INTRODUCTION In the Netherlands, 7% of patients admitted to acute care hospitals subsequently have a central venous catheter (CVC).1 These are mainly used in patients in intensive care units (ICU). Critically ill and other patients who are in need of a CVC are at increased risk of acquiring bloodstream infection (BSI). The risk of acquiring a CVC‐related bloodstream infection (CR‐BSI) ranged from 2 to 4/1000 CVC days in recent studies.2‐6 CR‐BSIs increase the duration of ICU and hospital stay, and are associated with increased medical costs varying in different studies between $4200 to €13500 per patient.7‐9 The aging population in the Netherlands (14% aged ≥ 65 years in 2006, predicted to increase to 24% in 2040),10 and the consequent increase in the number of hospital admissions, will result in a growing burden of nosocomial infections. From this perspective, the importance of preventing nosocomial infections is even more apparent. Many studies have evaluated interventions aimed at reducing the incidence of CR‐ BSI, including technical innovations as well as behavioural changes.11‐25 Surveillance is necessary in order to gain insight into the incidence of CR‐BSI. Effective surveillance can also result in a decrease in infection rates.4 26 In the Netherlands, PREZIES, the national nosocomial infection surveillance network, commenced surveillance of CR‐BSI in 2000. A national patient safety initiative began in 2009, focusing, among other things, on CR‐BSI prevention. As such, the data presented in this paper can be considered as national baseline data. METHODS PREZIES, established in 1996, is a collaboration of participating hospitals, the Dutch Institute for Healthcare Improvement and the National Institute for Public Health and the Environment (RIVM). In 2000, having offered an ICU‐wide surveillance module for four years27, PREZIES invited hospitals to participate in more targeted surveillance of CR‐BSI. This included collection of a larger and more targeted range of potential risk factors for CR‐BSI. As in most European surveillance systems, the definitions used are based on those of the former Centers for Disease Control and Prevention/National Nosocomial Infections Surveillance System, nowadays the National Healthcare Safety Network definitions. In Dutch clinical practice, CR‐BSI is usually investigated by culturing both peripheral blood and the catheter tip. Other laboratory methods such as paired blood cultures are uncommon. The diagnostic criteria are summarized below (box 1). Based on international literature and the preceding ICU surveillance, a protocol was developed by a working group consisting of an intensivist and an anaesthesiologist (representative of their societies), epidemiologists and infection control professionals. 3 45 Catheter application, vein and pre-insertion ICU stay affect CRBSI risk
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