{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T13:55:46Z","timestamp":1769176546105,"version":"3.49.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:00:00Z","timestamp":1765843200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>Ventilator-associated pneumonia (VAP), a leading cause of ICU mortality, remains prevalent in Southeast Asia, with limited data on critical care nurses\u2019 knowledge and prevention practices in Malaysia. The purpose of this study was to assess knowledge, self-reported practices, barriers, and predictors of VAP prevention among critical care nurses in Sarawak, Malaysia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study was conducted from July to August 2023 at four public hospitals in Sarawak, Malaysia. Universal sampling was used to recruit nurses from various critical care units managing patients requiring ventilator support. A self-administered questionnaire, consisting of four sections, was employed to gather background information from nurses, assess their knowledge, self-reported practices, and identify barriers related to VAP prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 298 critical care nurses participated in the study. Of these, 66.8% demonstrated poor knowledge of ventilator-associated pneumonia (VAP) prevention; however, self-reported practices with VAP prevention were significantly high at 76.5%. A Pearson\u2019s correlation test revealed a significant association between the nurses\u2019 knowledge and their self-reported practices related to VAP prevention (p\u2009&lt;\u20090.001). Additionally, multiple regression analyses identified several significant predictors of critical care nurses\u2019 self-reported practices in VAP prevention, including their level of knowledge, type of unit, number of official beds, and sociodemographic factors (p\u2009&lt;\u20090.05). While knowledge positively influenced self-reported practices, its impact was relatively minor compared to sociodemographic factors. Barriers to VAP prevention included nursing staff shortages, forgetfulness, and lack of written protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The prevention of ventilator-associated pneumonia (VAP) is a multidisciplinary challenge, emphasizing the crucial role of critical care nurses. The findings from this study underscore the necessity for updated, evidence-based interventions that target knowledge gaps, self-reported practices, and barriers to effective VAP prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0325637","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T18:30:32Z","timestamp":1765909832000},"page":"e0325637","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of self-reported practice in ventilator-associated pneumonia (VAP) prevention among critical care nurses in Sarawak public hospitals"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4333-1892","authenticated-orcid":true,"given":"Jia Hui","family":"Tan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6564-8770","authenticated-orcid":true,"given":"Chong Chin","family":"Che","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li Yoong","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei Chan","family":"Chong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,16]]},"reference":[{"key":"pone.0325637.ref001","doi-asserted-by":"crossref","first-page":"482","DOI":"10.3389\/fphar.2019.00482","article-title":"Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients","volume":"10","author":"D Wu","year":"2019","journal-title":"Front Pharmacol"},{"issue":"4","key":"pone.0325637.ref002","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.ccm.2018.08.004","article-title":"Is Zero Ventilator-Associated Pneumonia Achievable?: Practical Approaches to Ventilator-Associated Pneumonia Prevention","volume":"39","author":"C Vazquez Guillamet","year":"2018","journal-title":"Clin Chest Med"},{"issue":"3","key":"pone.0325637.ref003","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0247832","article-title":"Ventilator-associated pneumonia among ICU patients in WHO Southeast Asian region: A systematic review","volume":"16","author":"S Kharel","year":"2021","journal-title":"PLoS One"},{"issue":"3","key":"pone.0325637.ref004","first-page":"353","article-title":"Clinical characteristics and factors associated with diagnoses of ventilator and non-ventilator associated pneumonia in Intensive care unit","volume":"76","author":"MZ Nik Nurfazleen","year":"2021","journal-title":"Med J Malaysia"},{"issue":"3","key":"pone.0325637.ref005","doi-asserted-by":"crossref","DOI":"10.4037\/ajcc2014837","article-title":"Adherence to institution-specific ventilator-associated pneumonia prevention guidelines","volume":"23","author":"H Kiyoshi-Teo","year":"2014","journal-title":"Am J Crit Care"},{"issue":"12","key":"pone.0325637.ref006","doi-asserted-by":"crossref","DOI":"10.5430\/jnep.v5n12p42","article-title":"The effect of nurses training on ventilator-associated pneumonia (VAP) prevention bundle on VAP incidence rate at a critical care unit","volume":"5","author":"R Ismail","year":"2015","journal-title":"JNEP"},{"issue":"5","key":"pone.0325637.ref007","article-title":"Nurses\u2019 Knowledge Regarding Prevention of Ventilator Associated Pneumonia","volume":"1","author":"A Zeb","year":"2018","journal-title":"LOJNHC"},{"issue":"10","key":"pone.0325637.ref008","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.3390\/healthcare10101852","article-title":"Knowledge, Practice, Compliance, and Barriers toward Ventilator-Associated Pneumonia among Critical Care Nurses in Eastern Mediterranean Region: A Systematic Review","volume":"10","author":"K Al-Mugheed","year":"2022","journal-title":"Healthcare (Basel)"},{"issue":"5","key":"pone.0325637.ref009","doi-asserted-by":"crossref","DOI":"10.1111\/ijn.12838","article-title":"Prevention of ventilator-associated pneumonia in intensive care units: Barriers and compliance","volume":"26","author":"SM Aloush","year":"2020","journal-title":"Int J Nurs Pract"},{"issue":"3","key":"pone.0325637.ref010","first-page":"269","article-title":"Prevention of ventilator-associated pneumonia: A knowledge survey among intensive care nurses in Yemen","volume":"35","author":"KM Al-Sayaghi","year":"2014","journal-title":"Saudi Med J"},{"issue":"5","key":"pone.0325637.ref011","first-page":"1","article-title":"Critical care nurses\u2019 knowledge of ventilator-associated pneumonia prevention in selected hospitals, Khartoum","volume":"1","author":"FA Al Shameri","year":"2017","journal-title":"Nurs Healthc Int J"},{"key":"pone.0325637.ref012","doi-asserted-by":"crossref","first-page":"90","DOI":"10.9734\/jsrr\/2020\/v26i530263","article-title":"Sample Size Determination in Survey Research","author":"AM Adam","year":"2020","journal-title":"JSRR"},{"issue":"2","key":"pone.0325637.ref013","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4103\/2279-042X.137070","article-title":"Education alone is not enough in ventilator associated pneumonia care bundle compliance","volume":"3","author":"H Hamishehkar","year":"2014","journal-title":"J Res Pharm Pract"},{"issue":"3","key":"pone.0325637.ref014","first-page":"1526","article-title":"Nurses\u2019 knowledge assessment concerning prevention of ventilator-associated pneumonia","volume":"20","author":"HJ Mohammed","year":"2020","journal-title":"Med Leg Updat"},{"issue":"3","key":"pone.0325637.ref015","doi-asserted-by":"crossref","first-page":"185","DOI":"10.5152\/cjms.2021.1292","article-title":"Knowledge and Barriers of Critical Care Nurses Regarding Evidence-Based Practices in Ventilator-Associated Pneumonia Prevention","volume":"6","author":"MN Alkhazali","year":"2021","journal-title":"Cyprus J Med Sci"},{"issue":"5","key":"pone.0325637.ref016","doi-asserted-by":"crossref","first-page":"782","DOI":"10.4187\/respcare.01766","article-title":"Humidification during invasive and noninvasive mechanical ventilation: 2012","volume":"57","author":"American Association for Respiratory Care","year":"2012","journal-title":"Respir Care"},{"key":"pone.0325637.ref017","doi-asserted-by":"crossref","first-page":"715434","DOI":"10.1155\/2014\/715434","article-title":"Humidification during mechanical ventilation in the adult patient","volume":"2014","author":"HS Al Ashry","year":"2014","journal-title":"Biomed Res Int"},{"issue":"9","key":"pone.0325637.ref018","first-page":"94","article-title":"Knowledge of pediatric critical care nurses regarding evidence-based guidelines for prevention of ventilator-associated pneumonia (VAP)","volume":"6","author":"GE Ahmed","year":"2015","journal-title":"J Educ Pract"},{"key":"pone.0325637.ref019","first-page":"103895","article-title":"Knowledge of intensive care nurses\u2019 towards prevention of ventilator-associated pneumonia in North West Ethiopia referral hospitals, 2021: A multicenter, cross-sectional study","volume":"78","author":"AB Getahun","year":"2022","journal-title":"Ann Med Surg (Lond)"},{"key":"pone.0325637.ref020","doi-asserted-by":"crossref","first-page":"102827","DOI":"10.1016\/j.iccn.2020.102827","article-title":"Nurses\u2019 knowledge, experience and self-reported adherence to evidence-based guidelines for prevention of ventilator-associated events: A national online survey","volume":"59","author":"A Madhuvu","year":"2020","journal-title":"Intensive Crit Care Nurs"},{"issue":"3","key":"pone.0325637.ref021","doi-asserted-by":"crossref","first-page":"78","DOI":"10.5152\/dcbybd.2018.1880","article-title":"Knowledge Levels of Critical Care Nurses on Evidence-Based Practices for the Prevention of Ventilator-Associated Pneumonia","volume":"9","author":"N Ozen","year":"2018","journal-title":"Yo\u011fun Bakim Derg"},{"key":"pone.0325637.ref022","volume-title":"Benefits of subglottic secretion drainage endotracheal tubes: facilitator guide","author":"Agency for Healthcare Research and Quality","year":"2017"},{"issue":"155","key":"pone.0325637.ref023","doi-asserted-by":"crossref","first-page":"190107","DOI":"10.1183\/16000617.0107-2019","article-title":"Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis","volume":"29","author":"DP Pozuelo-Carrascosa","year":"2020","journal-title":"Eur Respir Rev"},{"issue":"2","key":"pone.0325637.ref024","first-page":"274","article-title":"Critical care nurses\u2019 compliance and barriers toward ventilator-associated pneumonia prevention guidelines: cross-sectional survey","volume":"16","author":"KM Al-Sayaghi","year":"2020","journal-title":"J Taibah Univ Med Sci"},{"issue":"6","key":"pone.0325637.ref025","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.ajic.2017.11.020","article-title":"Evidence-based guidelines for prevention of ventilator-associated pneumonia: Evaluation of intensive care unit nurses\u2019 adherence","volume":"46","author":"MW Darawad","year":"2018","journal-title":"Am J Infect Control"},{"issue":"1","key":"pone.0325637.ref026","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4103\/1735-9066.202073","article-title":"Compliance with the Standards for Prevention of Ventilator-Associated Pneumonia by Nurses in the Intensive Care Units","volume":"22","author":"SM Tabaeian","year":"2017","journal-title":"Iran J Nurs Midwifery Res"},{"issue":"1","key":"pone.0325637.ref027","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s13613-018-0412-8","article-title":"Impact of a VAP bundle in Belgian intensive care units","volume":"8","author":"L Jadot","year":"2018","journal-title":"Ann Intensive Care"},{"issue":"9","key":"pone.0325637.ref028","first-page":"67","article-title":"Exploration of knowledge of, adherence to, attitude and barriers toward evidence-based guidelines (EBGs) for prevention of ventilator-associated pneumonia (VAP) in healthcare workers of pediatric cardiac intensive care units (PCICUs): A quali-quantitative survey","volume":"5","author":"L Jahansefat","year":"2016","journal-title":"Int J Med Res Health Sci"},{"issue":"6","key":"pone.0325637.ref029","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1017\/ice.2022.88","article-title":"Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update","volume":"43","author":"M Klompas","year":"2022","journal-title":"Infect Control Hosp Epidemiol"},{"key":"pone.0325637.ref030","volume-title":"Ventilator-associated pneumonia: healthcare-associated infections (HAIs)","author":"Centers for Disease Control and Prevention","year":"2010"},{"key":"pone.0325637.ref031","volume-title":"Policies and procedures on infection prevention and control","author":"Ministry of Health M","year":"2019"},{"issue":"1","key":"pone.0325637.ref032","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s44158-024-00166-2","article-title":"Chlorhexidine is not effective at any concentration in preventing ventilator-associated pneumonia: a systematic review and network meta-analysis","volume":"4","author":"A De Cassai","year":"2024","journal-title":"J Anesth Analg Crit Care"},{"issue":"7","key":"pone.0325637.ref033","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1007\/s00134-018-5221-x","article-title":"Oral care with chlorhexidine: beware!","volume":"44","author":"L Bouadma","year":"2018","journal-title":"Intensive Care Med"},{"issue":"7","key":"pone.0325637.ref034","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1007\/s00134-018-5217-6","article-title":"Caution for chlorhexidine gluconate use for oral care: insufficient data","volume":"44","author":"J-D Ricard","year":"2018","journal-title":"Intensive Care Med"},{"issue":"1","key":"pone.0325637.ref035","first-page":"358","article-title":"Knowledge, adherence and barriers towards the prevention of ventilator-associated pneumonia among nurses","volume":"7","author":"K Soni","year":"2018","journal-title":"Int J Sci Res"},{"issue":"1","key":"pone.0325637.ref036","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s12912-021-00735-8","article-title":"Assessment of knowledge and compliance to evidence-based guidelines for VAP prevention among ICU nurses in Tanzania","volume":"20","author":"V Bankanie","year":"2021","journal-title":"BMC Nurs"},{"issue":"1","key":"pone.0325637.ref037","article-title":"Effect of Nursing Workload in Intensive Care Units","volume":"13","author":"AA Almenyan","year":"2021","journal-title":"Cureus"},{"issue":"6","key":"pone.0325637.ref038","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1177\/1757177419846588","article-title":"Lessons learned from a rapid implementation of a ventilator-associated pneumonia prevention bundle","volume":"20","author":"E Ladbrook","year":"2019","journal-title":"J Infect Prev"},{"issue":"2","key":"pone.0325637.ref039","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ajic.2013.09.026","article-title":"Assessing the impact of an educational intervention on ventilator-associated pneumonia in a pediatric critical care unit","volume":"42","author":"A Gupta","year":"2014","journal-title":"Am J Infect Control"},{"issue":"2","key":"pone.0325637.ref040","first-page":"1183","article-title":"Effectiveness of an educational intervention on knowledge and practice of staff nurses on prevention of ventilator-associated pneumonia among neonates in neonatal intensive care unit","volume":"13","author":"R Dipanjali","year":"2020","journal-title":"Int J Caring Sci"},{"issue":"5","key":"pone.0325637.ref041","doi-asserted-by":"crossref","DOI":"10.4037\/ccn2016520","article-title":"Use of Ventilator Bundle and Staff Education to Decrease Ventilator-Associated Pneumonia in Intensive Care Patients","volume":"36","author":"M Parisi","year":"2016","journal-title":"Crit Care Nurse"},{"issue":"4","key":"pone.0325637.ref042","first-page":"147","article-title":"Ventilator-associated pneumonia and the importance of education of ICU nurses on prevention - Preliminary results","volume":"8","author":"B Mogyor\u00f3di","year":"2016","journal-title":"Interv Med Appl Sci"},{"issue":"9","key":"pone.0325637.ref043","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.ajic.2017.04.009","article-title":"Does educating nurses with ventilator-associated pneumonia prevention guidelines improve their compliance?","volume":"45","author":"SM Aloush","year":"2017","journal-title":"Am J Infect Control"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0325637","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T18:30:40Z","timestamp":1765909840000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0325637"}},"subtitle":[],"editor":[{"given":"Vijay","family":"Hadda","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,16]]},"references-count":43,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0325637","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,16]]}}}