in Chapter 3 (CRBSI) and 4 (VAP). In chapter 3, the incidence of and independent risk factors for CRBSI are described. These results were also used to evaluate the data requirements of the protocol. In chapter 4, incidence of and independent risk factors for VAP are described. Meanwhile, awareness increased that national prevalence surveys of a wider range of HAI could be worthwhile for hospitals, while providing RIVM and the national government with better understanding of the disease burden imposed by the full range of HAI. Point prevalence surveys (PPS) were therefore introduced in 2007. The results of the first two years are presented in chapter 5 and describe the range of HAI prevalence, use of medical devices, and use of antibiotics among hospitals. Apart from HAI themselves, related outcomes can be monitored in surveillance programmes. HAI can lead to longer hospital admissions, repeated surgeries, readmissions, and increased mortality. These measures illustrate the impact of HAI on patients and the healthcare system. Attributing them to nosocomial infection is, however, often not straightforward and requires adjusting for the patient’s condition by using statistical approaches or relying on clinicians’ opinion. The inter‐rater reliability of a clinician‐based measure for the contribution of HAI to mortality was evaluated in a multicentre study commissioned by the European Centre for Disease Prevention and Control (ECDC). The results are presented in chapter 6. 1.4 Prevention of HAI: improving compliance to best practices (Part II) Although surveillance is known to increase awareness and can lead to improvement, in this case lower HAI rates [5, 23‐26], certain requirements must be met. HCWs must have knowledge of best practices and perceive them to be important and feasible; materials must be available and care processes optimally organised. The prevention of HAI is one aspect of ‘patient safety’. This concept within healthcare quality and the notion that it should be embedded and fostered throughout the entire healthcare system was developed in the USA [27]. Following the seminal studies from Berenholtz and Pronovost et al. [28, 29], the Institute for Healthcare Improvement (IHI) in the USA, in its 100,000 Lives Campaign to improve patient safety and outcomes in 2004, recommended as one of six interventions the “central line bundle” [30]. Central line bundles to prevent CRBSI or central‐line associated BSI (CLABSI) have been implemented in many hospitals and national surveillance programmes since [30‐32]. The bundle approach emphasises compliance to a coherent set of best practices instead of an uncoordinated introduction and monitoring of individual best practices. Included in these bundles is hand hygiene during the CVC insertion, as hand hygiene is a corner stone of infection prevention in general. Improving hand hygiene has proven to be challenging [33]. Whether a CRBSI 1 13 Introduction
RkJQdWJsaXNoZXIy MTk4NDMw