Development Of Nursing Practice Guidelines To Prevent Drug-Resistant Infections In Patients With Ventilators in Medical Intensive Care Unit 3, Roi Et Hospital

Abstract

Purposes: To develop and evaluate the effectiveness of nursing practice guidelines for preventing multidrug-resistant infections in mechanically ventilated patients at Medical Intensive MICU3, Roi Et Hospital.

Study design: Research and Development (R&D) applying the Evidence-Based Practice model (Soukup, 2000).

Materials and Methods: The sample consisted of nursing personnel and mechanically ventilated patients in Medical Intensive MICU3. The research was conducted in 4 phases: 1) Preparation phase to study the situation and review literature, 2) Development phase through focus group discussions to adapt WHAPO-MDR-CRE CNPG guidelines to the unit’s context, 3) Implementation phase involving the trial of guidelines combined with observation and supervision, and 4) Evaluation phase. Research instruments included the developed nursing practice guidelines, an observation form for clinical practice, and a satisfaction questionnaire.

Main finding: The study found that after implementing the developed guidelines, nursing personnel’s practices for preventing VAP-MDR-CRE were more accurate than before the implementation. This is evidenced by the data following the implementation from April to June 2025, where the infection rates among mechanically ventilated patients were 12.3, 8.47, and 4.00, respectively. Additionally, nursing personnel reported a high level of satisfaction with the developed guidelines, citing that they were clear, easy to understand, and capable of solving immediate problems within the unit's context, such as adjusting oral care methods for unconscious patients.

Conclusion and Recommendations: Developing guidelines through a participatory process helps build staff confidence and leads to sustainable practice. Recommendations include continuous clinical supervision, monitoring, the use of visual symbols (signage), and expanding the implementation of these guidelines to other critical care units to enhance the overall standard of care for mechanically ventilated patients across the hospital.