Random forest analysis of ICU nurses' knowledge, attitudes and practices in oral care for ventilator‐associated pneumonia prevention

Abstract Background Oral care is critical for preventing ventilator‐associated pneumonia (VAP) in intensive care unit (ICU) patients. ICU nurses play a key role in delivering this care but often encounter challenges stemming from knowledge gaps and inconsistent practices. Aim To assess ICU nurses' knowledge, attitudes and practices (KAP) in oral care for VAP prevention and identify demographic factors influencing these variations using random forest analysis. Study Design A multi‐centre cross‐sectional study was conducted. Between April and June 2023, 291 ICU nurses from five ICUs across three public tertiary hospitals in Ganzhou City were surveyed using proportionate stratified sampling. Likert‐scale questionnaires evaluated KAP, and statistical analyses, including t ‐tests, analysis of variance and random forest models, were used to determine demographic predictors of KAP scores. Results The average KAP scores were as follows: knowledge 27.34 (±4.53), attitudes 31.89 (±4.24), and practices 43.13 (±9.0). Significant predictors of KAP included academic titles, professional positions, gender, ICU tenure and department. Common barriers to effective oral care included lack of formal training, time constraints and limited resources. Conclusions ICU nurses demonstrate positive attitudes towards VAP prevention, but significant gaps in knowledge and practice remain. Targeted education, especially for less‐experienced and lower qualified nurses, and standardized protocols are essential to improve adherence to oral care practices and reduce VAP incidence. Relevance to Clinical Practice The findings highlight the need for tailored educational interventions to address knowledge gaps, particularly among male, less‐experienced and lower qualified nurses. Implementing standardized training protocols can enhance oral care practices, improve patient outcomes and reduce VAP incidence.