Acute respiratory infections (ARI) are a significant health concern in Tanzanian intensive care units (ICUs). Effective protocols are essential to improve patient outcomes. A mixed-methods approach combining surveys, interviews, and process evaluations was employed. Data were collected from ICUs in three Tanzanian hospitals over one year. Findings indicate that while protocol adherence increased by 60% among ICU staff, there remains variability in its implementation across different units. The study highlights the need for standardised training and ongoing support to ensure consistent protocol application. ICU managers should prioritise regular training sessions and supervision to enhance protocol fidelity and patient care quality. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.