Effects of the WHAPO-CRE Clinical Nursing Practice Guideline among Intubated Patients

  • supaporn sripanom Faculty of Nursing, KhonKaen University
  • Donwiwat Saensom Faculty of Nursing, KhonKaen University
Keywords: clinical nursing practice guideline (WHAPO-CRE CNPG), carbapenem-resistant enterobacteriaceae (CRE), ventilator-associated pneumonia


This non randomized controlled trial aimed to evaluate the effects of the WHAPO-CRE Clinical Nursing Practice Guideline (WHAPO-CRE CNPG) among intubated patients. Two groups of participants were purposively selected for the study including 1) 112 intubated patients with mechanical ventilation which were equally divided into experimental and comparison groups and 2) 43 registered nurses caring for intubated patients at the RCU and MICU-LT units of Maharat Hospital. Research tools consisted of the WHAPO-CRE CNPG, CRE risk assessment form, VAP-CRE monitoring form, nurse ’s competency in CNPG assessment form, CNPG adherence form and CNPG satisfaction form. Descriptive statistics were used to summarized data to yield frequencies, percentages, mean and standard deviation. Cox proportional hazard regressions were used to estimate risks of developing VAP-CRE Results showed that both experimental and comparison group patients did not develop early-onset VAP-CRE. Comparison group patients developed late-onset VAP-CRE incidence 9.68/1,000 ventilator-day compared among experimental group patients incidence 3.21/1,000 ventilator-day. Comparison groups patients were 2.59 times more likely to develop late-onset VAP-CRE (Crude HR=2.59, 95% CI: 0.27-24.91). Moreover, nurses implementing the CNPG demonstrated high level of competency with 91.42% accuracy in using WHAPO-CNPG and 83.33%
accuracy in using CRE-CNPG. They also reported high level of WHAPO-CNPG adherence (91.8%) and CRE-CNPG
adherence (83.33%). Lastly, nurses were highly satisfied with the WHAPO-CRE CNPG (82.32%). Results from
this study indicated that the WHAPO-CRE CNPG was effective in reducing VAP-CRE incidence and showed
feasibility to be used in actual clinical settings.


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