Evidence-Based Nursing to Reduce Adverse Events Regarding Ventilator Associated Pneumonia, Pressure Injuries and Central Line Bloodstream Infection in Intensive Care Unit in Bangladesh (EBP in Nursing)

Evidence-Based Nursing to Reduce Adverse Events Regarding Ventilator Associated Pneumonia, Pressure Injuries and Central Line Bloodstream Infection in Intensive Care Unit: A Quasi-experimental Study in Bangladesh

Quality of care is crucial for preventing adverse events such as infection in the intensive care units (ICUs). The most common ICU-acquired infections include pneumonia such as Ventilator Associated Pneumonia (VAP), Pressure Ulcer (PU), Medical Device Related Pressure Ulcer (MDRPU), and Central Line-Associated Bloodstream Infection (CLABSI). VAP, PU, and MDRPU are significant indicators of the quality of care, while CLABSI is a critical marker of healthcare quality in ICUs, as it is largely preventable through strict adherence to infection control protocols.

VAP is a lung infection that occurs in patients receiving mechanical ventilation for more than 48 hours. A PU is defined as localized damage to the skin or underlying tissue caused solely by pressure, while MDRPUs may also result from friction or pressure from medical devices or other objects. CLABSI is a severe infection caused by improperly inserted or maintained central venous catheters, which underscores the need for stringent catheter management protocols.

Study Overview

• Status: Not yet recruiting
• Conditions: Ventilator Acquired Pneumonia; Central Line Associated Blood Stream Infections (CLABSI); Pressure Ulcer (PU); Medical Device Related Pressure Ulcer (MDRPU)
• Intervention / Treatment: Behavioral: Education with EBP; Behavioral: This is a pre- and post- quasi-experimental study.

Detailed Description

General Objective:

The objective of this study is to evaluate whether implementing EBP and changing nurses' competency (skill, knowledge, practice, and attitude) can reduce ICU adverse events such as VAP, PU, MDRPU, and CLABSI, and improve patient outcomes.

Specific Objectives:

1. To identify insights on perceptions, barriers, and facilitators related to EBP implementation in the ICU setting.
2. To evaluate the effect of EBP training on nurses' competency (skill, knowledge, practice, and attitude) regarding EBP for CLABSI, PU, and MDRPU in an ICU setting.
3. To evaluate the effects of EBP on ICU patient incidence rates of VAP, CLABSI, PU, and MDRPU.

Hypothesis:

H1- Hypothesize that training on EBP and its implementation in ICU settings will improve nurses' competency (Skill, knowledge, practice and attitude).

H2- Hypothesize that implementation of EBP by trained ICU nurses will reduce adverse events-such as VAP, pressure ulcers, medical device-related PU, and CLABSIs-and improve overall patient outcomes.

These research consist of two studies:

1. Evaluating the effect of EBP training on ICU nurses' competency (skill, knowledge, practice, and attitude) regarding EBP for CLABSI, PU, and MDRPU in an ICU setting.

   A pre- and post-quasi-experimental study will be conducted over a 16-month period, with a total data collection period of 6 months, to evaluate nurses' competency. The study consists of a recruitment period (1 month), nurses' baseline data collection (1 month), nurses' EBP training with midline data collection (2 months), and nurses' endline data collection during EBP implementation (2 months).

   Study nurses will receive EBP training and appropriate equipment for patient management. EBP education and training will be provided with necessary equipment, such as a closed suction catheter, an endotracheal tube, a suction device, and a mouth care brush. In this study, global standard equipment will be used to ensure patient safety.

2. Evaluating the effect of EBP implementation on ICU patient incidence rates of VAP, CLABSI, PU, and MDRPU.

A pre- and post-quasi-experimental design with a non-equivalent control group (Study 1, Phase 1 data used as historical data) will be applied by comparing the rate of adverse events such as VAP, CLABSI, PU, and MDRPU before and after the EBP intervention (2-month baseline data and 2-month intervention data will be collected).

• Study Type: Interventional
• Enrollment (Estimated): 272
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nahida Akhter, Ph. D Fellow; Phone Number: +8801925478065; Email: nahida1789@gmail.com
• Study Contact Backup: Name: Moriyama Michiko, Ph.D; Phone Number: +81-82-257-5367; Email: morimich@hiroshima-u.ac.jp

Study Locations

• Bangladesh
  • Dhaka Division
    • Dhaka, Dhaka Division, Bangladesh
      • Dhaka Medical College Hospital
      • Contact: Nahida Akhter, PhD Fellow; Phone Number: +88-01925478065; Email: nahida1789@gmail.com
• Japan
  • Hiroshima City
    • Hiroshima, Hiroshima City, Japan, 7348551
      • Hiroshima University
      • Contact: Moriyama Michiko, PhD; Phone Number: +81-82-257-5367; Email: morimich@hiroshima-u.ac.jp

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Trial 1 & 2-

Inclusion Criteria:

Nurse

• who is a registered nurse in Bangladesh.
• who agrees to participate in this study and the EBP training.
• who will stay at the ICU for 6 months. Patient
• Irrespective of age and sex, participants must be at least 18 years old
• Legal guardian of a patient consent to participation in the study

Exclusion Criteria:

Nurse

• Who will not directly involve patient care in ICU. Patient
• No exclusion criteria

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Experimental: Trial 1: All Nurses in GICU; Trial 2: All patients admitted in the general GICU; Nurses: All nurses who work at GICU of DMCH Patients: all patients who will admit at the assigned GICU during the study period of DMCH

Behavioral: Education with EBP; Trial 1: Nurse's EBP training ( VAP, PU, MDRPU, CLABSI management), online lecture, 2 hours lecture and 3 hours skill training for nurses training. Trail 1 we use advanced equipment necessary for EBP implementation for VAP, PU, MDRPU and CLABSI management, and EBP-trained nurses implementation for all this management.; Behavioral: This is a pre- and post- quasi-experimental study.; We will use advanced equipment and implement EBP (VAP, PU, MDRPU and CLABSI management) for patients by trained nurses and check the outcome of the patients. We will compare pre and post findings for this study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The nurse's skill related to the PU, MDRPU and CLABSI total score measured by the researcher-developed checklist	1. The nurse's skill and knowledge related to the PU, MDRPU and CLABSI checklist. Researcher developed checklist, 50 items with 0: not correct/did not do, 1: partially correct, 2: correct. Score range 0-114.	6 month data collection and total time frame of this study 16 months
Incidence rates of PU, MDRPU and CLABSI.	The incidence rate of PU was calculated as the number of newly developed pressure ulcers after hospitalization per 1000 person-days at risk. The incidence rate of MDRPU was calculated as the number of newly developed MDRPU cases per 1000 patients assessed. The incidence rate of CLABSI was calculated as the number of CLABSI cases per 1000 central line-days. Data will be collected: Patients' demographic data (age, sex, occupation etc.) Medical past and current history (diagnosis, treatment, medication, hospitalization). Reasons and date to be admitted to ICU. Treatment in ICU. Daily laboratory data taken in ICU. Daily biological data including vital signs. Results of patients' stay during ICU. Diagnosis of PU, MDRPU and CLABSI included of this list.	2 month for data collection and total time frame 16 months.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nurses' knowledge, Attitude and Practice (KAP) related to the PU, MDRPU and CLABSI prevention measured by the researcher-developed scale based on Knowledge of EBP guidelines for the PU, MDRPU and CLABSI prevention scale	Nurses attitude, practice and knowledge related PU, MDPU and CLABSI related prevention scale. The researcher makes an attitude, practice and knowledge related of EBP guideline for PU, MDPU and CLABSI question Total item 22 and validity was tested by ICU and PU specialized nurses in Japan. Knowledge was assessed using multiple-choice questions, with one correct answer among four options. Each correct response was awarded a score of 1, and incorrect or "don't know" responses were scored 0. Attitude and practice were measured using a Likert scale, with responses indicating the degree of agreement or frequency.	Total data collection time 6 months within 16 months
Rate (number of patients) of each stage of PU and MDRPU	After diagnosis of sore we measured stage of PU and MDRPU. Number of ICU patients developing PU and MDRPU categorized by stage (Stage I-IV). Unit of Measure: Number of patients per PU/MDRPU stage.	Total 2 months
Micro-organism link to CLABSI	After diagnosis of CLABSI then identify what kind organism relate to CLABSI. Type and frequency of microorganisms identified in laboratory-confirmed CLABSI cases. Unit of Measure: Number of cases per microorganism.	2 months
Incidence and rate of VAP	Incidence rate of VAP per 1000 ventilator days. Unit of Measure: VAP cases per 1,000 ventilator days	2 months
Mortality and morbidity rate of adverse events	Mortality and morbidity rate of ICU patients All-cause mortality among ICU patients during the study period. Unit of Measure: Percentage (%)。Occurrence of ICU-related adverse events (VAP, CLABSI, PU, MDRPU). Unit of Measure: Number of patients with adverse events.	2 months
Average length of stay ICU patients	Average length of stay ICU patients. Mean length of stay in the intensive care unit for enrolled patients. Unit of Measure: Days (mean ± SD).	2 months
Survival rate of ICU	Average survival rate of ICU. Data will be collected: Length of stay and survival rate. Proportion of enrolled patients alive at ICU discharge. Unit of Measure: Percentage (%) of patients surviving to ICU discharge.	2 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
APACHE II score	Will be collected from patient record file. Sum Acute Physiology Points + Age Points + Chronic Health Points = APACHE II total (range 0-71). APACHE II total score (integer). Optionally report distribution (mean ± SD) or stratify by score ranges.	2 months
SOFA score	Will be collected from patient record file. Sum Acute Physiology Points + Age Points + Chronic Health Points = APACHE II total (range 0-71). APACHE II total score (integer). Optionally report distribution (mean ± SD) or stratify by score ranges. Use worst values within first 24 h for baseline SOFA. For organ-dysfunction trajectory, compute daily SOFA scores。Sum component scores → SOFA total (0-24). SOFA total score (integer). Can also report number/proportion with increase ≥2 points.	2 months
GCS score	Total GCS = E + V + M (range 3-15). Record at ICU admission (worst value in first 24 h for scoring systems). Note if patient is sedated or intubated - document sedation/intubation; if intubated, record "V = T" and use local protocol for scoring (some protocols assign V=1 or use best pre-sedation score). Unit / reporting: GCS total (3-15). Report component scores if relevant.	2 months

Collaborators and Investigators

• Sponsor: Hiroshima University

Study record dates

Study Major Dates

• Study Start (Estimated): February 15, 2026
• Primary Completion (Estimated): May 30, 2026
• Study Completion (Estimated): May 30, 2026

Study Registration Dates

• First Submitted: November 23, 2025
• First Submitted That Met QC Criteria: December 17, 2025
• First Posted (Actual): December 23, 2025

Study Record Updates

• Last Update Posted (Actual): February 11, 2026
• Last Update Submitted That Met QC Criteria: February 10, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Ventilator Associated Pneumonia; Pressure Ulcer; evidence based practice; Nurses competency; Central Line Bloodstream Infection; Medical Device Related Pressure Ulcer
• Additional Relevant MeSH Terms: Healthcare-Associated Pneumonia; Pathologic Processes; Disease Attributes; Respiratory Tract Infections; Infections; Respiratory Tract Diseases; Lung Diseases; Skin Diseases; Pneumonia; Skin Ulcer; Cross Infection; Iatrogenic Disease; Pathological Conditions, Signs and Symptoms; Skin and Connective Tissue Diseases; Pneumonia, Ventilator-Associated; Pressure Ulcer; Socioeconomic Factors; Population Characteristics; Educational Status
• Other Study ID Numbers: BMRC/NREC/2025-2027/313; 24K02733 (Registry Identifier: Japan Society for the Promotion of Science (JSPS)); 65313072025 (Registry Identifier: BMRC (Bangladesh Medical Research Council))

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: IPD will not be share due to personal confidentiality of the participants. When the data will be available and we will share the data according to the recommendations of the clinical trial registration and the requests of the journals.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No