participate, provides the RIVM with a national overview of HAI and enables hospitals to monitor HAI according to a standardised protocol, including a limited set of relevant literature‐based risk factors to allow a case mix‐adjusted, benchmark. The first surveillance programme targeted SSI, complemented in 1998 by a programme focussed on the intensive care unit (ICU), where patients are at higher risk of acquiring HAI than in most other hospital wards. Lasting from 1997‐2000, this programme monitored ICU‐ acquired infections and patient mortality. In chapter 2 we present the results of this programme, focussing on the device‐associated infections, associated mortality and their risk factors. Nineteen hospitals participated in this surveillance. Of the ventilated patients 19% developed VAP (25/1,000 ventilator days); of the patients with a CVC 3% developed CRBSI (4/1,000 CVC days) and of the catheterized patients 8% developed CAUTI (9/1,000 catheter days). Longer device use increased the risk for all infections, especially for CRBSI. Independent risk factors were sex, immunity, acute or just elective admission, selective decontamination of the digestive tract (SDD), and systemic antibiotics at admission, depending upon the infection type. Crude mortality was (statistically) significant higher in patients with CRBSI or CAUTI but not in patients with VAP, compared to patients without such an infection. Acquiring a device‐associated infection was not an independent risk factor for mortality but being in need of ventilation or a central line, and the duration of these treatments, contributed significantly to mortality. Evaluation of the ICU‐programme led to the development of two more targeted programmes, one aimed at CRBSI and one at VAP, with more detailed patient and device‐ specific data to improve case mix correction and increase insight. The first study on the CRBSI surveillance covered the initial period 2002‐2009 and in chapter 3 we describe the CRBSI incidence rate and its risk factors. Nine hospitals, participating 1‐4 years, recorded data for ICUs or for the entire hospital. Of the CVCs surveyed, 1.6% (95%CI 1.2‐2.0) resulted in CRBSI, representing 2.0/1000 CVC days (95% CI 1.6‐2.6). Multivariable analysis revealed that the length of the ICU stay prior to CVC insertion, insertion in the jugular or femoral vein, and use of the CVC to deliver total parenteral nutrition (TPN) increased the risk of CRBSI, whereas use of the CVC to deliver antibiotics decreased the risk of CRBSI. These data also informed the Dutch Hospital Patient Safety Programme (DHPSP) (chapter 9). In chapter 4 we present the results of the surveillance for VAP and its risk factors, some of which were determined daily. The prospective surveillance of ventilated patients ran from 2004 to 2011 across seven hospitals, each participating for 1‐4 years. The average VAP incidence density was 10.3/1000 ventilation days. We analysed time‐independent and time‐dependent risk factors for VAP using the standard Cox regression and the flexible Weighted Cumulative Effects method (WCE) that evaluates both current and past 266 Summary
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