---

Objectives: The specific aims of this study were to examine the effect of adopting five best health practices in decreasing ventilator associated pneumonia (VAP) for patients ventilated longer than 48 hours and to measure clinician adherence to five best practices in lowering risk of infection. Methods: The integrated framework guiding this study included elements from Stetler's Model of Evidence-Based Practice (Stetler, 2002) and the Diffusion of Innovations Model (Rogers, 1995). A prospective quasi-experimental research design was used. A direct observation methodology compared staff outcomes of an education intervention in non-equivalent groups. Nurses, physicians, respiratory therapists, and technicians in five critical care units at two military medical centers participated over the past two years. Additionally, focus group interviews with staff were used to tailor an education intervention to teach measures that decrease the risk of infection for the ventilated patient. The observation component compared staff adherence to the five best practices at baseline (pretest) to adherence three months following the education intervention (posttest). The sample included a total of 146 baseline and 150 posttest, two- hour observations of all direct patient care healthcare personnel for five critical care units at two military medical centers during all shifts regarding adherence to five best practices for ventilated patients. Findings: Quarterly incidence rates measured the VAP rate and chi-square analysis measured the difference in compliance before and after best practice implementation. Pearson's product moment correlation tested relationships between best practice adherence and VAP rates. Findings showed a steady downward trend in VAP rates, significant improvement in oral care and protective glove use with variability in adherence to hand washing. Implications: Studies are needed to verify nursing practices with the necessary evidence to set policies and procedures. Evidence-based practice projects should be instituted throughout the hospital with involvement of all disciplines involved in patient care.