Results are also published on the website (PREZIES | RIVM) and in journals, serving as a reference and motivation for more hospitals to join the ongoing surveillance. The range in CRBSI incidence densities additionally served the Dutch Hospital Patient Safety Programme (DHPSP) to define attainable goals (chapter 9). Participation in a voluntary programme such as PREZIES means that the group of participating hospitals changes from year to year. The voluntary basis also implies that hospitals may choose to monitor a certain procedure or patient category because they are interested in infection monitoring in these procedures/patients. This could result from perceived problems resulting in initially high rates, but the existing interest could already have led to lower rates, before the data collection for the national programme was accomplished, as well (chapter 9). The variable pool of hospitals and the unknown trajectory preceding the participation in surveillance limits the straightforward interpretation of results when assessing national HAI trends. Additionally, implementing HAI surveillance may sometimes be hampered by lack of support or ownership by certain specialties [22]. This may lead to ongoing surveillance in a more cooperative discipline despite limited room for further improvement, as has been observed in some hospitals. Mandatory surveillance may divert scarce infection prevention and control (IPC) capacity to the included patient categories even when rates are already low [23]. Mandatory public reporting or even penalties for HAI, as practiced in some US states, can additionally raise concerns on underreporting [24]. Monitoring HAI, by itself—unless unobtrusively or without feedback—can increase HCW awareness and may decrease infection rates if HCWs have sufficient understanding and opportunity to prevent these infections [25]. If this is not to be expected or unknown, an intervention is called for (Part II). 10.2 HAI rates in the Netherlands: the present This thesis begins with four papers describing the incidence of HAI and their risk factors during the first years of specific surveillance programmes. The surveillance results provided benchmarks for hospitals and targets for improvement programmes, including the CRBSI prevention component of the DHPSP discussed in chapter 9. Since generation of the data included in these first papers, medical insight, technology, and infection prevention and control (IPC) have moved forward. During this time, many countries have reduced HAI rates with the development and implementation of healthcare technology and infection control surveillance guidelines, and intervention campaigns [5, 26, 27]. In the Netherlands, similar reductions were achieved. As described in chapter 9, the risk of developing CRBSI in the ICU decreased an average of 10% per 240 Chapter 10
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