prevention bundle, a World Health Organisation (WHO)‐based intervention addressing hand hygiene, or both in combination would be effective in CRBSI prevention was evaluated in a wide range of European hospitals by the PROHIBIT (Prevention of hospital infections by intervention and training) study. As discussed in chapter 7, both process parameters ‐ the CVC insertion score and hand hygiene compliance ‐ were measured, and facilitating factors and barriers were evaluated in‐depth in a related study of six hospitals [34]. The individual HCW’s response to a hand hygiene intervention remains terra incognita in most studies. In chapter 8 additional analyses of individual hand hygiene in seven PROHIBIT hospitals are presented. More insight into personal uptake of a hand hygiene intervention enables the design of more effective interventions in the future. To ensure that a large number of hospitals adopt a multifaceted intervention without too much delay, the key is a national or otherwise large‐scale movement, such as the IHI or, based on this initiative, the Dutch Hospital Patient Safety Programme (DHPSP), starting in 2009. The DHPSP encouraged Dutch hospitals to introduce a CRBSI prevention bundle and 62% of them acted upon this, with a concurrent reduction in CRBSI rates. In chapter 9 the association between bundle compliance and CRBSI risk is evaluated. Finally, chapter 10 presents a discussion and reviews the merits and limitations of the surveillance and study methods. It will briefly consider the consequences of the current HAI incidence and achieved reductions for the relevance of and future set‐up of HAI surveillance, particularly with regard to CRBSI in the Netherlands. The relevance of hand hygiene and the current compliance in Dutch hospitals are additionally discussed. 14 Chapter 1
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