6th Edition of World Nursing Science Conference 2026

Abstract

Background
Airway secretion removal is an essential nursing intervention in mechanically ventilated patients admitted in intensive care units (ICUs). Inadequate knowledge and poor adherence to recommended airway secretion removal practices may contribute to complications such as hypoxemia, ventilator-associated pneumonia, respiratory compromise, and prolonged hospital stay. Despite the importance of this procedure, there is limited evidence regarding nurses’ knowledge and practices on airway secretion removal in Tanzania.

Objective
To assess nurses’ knowledge and practices on airway secretion removal in mechanically ventilated patients admitted in ICUs at Muhimbili National Hospital, Muhimbili Orthopaedic Institute, and Jakaya Kikwete Cardiac Institute in Dar es Salaam, Tanzania.

Methods
A quantitative descriptive cross-sectional study was conducted among 111 registered nurses working in ICUs at Muhimbili National Hospital, Muhimbili Orthopaedic Institute, and Jakaya Kikwete Cardiac Institute. Participants were selected using convenience sampling. Data were collected using a self-administered structured questionnaire and an observational checklist assessing knowledge and practices related to airway secretion removal in mechanically ventilated patients. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were used to summarize the findings.

Results
A total of 111 ICU nurses participated in the study. The mean age was 39 ± 7 years, and the majority were female (63.1%). Most participants held a diploma in nursing (55.0%) and had 2–5 years of ICU experience (63.1%). Knowledge gaps were identified in several aspects of airway secretion removal. All participants lacked knowledge regarding the current recommendation against routine normal saline instillation before suctioning, and only 15.3% correctly identified the recommended suction system used in the unit. Furthermore, only 37.8% recognized crackles during ventilation as an indication for airway secretion removal, while 24.3% correctly identified absence of crackles as a sign of successful suctioning.
In practice, most nurses demonstrated good procedural skills. Pre-oxygenation before suctioning was performed by 91.9% of nurses, 82.9% used an appropriately sized suction catheter, and 94.6% maintained suction duration below 15 seconds. Pulse oximetry monitoring during suctioning was observed in all participants. However, deficiencies were noted in infection prevention practices, as only 32.4% adhered to hand hygiene and personal protective equipment use, while only 19.8% maintained sterility of the suction catheter.

Conclusion
ICU nurses demonstrated generally good practical skills in airway secretion removal; however, significant theoretical knowledge gaps and poor adherence to infection prevention practices were identified. Strengthening critical care nursing education, regular in-service training, and reinforcement of evidence-based airway secretion removal guidelines are essential to improve the quality and safety of care for mechanically ventilated patients.

Keywords
Airway secretion removal; Endotracheal suctioning; Mechanical ventilation; Intensive care unit; Nursing practice; Tanzania