. Some questions were also obtained from another study done in southern Taiwan, and finally, the questions were extended to correspond to the context of the Aswan Heart Center in Egypt. In addition to this, the questionnaire will be contextualized and validated with this research by the main researcher and other research experts, including the research supervisor (Aziz \u003cem\u003eet al.\u003c/em\u003e, 2020).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIt consists of two parts;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePart A: Nurse’s demographic data, e.g., age, professional qualification, and clinical experience.\u003c/p\u003e\n \u003cp\u003ePart B: VAP bundle prevention Knowledge questionnaire\u003c/p\u003e\n \u003cp\u003eIt was created by the multiple-choice questions (MCQs) to assess the knowledge of nurses regarding the VAP prevention bundle\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e:Scoring system for the knowledge level\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEach question had four options, out of which one option was correct and given one mark, whereas the rest of the three options were incorrect and marked zero (0). Based upon the scoring system utilized and the overall mean score earned, the knowledge level was categorized into four categories\u0026nbsp;\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n \u003cdiv align=\"left\"\u003eRELIABILITY AND VALIDITY OF THE RESEARCH TOOLS\u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003eReliability of the Tool\u003c/h2\u003e\n \u003cp\u003eThe items or questions on the questionnaire had a logical connection with the study objectives since the questions were about the knowledge of nurses working in adult critical care areas regarding VAP prevention bundles and were described as related to other previously conducted research on the same topic.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003eValidity of the instrument\u003c/h2\u003e\n \u003cp\u003eThe instrument used was adopted from the previously developed questionnaire and used in different studies to evaluate the knowledge of nurses working in adult cardiac critical care areas regarding VAP prevention bundles (Aziz \u003cem\u003eet al.\u003c/em\u003e, 2020). The questionnaire that used in data collection was enough and appropriate to measure the knowledge of nurses working in adult cardiac critical care areas regarding VAP prevention bundles at Aswan Heart Center-Magdy Yacoub Foundation. The items or structured questionnaire was more appropriate and have adequate representation in each section. This instrument was checked with deep analysis by various experts in research including the research supervisor for content validity. This tool justified the face validity of this study.\u003c/p\u003e\n \u003cp\u003eA pilot study was conducted on the participants' nurses at least 7 (10% of the total number of sample), to test the instrument for validity and feasibility purposes to contextualize it with the study setting (Aswan Heart Centre). The internal consistency was measured and Cronbach’s alpha coefficient is 0.755. Files selected in the pilot study were not included in the main results of the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003ePROCEDURES OF DATA COLLECTION\u003c/h2\u003e\n \u003cp\u003eData collection was conducted after getting permission from the British University in Egypt (BUE) Research Ethical Committee with the approval reference No: P.015, and the Ethical Committee of Aswan Heart Center. Permission from the respective departments was granted verbally after presenting approval from the hospital administration. A structured questionnaire was used in data collection. A structured questionnaire, was administered to the study participants who were critical care nurses (CCNs) working in the Adult Cardiac Intensive Care Unit and Coronary Cardiac Unit (CCU) who were willing to be part of the research. Prior to administering the questionnaires to the study participants, the investigator explained the purpose of the research to the participants and clarified that participation is entirely voluntary. After the participants consented to participate, they were requested to sign a consent form for participation. After consenting verbally and signing written consent, the participant were given a structured personal questionnaire for assessing the knowledge level on the VAP prevention bundle. The participants were requested to complete it and ask questions if there is an unclear or difficult term, and were given enough time to complete it as it pleases them.\u003c/p\u003e\n \u003cp\u003eAfter completing the questionnaire, the participant were requested to hand it back to the principal investigator (PI) for data processing. The filled questionnaire was then be kept by the principal investigator for further analysis. Each structured questionnaire was given a code, and the researcher made a list of participants' names to the code to avoid using the same name or code twice and for ensuring the anonymity of the study participants. Data collection took place in September 2025, and data was collected after the approval was granted by the Aswan Heart Center administration and respective departments.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003eDATA ANALYSIS\u003c/h2\u003e\n \u003cp\u003eThe researcher analyzed the knowledge of nurses working in adult cardiac critical care areas regarding ventilator-associated pneumonia prevention bundles at Aswan Heart Center using SPSS version 24. Sociodemographic characteristics were presented in frequencies and percentages, and the knowledge level of the study participants towards the VAP prevention bundle was presented in frequency and proportion. To determine the relationships between different factors and the CCNs knowledge level of VAP prevention bundles, a bivariate and multivariate binary logistic regression model will be computed, and OR, p value will be reported. A variable with a p value that is equal to or less than 0.05 will be considered significant. Data will be presented using tables, and graphs.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS PRESENTATION AND INTERPRETATION","content":"\u003cdiv id=\"Sec16\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2: Frequency distribution of studied participants according to demographic characteristics (N=67)\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv\u003e\u003cimg 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\"\u003e\u003c/div\u003e\n \u003cp\u003eRegarding the sociodemographic characteristics of the study participants, most of the study participants were aged below 24 years, with 58.2% (N.39), and the mean age of 25.2687. According to gender, the majority were female 53.7% (N.36). Regarding the marital status, the majority were unmarried with 82.6% (N.54), versus married, while the working experience, the majority were having the experience of 2 to 5 years with 56.7% (N.38), On the other hand, the education level, the majority had completed the college/university with 77.6% (N.52). And regarding the place of work, the majority of the participants were working in ACICU, with 85.1% (N.57). Finally, regarding the previously attended training on VAP or IPC, the majority of the participants attended one or both training sessions, with 91% (N.61) \u003cstrong\u003e(\u003c/strong\u003eTable 2\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eVAP knowledge assessment parameters (N\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eWhat is VAP Bundle\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo compliance with the VAP bundle is associated with\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eVAP occurs in a patient who has received mechanical ventilation for\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhich Component is not included in the VAP bundle for the prevention of VAP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhich is the recommended position for a ventilator patient for the prevention of VAP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe head of the bed elevation should range from\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat is the effect of kinetic beds for the prevention of VAP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhich route is best recommended when intubating a patient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow frequently should the ventilator circuit be changed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eA nurse caring for a ventilated patient is required to wash their hands(Frequency)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eIt is recommended to perform Oral care by using a swab moistened with Chlorhexidine 1%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eOne of the components of VAP Bundle is\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly weaning from the ventilator\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat is your opinion regarding respiratory physiotherapy for the prevention of VAP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eContraindications for DVT prophylaxis include\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eRegarding the definition of VAP bundle, the majority of the studied participants answered the question knowledgeably at about 89.6% (N.60). None compliance to VAP bundle the majority answered correctly the question with 85.1% (N.57) and VAP occur in patient with mechanical ventilation for how long in hours, the majority answered correctly with 77.6%(N.52). Regarding the component not included in VAP bundle, the majority of nurses reported correctly with 92.5% (N.62), while the recommended position in degree centigrade for VAP prevention, nurses reported the question correctly with 91% (N.61). About the head of the bed elevation 91% (N.61) answered correctly the question, and on the effect of kinetic bed on VAP prevention, 94% (N.64) answered correctly the question. Regarding the recommended route for intubation, the nurses answered the question with 100% (N.67), while on how frequently the ventilator circuit should be changed, the study participants answered the question correctly with 82.1% (N.55).\u003c/p\u003e\n \u003cp\u003eRegarding how frequently the nurse should wash hands when handling a patient, the nurses answered the question correctly with the proportion of 100%(N.67), while the recommended frequency to perform oral care by using a swab moistened with Chlorhexidine 1% frequency, the participants answered correctly with 73.1%(N.49), and on the identifying the component of VAP, responded correctly the question with 98.5%(N.66). The impact of early weaning from the ventilator, the study participant answered correctly the question with 98.5% (N.67), and if the respiratory physiotherapy for VAP is recommended was answered correctly with 59.75% (N.40), and in addition to this the contraindication for DVT prevention the study participants responded correctly with 64.2%(N.43)\u003cstrong\u003e(\u003c/strong\u003eTable 3\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(4)\u003c/strong\u003e illustrates computed bivariate binary logistic regression analysis of sociodemographic characteristics of the knowledge variables against the overall nurses\u0026rsquo; knowledge level towards VAP prevention bundle and the result showed that there was a significant relationship between the sociodemographic characteristics, nurses\u0026rsquo; knowledge variables, and nurses\u0026rsquo; knowledge level as follows: attending the training session on either VAP or IPC was significantly associated with nurses\u0026rsquo; knowledge with OR:11.556 (C.I:1.837\u0026ndash;72.685) and p value 0.009 compared to those who did not attend the training session. Workplace; working in CCU was significantly associated with knowledge level with OR: 0.050 (C.I:0.010\u0026ndash;0.249) and p value 0.000, compared to working in ACICU. The head of the bed elevation in the prevention of VAP, the correct answer was significant with OR: 8.556(C.I:0.821\u0026ndash;36.019) and p value 0.002 compared to those wrongly answered the question. Kinetic bed effect on VAP prevention, the correctly answered response was associated with nurses\u0026rsquo; knowledge with OR: 15.900 (C.I:1.498-168.716) and p value 0.003 compared to incorrect answer responses. The correct answer about how frequently the ventilator circuit should be changed was significantly associated with knowledge level, with OR: 38.250 (7.300-200.406) and p value 0.000 compared to incorrectly answered questions. And finally, regarding the correctly answered response on the component of VAP, it was significantly associated with nurses\u0026rsquo; knowledge level with OR: 69 (7.849-606.604) and p value 0.000 compared to incorrectly answered questions.\u003c/p\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eRelationship between nurses\u0026apos; demographic characteristics, knowledge variables, against nurses\u0026rsquo; knowledge level regarding VAP prevention bundle (Multivariate logistic regression analysis).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eKnowledge Level\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95%CI.For OR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eP Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSatisfactory knowledge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eUnsatisfactory knowledge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorkplace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eACICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCCU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttended Training on VAP or IPC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow frequently should the ventilator circuit be changed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorrect answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e54 80.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e13 19.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(5).\u003c/strong\u003e Illustrates computed multivariate binary logistic regression analysis of variables statistically significant in the bivariate model with nurses\u0026rsquo; knowledge level towards VAP prevention bundle, and the result showed that there was a significant relationship between the workplace, where working in CCU was significant with OR:0.032(0.01\u0026ndash;0.200) and p value 0.000 compared to working in ACICU. Not attending the training session on VAP or IPC was statistically significant with OR: 0.040 (C.I:0-0.33) and p value 0.003 compared to attending the training session on VAP or IPC. Finally, an incorrect answer on how frequently the ventilator circuit should be changed was significantly associated with the knowledge level, with OR: 0.043 (C.I:0.000-0.660) and P value 0.024.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOn computing the sociodemographic characteristics of the study participants, most of the study participants were aged below 24 years (58.2%), and the mean age of 25.2687. According to gender, the majority were female (53.7%). On the other hand, the education level, the majority had completed the college/university (77.6%), contrary to this study, the results from a study conducted in Nepal on the same topic in adult critical care setting, the mean age was 26.8 years and the majority of the participated nurses had university education and were having the experience of more than one year[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Regarding marital status, the majority were unmarried (82.6%), versus married. Contrary to this study, the results from Egypt, at Mansoura University teaching Hospital, most of the study participants were married, and similarly, the majority were female[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. On the working experience, the majority had experience of 2 to 5 years (56.7%), similarly to this, results were reported in a study conducted in Cairo Military hospital, the work experience, the majority were having between 6 months to 4 years[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRegarding the place of work, the majority of the participants were working in ACICU, with (85.1%). On the previously attended training on VAP or IPC, the majority of the participants attended one or both training sessions, with 91%. In contrast to this, in Nepal, the majority did not attend the above-mentioned training session on VAP[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Regarding the definition of VAP bundle, the majority of the studied participants answered the question knowledgeably at about 89.6%). Non-compliance to the VAP bundle, the majority answered the question correctly (85.1%), and VAP occurs in patients with mechanical ventilation for how long in hours, the majority answered correctly (77.6%). And the component not included in the VAP bundle, the majority of nurses reported correctly (92.5%), similar results were reported in a study conducted in a governmental hospital in Gaza, Palestine [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe recommended position in degrees centigrade for VAP prevention, most nurses reported the question correctly (91%), the head of the bed elevation, most of them (91%) answered the question correctly, and on the effect of kinetic bed on VAP prevention, most nurses (94%) answered correctly. the question. Regarding the recommended route for intubation, the nurses answered the question (100%), while on how frequently the ventilator circuit should be changed, the study participants answered the question correctly (82.1%), Similarly to the study participants on the study conducted in Ethiopia, reported to have sufficient knowledge on the patient position, ventilator circuit change and oropharyngeal intubation[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Regarding how frequently the nurse should wash hands when handling a patient, most of nurses answered the question correctly with the proportion of 100%, while the recommended frequency to perform oral care by using a swab moistened with Chlorhexidine 1% frequency, the participants answered correctly with (73.1%), and on the identifying the component of VAP, most of nurses responded correctly the question (98.5%). The impact of early weaning from the ventilator, the study participant answered correctly the question (98.5%), and if the respiratory physiotherapy for VAP is recommended for VAP prevention, nurses answered correctly at 59.75%, and finally, the contraindication for DVT prevention, most of the study participants responded correctly (64.2%), similarly results was found in a study conducted in Gaza, Palestine and Spain on the same variables used in the assessment of nurses\u0026rsquo; VAP knowledge level[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In Spain, the most reported component of the ventilator bundle was head-of-bed elevation, followed by oral care[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. And finally to what was reported in the Philippines, knowledge regarding specific components of VAP prevention is lacking[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBy computing the overall knowledge level of nurses towards VAP prevention bundle; The majority of the evaluated nurses (80.6%) had a satisfactory knowledge level(61\u0026ndash;100%) regarding the VAP bundle, similar to the study conducted in Nepal, the study participants had satisfactory knowledge towards VAP bundle prevention at around 97.4%%[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. And in another study conducted in Cairo University Hospital in Egypt, the nurses\u0026rsquo; knowledge level was good in at around 52.4% of the overall knowledge score[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Contrary to this, a study conducted in Egypt at Mansoura University teaching hospital, where the study participants reported having poor knowledge level towards the VAP bundle at around 90% of the study participants[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].And in another study conducted in Egypt in a Governmental hospital, In Egypt, the results of 20- items questionnaire revealed unsatisfactory knowledge scores (mean 7.46\u0026thinsp;+\u0026thinsp;2.37), and most of the nurses were not compliant with ventilator-associated pneumonia bundle practices (average mean\u0026thinsp;=\u0026thinsp;8.62\u0026thinsp;+\u0026thinsp;7.9 out of 29)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Ethiopia, the overall knowledge of nurses on VAP evidence-based guidelines was inadequate[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. And in another study conducted in Palestine, the nurses\u0026rsquo; knowledge was moderate on the VAP prevention bundle[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. While the results from the study conducted in the neonatal intensive care Unit at Port Said University reported insufficient knowledge of nurses towards VAP bundle[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. And another study conducted in Saudi Arabia, at King Fahad general hospital, revealed that the nurses' overall knowledge towards VAP bundle was insignificant, which was reported to be a big concern[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. And finally, in Sri Lanka, the majority of nurses reported having insufficient knowledge of the VAP prevention bundle[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. While in Rwanda, only 9.7% self-reported and 13.3% observed participants demonstrated acceptable levels of adherence to the ventilator-associated pneumonia prevention bundle[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eComputed multivariate binary logistic regression analysis of sociodemographic characteristics variables against the overall nurses\u0026rsquo; knowledge level towards VAP prevention bundle showed that there was a significant relationship between the sociodemographic characteristics, and nurses\u0026rsquo; knowledge level as follows: There was a significant relationship between the workplace and nurses\u0026rsquo; knowledge level, where working in CCU was significant with OR:0.032(C.I:0.01\u0026ndash;0.200) and p value 0.000 compared to working in ACICU, similarly to this study, the results from the study conducted in China, reported that the work place like ICU was significantly associated with VAP bundle knowledge, in addition to this had attended the VAP training also was significantly associated with nurses\u0026rsquo; knowledge on VAP bundle[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Contrary to this, a study conducted in KSA, revealed that there was a significant relationship between nurses' knowledge and age, experience in nursing, and having training on the VAP bundle[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In addition to this, the reported results in a study conducted in a governmental hospital in Gaza, Palestine, the age, gender, and work experience were statistically significantly associated with critical care nurses\u0026rsquo; knowledge[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. And in another study conducted in Saudi Arabia, revealed that the nurses\u0026rsquo; knowledge was associated with nationality, level of education, and work experience among critical care nurses[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNot attending the training session on VAP or IPC was statistically significant with OR:0.040 ( C.I:0-0.33) and p value 0.003 compared to attending the training session on VAP or IPC, Similarly results was reported in a study conducted in Benha University hospital in Egypt, where the results showed that, attending VAP prevention bundle training was statistically associated with nurses\u0026rsquo; knowledge on VAP bundle compared to those who did not attend the training[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Finally, on the evaluating the association between the knowledge variables and nurses\u0026rsquo; knowledge level; how frequently the ventilator circuit should be changed was significantly associated with the knowledge level, with OR: 0.043 (C.I:0.000-0.660) and P value 0.024, contrary to this study, the results from a conducted at Port Said University hospital, they reported no significant association between the nurses\u0026rsquo; knowledge level and other parameters involved in the assessment of evaluating knowledge[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Whereby, in another study conducted in Finland, quite similar results to this study, a systematic analysis was conducted, the results showed that the factor associated with VAP prevention bundle were the head of the bed elevation and oral care[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e"},{"header":"CONCLUSION AND RECOMMENDATIONS","content":"\u003ch2\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eOn sociodemographic characteristics of the cardiac critical care nurses who participated in this study, the results showed that the majority were single females and had an age below 24 years old, with a mean age of 25 years old, who attended university/college. And most of them had the work experience of about 2 to 5 years working in ACICU, and also had attended VAP/IPC training course or both. The overall nurses\u0026rsquo; knowledge level towards VAP was satisfactory, especially to those working in ACICU. And finally, to the factors associated with nurses\u0026rsquo; VAP knowledge level: workplace, having attended or not VAP/IPC training, and changing ventilator circuit frequency were statistically significant in multivariate binary logistic regression analysis.\u003c/p\u003e\n\u003ch2 id=\"_Toc209434257\"\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eIt is therefore recommended that nurses working in cardiac critical care areas, as it is very sensitive to determining the outcome of post-operative patients, nurses working in those areas should keep updating their knowledge on VAP prevention bundle and IPC in general, and be aware of VAP prevention methods for further improving the quality of care and outcome of patients admitted there.\u003c/p\u003e"},{"header":"Study limitations","content":"\u003cp\u003eThis study was conducted in one cardiac center in Egypt; therefore, the results generated may not represent the whole of Egypt towards the cardiac critical care nurses\u0026rsquo; VAP knowledge level and its associated factors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACICU: Adult cardiac Intensive care Unit; CCU: Cardiac care Unit; VAP: Ventilator Associated pneumonia; IPC: Infection Prevention and control; OR: odds ratio; C.I: Confidence interval; INICC: International Nosocomial Infection Control Consortium; EBP: Evidence-based Practice\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003ch3 style=\"text-align: left;\"\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/h3\u003e\n\u003cp style=\"text-align: left;\"\u003eThe research team is thankful to the help provided by Madgy Yacoub foundation-Aswan Heart Centre management, its education department, and most importantly, our gratitude goes to the nurses who participated in this research for their efforts and willingness.\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003eAuthor affiliation\u003c/strong\u003e\u003c/p\u003e\n\u003cp dir=\"RTL\" style=\"text-align: left;\"\u003e\u003csup\u003e1\u003c/sup\u003eBritish University in Egypt, Faculty of Nursing, Cairo, Egypt\u0026nbsp;\u003c/p\u003e\n\u003cp dir=\"RTL\" style=\"text-align: left;\"\u003e\u003csup\u003e2\u003c/sup\u003eMagdy-Yacoub Foundation, Aswan Heart Center, Aswan, Egypt\u003c/p\u003e\n\u003cp dir=\"RTL\" style=\"text-align: left;\"\u003e\u003csup\u003e3\u003c/sup\u003eThe Heart Care and Research Foundation, Rwanda- Egypt Heart Centre, Kigali, Rwanda\u003c/p\u003e\n\u003cp dir=\"RTL\" style=\"text-align: left;\"\u003e\u003csup\u003e4\u003c/sup\u003eUniversity of Rwanda, School of Nursing and Midwifery, Huye Campus, Rwanda\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003eIM, MF\u0026nbsp;\u003c/strong\u003econtributed to the study conception, design, data collection, data analysis, and manuscript refinement.\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003eMIIK, MEK, JU, JRVM, JBM, AU\u003c/strong\u003e, and\u0026nbsp;\u003cstrong\u003eMMMA\u003c/strong\u003e contributed to the data collection, data analysis, and manuscript refinement.\u003c/p\u003e\n\u003cp id=\"_Toc209434260\" style=\"text-align: left;\"\u003e\u003cstrong\u003eDeclarations\u003c/strong\u003e\u003c/p\u003e\n\u003ch2 style=\"text-align: left;\"\u003e\u003cstrong\u003eConflict of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einterest\u003c/strong\u003e\u003c/h2\u003e\n\u003cp style=\"text-align: left;\"\u003eThe authors declare no conflict of interest\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003eEthical Approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003eEthical approval to conduct the study was granted by the British University in Egypt (BUE) Institutional Review Board (IRB) with the reference number: P.015, and permission to collect data was granted by the Aswan Heart Centre- Magdy Yacoub Foundation administration. Participants` privacy and confidentiality were considered by using patient codes instead of names. Privacy during data collection was ensured by identifying the private area before starting data collection. Filled questionnaires were kept in a closed cupboard to maintain confidentiality. The data was stored electronically, and password-locked file software was used according to the BUE IRB rules and regulations regarding research projects. This research involved human subjects and therefore followed the Declaration of Helsinki for research involving human subjects. All research participants were explicitly informed in detail about the objective and benefits of the study, and they consented verbally after asking questions and getting answers. Finally, the study participants signed a consent form before participating in the research. The individuals volunteered to participate in the study, and they were free to withdraw at any time without penalty. The use of participant numbers rather than names protected the participants\u0026apos; privacy and confidentiality. There was no risk in participating in this research. Collected data were stored in a password-protected computer, computer was only accessed by the research team; nobody else had access to that computer. The data was entered into a computer protected with a personal computer password.\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003eNot Applicable\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003eNot applicable\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: left;\"\u003eAll data relevant to this study are included in the article\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEl-Kass SM, Alruwili HA, Alrowily MA, Ellayan OM, El-Kass LM, Hijo EE, et al. Critical Care Nurses\u0026rsquo; Knowledge on Prevention of Ventilator-associated Pneumonia: A Cross-sectional Study. Indian J Crit Care Med. 2024;28(12):1122\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eHellyer TP, Ewan V, Wilson P, Simpson AJ. The Intensive Care Society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. J Intensive Care Soc. 2016;17(3):238\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eAziz Z, Kausar S, Zahid S, Farooqi S, Aziz Z, Ahmad RA. Knowledge and practice of ventilator care bundle for preventing ventilator associated pneumonia by ICU nurses of tertiary care hospitals of Lahore. Anaesthesia, Pain Intensive Care. 2020;24(4):426\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eAlreshidi MS, AlRashidi FA, Tuppal CP, Prudencio DAM, Alrashidi N, Villagracia RWA, et al. Nurses\u0026rsquo; Knowledge on the Prevention of Ventilator-Associated Pneumonia (VAP) among Critically Ill Patients. Nurse Media J Nurs. 2024;14(1):65\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eAboul-fotouh AM, Megahed LA mawala, Elnakib MM, Madany MH, Abd H, Abd E haleem A. Assessment of nurses \u0026rsquo; knowledge and compliance to evidence based guidelines regarding bundle of ventilator associated pneumonia in a military hospital. 2022; \u003c/li\u003e\n\u003cli\u003eLadbrook E, Bouchoucha SL, Hutchinson A. Lessons learned from a rapid implementation of a ventilator-associated pneumonia prevention bundle. J Infect Prev. 2019;20(6):274\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eAlkhazali MN, Bayraktar N, Al-Mugheed KA. Knowledge and Barriers of Critical Care Nurses Regarding Evidence-Based Practices in Ventilator-Associated Pneumonia Prevention. Cyprus J Med Sci. 2021;6(3):185\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eWeheida SM, Omran ES, Taha AS. Effect of Designed Bundle Protocol about Ventilator Associated Pneumonia on Nurses\u0026rsquo; Performance, Compliance, and Patient Outcomes. Evidence-Based Nurs Res. 2022;4(3):71\u0026ndash;85. \u003c/li\u003e\n\u003cli\u003eAhmad Al-Nawaja\u0026rsquo;a I, Salameh B, Toqan D, Hammad BM, Fashafsheh I. Assessing Critical Care Nurse\u0026rsquo;s Knowledge and Adherence to Evidence-Base Guidelines for Ventilator-Associated Pneumonia Prevention in Palestinian Hospitals. Nurs Res Pract [Internet]. 2024;2024:1434479. Available from: http://www.ncbi.nlm.nih.gov/pubmed/39758455%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC11698611\u003c/li\u003e\n\u003cli\u003eAbdelazeem E, Fashafsheh I, Fadllalah H. Effect of Training Program on Nurses Knowledge and Competence Regarding Endotracheal Tube and Tracheostomy Care in Mechanically Ventilated Patients. Int J Nurs. 2019;6(1). \u003c/li\u003e\n\u003cli\u003eSetia MS. MODULE ON BIOSTATISTICS AND RESEARCH METHODOLOGY FOR THE DERMATOLOGIST. Indian J Dermatol [Internet]. 2016;61(3):261\u0026ndash;4. Available from: http://www.e-ijd.org\u003c/li\u003e\n\u003cli\u003eBhandari S, Medha S, Gentle S. Knowledge of Nurses Working in Critical Care Areas Regarding Ventilator Associated Pneumonia Prevention Bundles in a Tertiary Level Cardiac Centre. J Inst Med Nepal [Internet]. 2021;43(1):36\u0026ndash;42. Available from: www.jiomnepal.com.np\u003c/li\u003e\n\u003cli\u003eGerida AA, Youssef O, Abdelraouf E sheikh E, Abdallah A. Nurses \u0026rsquo; knowledge and Performance regarding Infection Preventive Measures for Ventilators Associated Pneumonia. 2022;9(2):291\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eMartinez-reviejo R, Tejada S, Jansson M, Ruiz-spinelli A, Ramirez-estrada S, Ege D, et al. Prevention of ventilator-associated pneumonia through care bundles : A systematic review and meta-analysis. J Intensive Med [Internet]. 2023;3(4):352\u0026ndash;64. Available from: https://doi.org/10.1016/j.jointm.2023.04.004\u003c/li\u003e\n\u003cli\u003eZones WG, Misganaw A, Ayenew NT. Intensive care unit nurses \u0026rsquo; knowledge and compliance with ventilator associated pneumonia bundle at a resource limited setting in East Gojam and West Gojam Zones , Ethiopia . a cross-sectional. 2025;(April). \u003c/li\u003e\n\u003cli\u003eMartinez-Reviejo R, Tejada S, Jansson M, Ruiz-Spinelli A, Ramirez-Estrada S, Ege D, et al. Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis. J Intensive Med [Internet]. 2023;3(4):352\u0026ndash;64. Available from: https://doi.org/10.1016/j.jointm.2023.04.004\u003c/li\u003e\n\u003cli\u003eAbad CL, Formalejo CP, Mantaring DML. Assessment of knowledge and implementation practices of the ventilator acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital. Antimicrob Resist Infect Control [Internet]. 2021;10(1):1\u0026ndash;6. Available from: https://doi.org/10.1186/s13756-021-01027-1\u003c/li\u003e\n\u003cli\u003eAlqaissi N, Qtait M. Knowledge and Practices of Intensive Care Unit Nurses Related to Prevention of Ventilator-Associated Pneumonia Cross-Sectional Study. 2025; \u003c/li\u003e\n\u003cli\u003eAbd El-Sattar El-Sayed El-Sayed S, Amal Ahmed Khalil P, Rehab Hanie EL-kazaz A. Assessment of Nurses\u0026rsquo; Knowledge and Practice Regarding Prevention of Ventilator Associated Pneumonia In Neonates. Port Said Sci J Nurs. 2023;10(3):207\u0026ndash;35. \u003c/li\u003e\n\u003cli\u003eBarnawi FAJ, Barnawi Y, Al-Modallal H. Enhancing Patient Safety: Assessing ICU Nurses\u0026rsquo; Knowledge and Compliance in Ventilator-Associated Pneumonia Prevention at King Fahad General Hospital, Saudi Arabia. Saudi J Nurs Heal Care. 2025;8(01):20\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eMuralitharan P., Seneviratne S.M.K.S. Knowledge Regarding Ventilator-associated Pneumonia and its Prevention Among Nurses Working at Intensive Care Units of Two Teaching Hospitals in Sri Lanka. J Heal Sci Innov Res. 2022;3(01):28\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003eRuririmbwa E, Bhengu BR, Teshome GS. Assessing Measures for Preventing Ventilator Associated Pneumonia among Nurses Working in Intensive Care Units : A Case of Two Selected Referral and Teaching Hospitals in Kigali. 2025;1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eLi X, Zhang X, Feng Y, Yao Z, Sun Y, Zhang L, et al. of nurses in ICU on preventing ventilator-associated pneumonia : a cross-sectional study in Gansu. 2025;(July):1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eAlhamad N, Elsayed W. Nursing Knowledge and Preventive Practices of Ventilator-Associated Pneumonia as Perceived by Intensive Care Nurses in Hail City, KSA. Evidence-Based Nurs Res. 2024;6(4):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eMohmmad A, Bokhary H, Salem AH, Al-Qahtani FM. Critical Care Nurses\u0026rsquo; Knowledge Regarding Evidence-Based Guidelines for Preventing of Ventilator-Associated Pneumonia in the Intensive Care Units: A cross-sectional study. Int J Healthc Sci [Internet]. 2021;9(2):139\u0026ndash;49. Available from: www.researchpublish.com\u003c/li\u003e\n\u003cli\u003eMartinez-reviejo R, Tejada S, Jansson M, Ruiz-spinelli A, Ramirez-estrada S, Ege D, et al. Prevention of ventilator-associated pneumonia through care bundles : A systematic review and meta-analysis. 2023;3(March):352\u0026ndash;64. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nurses, Knowledge, Ventilator-associated pneumonia, Bundle, Adult Cardiac Care Units","lastPublishedDoi":"10.21203/rs.3.rs-7696169/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7696169/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eVentilator-associated pneumonia is the most serious acquired infection in intensive care units for patients undergoing mechanical ventilation following urinary tract infections. The mortality associated with VAP ranges from 20% to 50%, and the attributable mortality is estimated at 13%. And the knowledge of nurses working in critical areas regarding the VAP prevention bundle is not well established. This study determined the knowledge level of the VAP bundle among nurses working in cardiac critical areas.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study design with a quantitative approach was used. A convenient sampling method was used in selecting study participants and was conducted in the adult cardiac intensive care unit and the Cardiac care unit. Participation was voluntary, and a sample of 67 nurses was selected. A structured questionnaire was used in data collection, and SPSS version 21 was used in data analysis. The data was collected in the first week of September 2025.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eRegarding the sociodemographic characteristics of the study participants, most of the study participants were aged below 24 years (58.2%), and the mean age of 25.2687. The majority of the participants were working in ACICU (85.1%). The Overall knowledge level, about 80.6% of the studied subjects had a satisfactory knowledge level (61\u0026ndash;100% score). Computed multivariate binary logistic regression analysis, the result showed a significant relationship between the workplace, not attending the VAP or IPC training and frequency of ventilator circuit change were statistically significant with nurses\u0026rsquo; VAP knowledge level with OR: 0.032 (C.I:0.01\u0026ndash;0.200), p value 0.000; OR: 0.040(C.I:0-0.33), p value 0.003, and OR: 0.043 (C.I:0.000-0.660), P value 0.024 respectively\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe overall nurses\u0026rsquo; knowledge level towards VAP was satisfactory, especially for those working in ACICU. And the factors associated with nurses\u0026rsquo; VAP knowledge level, workplace, having attended or not VAP/IPC training, and changing ventilator circuit frequency were statistically significant.\u003c/p\u003e","manuscriptTitle":"Nurses’ Knowledge Regarding Ventilator-Associated Pneumonia Prevention Bundle in Adult Cardiac Care Unit- A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-01 08:13:14","doi":"10.21203/rs.3.rs-7696169/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8a58c97c-0b25-41b4-9a7c-a8437de40a88","owner":[],"postedDate":"October 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-10T10:54:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-01 08:13:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7696169","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7696169","identity":"rs-7696169","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}