Traditionally, hand hygiene (HH) interventions do not identify the observed healthcare workers (HWCs), apart from their profession and student status, and therefore, reflect HH compliance only at population level. We performed analyses of individual hand hygiene data, collected in seven PROHIBIT hospitals, to better understand the determinants and dynamics of individual change in relation to the overall intervention effect (chapter 8). We defined improving, non‐changing, and worsening HCWs with a threshold of 20% compliance change. In total 280 HCWs contributed at least two observation sessions before and after intervention and were included. The proportion of improving HCWs ranged from 33 to 95% among ICUs. The median HH increase per improving HCW ranged from 16 to 34 percentage points. ICU wide improvement in HH correlated significantly with both the proportion of improving HCWs and their median HH increase. Multilevel regression demonstrated that individual improvement was significantly associated with nurse profession (vs. doctors, auxiliary nurses and other HCWs), lower activity index, higher nurse‐to‐patient ratio, and lower baseline compliance. With comparable overall means the range in individual HH varied considerably between some hospitals, implying different transmission risks. Greater insight into improvement dynamics might help to design more effective HH interventions in the future. To ensure that a large number of hospitals adopt a multifaceted intervention without too much delay, the key is a national or otherwise large‐scale movement, such as the DHPSP, starting in 2009. This programme encouraged 62% of the Dutch hospitals to participate in the national CRBSI surveillance and additionally introduce a six item CRBSI prevention bundle. Using data from 2009 to 2019 we evaluated the association of the CRBSI risk with the bundle compliance as a total (‘overall’) bundle (all six items) and as an insertion bundle (four items) and a maintenance bundle (two daily checks) (chapter 9). In the ICUs, with relatively low rates already, compliance proved to be not associated with CRBSI risk, but outside the ICU improved compliance with the insertion bundle resulted in a decreased CRBSI risk. In the general discussion (chapter 10) I review the merits and limitations of the surveillance and study methods. The consequences of the achieved reductions for the relevance and future set‐up of HAI surveillance are considered, particularly with regard to CRBSI in the Netherlands. In the past two decades, HAI surveillance has been increasingly implemented, both in the Netherlands and in other countries. In this period, surveillance of HAI has facilitated the reduction of most types of HAI. Surveillance in combination with patient safety programmes has boosted both monitoring and infection C 269 Summary
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