1.1 Background information

Ventilator-associated pneumonia (VAP) is among of the most common health care challenges in the intensive care unit (ICU), and is associated with significant morbidity and mortality Between 10-20% of patients ventilated for duration of over 48 hours develop VAP(1) . It is associated with increased duration of being mechanically ventilated, increased number of days patients are admitted in the hospital and higher hospital charges(2). There are several published studies with guidelines that summarize effective interventions and infection control practices and provide recommendations to prevent VAP. Some of these guidelines are now close to 10 years old and fail to include more recent evidence(3). Some recommendations are inconsistent across these guidelines. However, despite these guidelines, many patients do not receive the recommended interventions as translation of evidence into practice remains as a big challenge. Effective strategies to increase adherence to the guidelines and reduce related public health consequences associated with VAP are paramount. The use of guidelines improves process reliability and clinical outcomes(4). Implementation of designed guidelines to improve care for mechanically ventilated patients has been associated with significant reductions in VAP rates. Nevertheless, the specific care processes included in these guidelines vary, and the approach to use these
guidelines in Tanzania has never been much successfully (5). Furthermore, the most widely used guidelines was originally developed to reduce various complications associated with mechanical ventilation, not just VAP. As a result, concerns exist regarding the internal validity of these guidelines and their use as potential quality indicator for reducing VAP rates. The purpose of this study was to assess the knowledge and attitudes on prevention of ventilator associated pneumonia among clinical attending students at the Catholic University of Health and Allied Sciences, Mwanza, Tanzania.

1.2 Problem statement

Ventilator-associated pneumonia (VAP) is among of the most known infections acquired in the intensive care units as it accounts 6-68% incidence, and a high morbidity-mortality rate and an increase in healthcare costs (5). VAP is a problem in ICU and leads to increased morbidity and mortality rates on mechanically ventilated patients. It is among the most common infectious complication among patients admitted to ICU. When VAP occurs, it prolongs the ICU days of stay and risk of deaths in ICUs. VAP is also associated with an increased duration of mechanical ventilation and increased health care costs due to an increased ICU and hospital length of stay. VAP prolongs the length of stay by up to almost two months, and increase the duration of mechanical ventilation by 5 to 7 days which generates extra cost of care (2). Since ventilator support is directly related to critical care and its outcomes, improvements in ventilator support is required to be understood in order to improve Emergency and Critical Care. Although VAP is a serious problem found in ICU in underdeveloped countries, the exact magnitude as well as intensity in developing countries is not clear, it is therefore reasonable exploring the situation. This study was assessing the attitude and how much undergraduate clinical students at Catholic University of Health and Allied Sciences are knowledgeable on the ways of preventing ventilator associated pneumonia in patients, according to their clinical experience as they are going to be given the trust to be future ICU medical; personnel in the health care system.

1.3 Rationale of the study

The results obtained by this study will help the health sectors to identify the magnitude and outcomes of ventilator associated pneumonia at Bugando medical Centre Hospital, Tanzania and information will be used in health education programs for prevention of Ventilator associated pneumonia.

1.4 Research question

What is the knowledge of clinical students on prevention of ventilator associated pneumonia?
Is there any association between knowledge of VAP prevention and demographic characteristics? What is the opinion of clinical students on VAP prevention?

1.5. Research objectives 1 .5.1 Broad objective

To determine the clinical student's knowledge and attitude on prevention of ventilator associated pneumonia among critically ill patients.

1.5.2 Specific objectives

Knowledge and attitudes on prevention of ventilator associated pneumonia.