intervention, attended a two‐day PROHIBIT workshop on best practices and implementation science. For the HH improvement strategy, PROHIBIT used the WHO HH training and campaign materials (http://www.who.int/gpsc/5may/tools/en/). Hand hygiene promotion included educational sessions and bedside training. In addition, the ICUs displayed posters and/or other reminders in the workplace and participants came up with various additional promotion activities. Hand hygiene compliance was measured by direct observation according to the WHO observation method.[24] PROHIBIT study nurses, most often infection prevention and control (IPC) or ICU nurses with IPC responsibilities, were trained in the methodology of direct HH observation at the University of Geneva Hospitals, Switzerland. Hand hygiene observations were randomized for date (weekdays), time slot (08‐12:00, 12:00‐16:00 and 16:00‐20:00), and ICU bed [7]. One observation session could include observations of multiple HCWs. However, to avoid missing HH opportunities, observers were not allowed to observe more than three HCWs in one session. Hand hygiene opportunities were stratified by observation sessions and by the five WHO indications for HH [24]. HH compliance was calculated as the proportion of HH opportunities met by a HH action. Individual HCWs identity was recorded using a four‐letter code, based on their given and family name, where needed retrieved from the badge and, if that proved impossible, by asking the HCW. During the intervention on site investigators received quarterly feedback reports on the average HH compliance in their ICU and individual HCWs on their HH compliance after being observed, but not during baseline [7]. HCW codes were used for statistical analysis only. Study population of the present analysis Ten of the 14 ICUs agreed to capture the HCWs’ identity during HH observations. Seven of these ICUs implemented the HH intervention, either alone or in combination with the CRBSI‐prevention strategy and were included in the present analysis as study ICUs. Only data of HCWs with at least two observation sessions, during both baseline and intervention periods, were included for the individual analysis (‘study HCWs’).
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