Evidence-Based Nursing to Reduce Adverse Events Regarding Ventilator Associated Pneumonia, Pressure Injuries and Central Line Bloodstream Infection in Intensive Care Unit in Bangladesh

• The nurse's skill and knowledge related to the PU, MDRPU and CLABSI checklist. Researcher developed checklist, 50 items with 0: not correct/did not do, 1: partially correct, 2: correct. Score range 0-114.

The incidence rate of PU was calculated as the number of newly developed pressure ulcers after hospitalization per 1000 person-days at risk.

The incidence rate of MDRPU was calculated as the number of newly developed MDRPU cases per 1000 patients assessed.

The incidence rate of CLABSI was calculated as the number of CLABSI cases per 1000 central line-days.

Data will be collected: Patients' demographic data (age, sex, occupation etc.) Medical past and current history (diagnosis, treatment, medication, hospitalization). Reasons and date to be admitted to ICU. Treatment in ICU. Daily laboratory data taken in ICU. Daily biological data including vital signs.

Results of patients' stay during ICU. Diagnosis of PU, MDRPU and CLABSI included of this list.

Nurses attitude, practice and knowledge related PU, MDPU and CLABSI related prevention scale.

The researcher makes an attitude, practice and knowledge related of EBP guideline for PU, MDPU and CLABSI question Total item 22 and validity was tested by ICU and PU specialized nurses in Japan.

Knowledge was assessed using multiple-choice questions, with one correct answer among four options. Each correct response was awarded a score of 1, and incorrect or "don't know" responses were scored 0.

Attitude and practice were measured using a Likert scale, with responses indicating the degree of agreement or frequency.

After diagnosis of sore we measured stage of PU and MDRPU. Number of ICU patients developing PU and MDRPU categorized by stage (Stage I-IV). Unit of Measure: Number of patients per PU/MDRPU stage.

After diagnosis of CLABSI then identify what kind organism relate to CLABSI. Type and frequency of microorganisms identified in laboratory-confirmed CLABSI cases. Unit of Measure: Number of cases per microorganism.

Incidence rate of VAP per 1000 ventilator days. Unit of Measure: VAP cases per 1,000 ventilator days

Mortality and morbidity rate of ICU patients All-cause mortality among ICU patients during the study period. Unit of Measure: Percentage (%)。Occurrence of ICU-related adverse events (VAP, CLABSI, PU, MDRPU). Unit of Measure: Number of patients with adverse events.

Average length of stay ICU patients. Mean length of stay in the intensive care unit for enrolled patients. Unit of Measure: Days (mean ± SD).

Average survival rate of ICU. Data will be collected: Length of stay and survival rate. Proportion of enrolled patients alive at ICU discharge. Unit of Measure: Percentage (%) of patients surviving to ICU discharge.

Will be collected from patient record file. Sum Acute Physiology Points + Age Points + Chronic Health Points = APACHE II total (range 0-71). APACHE II total score (integer). Optionally report distribution (mean ± SD) or stratify by score ranges.

Will be collected from patient record file. Sum Acute Physiology Points + Age Points + Chronic Health Points = APACHE II total (range 0-71). APACHE II total score (integer). Optionally report distribution (mean ± SD) or stratify by score ranges. Use worst values within first 24 h for baseline SOFA. For organ-dysfunction trajectory, compute daily SOFA scores。Sum component scores → SOFA total (0-24). SOFA total score (integer). Can also report number/proportion with increase ≥2 points.

Total GCS = E + V + M (range 3-15). Record at ICU admission (worst value in first 24 h for scoring systems). Note if patient is sedated or intubated - document sedation/intubation; if intubated, record "V = T" and use local protocol for scoring (some protocols assign V=1 or use best pre-sedation score). Unit / reporting: GCS total (3-15). Report component scores if relevant.