INTRODUCTION Healthcare‐associated infections (HAIs) affect on average 6% of hospitalized patients in Europe [1, 2]. Patients in hospitals are at increased risk of acquiring HAIs mainly because of invasive procedures. The proximity to other patients and frequent healthcare contacts facilitate the transmission of pathogens, and the use of broad‐spectrum antibiotics increases the burden of multidrug‐resistant microorganisms (MDROs) in hospital settings [3]. Hand hygiene (HH) is the most basic and essential element in the prevention of cross‐ transmission. Although widely promoted, HH compliance in intensive care units (ICU) remains on average 40‐50% [4‐7], and to sustain achieved improvements remains challenging [8‐11]. All but a few small studies [12‐17] on HH compliance report only pooled data across all healthcare workers (HCW). Thus there is little data on the contribution of individuals to the overall response to behavioural interventions. Individual HH compliance is relevant because average compliance does not reflect variations among HCWs and thus, might not capture overall transmission risk. Moreover, data on changes in individual HH compliance could provide insights into barriers and facilitators of a HH intervention. In the Prevention of Hospital Infections by Intervention and Training (PROHIBIT) intervention study, HH compliance was observed at the individual HCW level during baseline and intervention study periods. We analysed these data to better understand the determinants and dynamics of individual change in HH compliance in relation to the overall intervention effect. METHODS Methods of the PROHIBIT intervention study The PROHIBIT intervention study tested two interventions to prevent central venous catheter bloodstream infection (CRBSI) in Intensive Care Units (ICUs) in European acute care hospitals: a central venous catheter (CVC) insertion strategy, and a HH improvement strategy. Several other work packages addressed the topic of HAI prevention more widely [18‐22]. After a baseline period of at least six months, three ICUs of 14 hospitals in 11 European countries were randomly allocated every three months to start with one of the two intervention strategies or both [7]. The method and results of this step wedge randomised controlled intervention study have been reported in detail elsewhere [7, 23]. In brief, each ICU appointed one dedicated on‐site investigator and one study nurse to the project. PROHIBIT offered reimbursement of a 0.5 full‐time equivalent study nurse. Three to six months before the start of the intervention, local study nurses and/or infection control physicians, anaesthetists, and intensivists, depending on the
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