Summary Healthcare is intended to be for the benefit of patients, but unfortunately invasive devices and procedures also form a risk for patients to acquire healthcare‐associated infections (HAI). In this thesis, HAI will refer more specifically to hospital‐associated infections. This thesis investigates the progress in HAI prevention over the last two decades, as measured within the national surveillance (part I), and the effect of the promotion of best practices regarding central venous catheter insertion and hand hygiene (part II). In the introduction, chapter 1, I provide a short historical account of the developments in infection prevention and control in hospital care, the present incidence and aetiology of HAI and the more recent expansion of HAI surveillance programmes. Next, I present results from the Dutch HAI surveillance and a European mortality review study (part I), and describe two intervention programmes and their effect on both outcome and process parameters (part II). Most progress in the field of infection prevention was made in the second half of the 19th century – when the importance of hygiene became increasingly acknowledged and the role of micro‐organisms in infections was discovered. The level of infection treatment was not significantly improved until the discovery of antibiotics in the first half of the last century. Unfortunately, antimicrobial resistance evolved almost instantaneously, and this set the stage for professional hospital infection control programmes. In the 1960s the US Centers for Disease Control (CDC) recommended hospitals to perform surveillance of HAI, to inform the development of interventions. Since then, surveillance of HAI is considered a cornerstone of prevention and control. At present, the most frequently diagnosed and impactful HAI are surgical site infections (SSI), lower respiratory tract infections including (ventilator‐associated) pneumonia (VAP); bacteraemia (bloodstream infection (BSI)), including central venous catheter‐related bloodstream infection (CRBSI) and urinary tract infections (UTI), including urinary catheter‐associated UTI. The acquisition of HAI is influenced by both endogenous and exogenous risk factors. Almost all HAI cause delayed or inadequate recovery, additional pain and/or anxiety or worse, and many require antibiotic treatment. Part I In 1996 the Dutch Institute for Public Health and the Environment (RIVM) and the former Dutch Institute for Healthcare Improvement (CBO) formed one national surveillance programme together: Prevention of Hospital infections by Interventions and Surveillance (PREZIES) (https://www.rivm.nl/prezies). PREZIES, in which hospitals and the RIVM C 265 Summary
RkJQdWJsaXNoZXIy MTk4NDMw