In each hospital, an onsite investigator has the primary responsibility for the local study-organization. Additionally, 0.5 full-time equivalent of a study nurse is paid by PROHIBIT who is responsible for performing CRBSI surveillance, measuring process outcomes, and implementing hand hygiene promotion and catheter care training, depending on which intervention package the hospital is randomized to. Study nurse received training in hand hygiene and CRBSI surveillance in Geneva, Switzerland.
The study intervention includes focus group meetings with healthcare professionals of the participating hospitals (study nurses and intensive care physicians). Upon the meetings, the most recent evidence in CRBSI prevention and hand hygiene is delivered, and the participants will be trained in performing practical simulator training of catheter insertion and hand hygiene. Furthermore, a practical workshop on how to use a web-based e-learning tool for catheter care (http://www.carepractice.net) was organized, and they were provided with information about how to implement an intervention program successfully.
Intervention strategy 1
WHO hand hygiene promotion strategy based on materials designed by WHO and the University of Geneva Hospitals, Switzerland[31, 32]. The five essential elements of the strategy are: 1) system change, including availability of alcohol-based hand rub at the point of patient care and/or access to a safe, continuous water supply and soap and towels; 2) training and education of health-care professionals; 3) monitoring of hand hygiene practices and performance feedback; 4) reminders in the workplace; 5) the creation of a hand hygiene safety culture with the participation of both individual healthcare workers and senior hospital managers.
Intervention strategy 2
CRBSI prevention bundle according to the Geneva model[33–35]: 1) hand hygiene; 2) maximal barrier precaution measures at CVC insertion (sterile gloves, cap, gown, large drape); 3) skin antisepsis with alcohol-based chlorhexidine; 4) subclavian access as the preferred insertion site; 5) early central line removal.