1. Healthcare-associated infections (HAI) and especially central line associated bloodstream infections (CLABSI) are adverse events in health care delivery which are associated with increased morbidity and mortality. There has been expansion and proliferation of infection control guidelines and studies showing evidence about effective intervention strategies in HAI-prevention. There is variability in HAI-rates among EU-countries. It is not known what practices European hospitals have adopted and whether such are implemented and effective in daily practice. The aim of PROHIBIT is to understand existing guidelines and practices to prevent HAI in European hospitals, identify factors that encourage or impede compliance with best practices, and test the effectiveness of interventions of known efficacy. The project employs a mixed-methods approach combining the strengths of qualitative research, survey methods, observational and experimental designs. After systematically reviewing current guidelines and recommendations in HAI-prevention, a large scale survey will be carried out among European hospitals about infection control practices and how such activities are related to CLABSI-prevention. Factors interfering with adoption and implementation of infection control practices will be determined using qualitative research. Finally, a multimodal prevention strategy to reduce CLABSI will be compared to hand hygiene in a randomized controlled study among 15 tertiary care hospitals in Europe. Information obtained by PROHIBIT will be synthesized to develop recommendations for the EU, policy makers, managers and medical professionals. EU-funding: 2,999,934.00 EUR Start: 1.1.2010; End: 31.12.2013 www.prohibit.unige.ch Organization and Work packages Contact Partners/Collaborations Coordination UniGE – Prof Didier Pittet & Dr Walter Zingg WP1 – Project Coordination/Organization Lead: UniGECollaborations: CUB, RIVM WP2 – Systematic review about European guidelines Lead: UKL-FRCollaborations: CUB WP2 will provide a systematic review about current guidelines on the prevention of healthcare-associated infections (HAI), surveillance and public reporting in European countries with the focus on surgical site infection (SSI), ventilator-associated pneumonia (VAP), catheter- associated urinary tract infection (CAUTI), catheter- associated blood stream infection (CA-BSI) and C. difficile associated infection (CDI). Information will be retrieved with the help of national contact points (NCP). WP3 – Survey of HAI-prevention in European hospitals Lead: CUBCollaborations: ICL, NCE, UKL-FR, WHO The objective of WP3 is to describe activity of European hospitals in HAI-prevention, to describe which guidelines have been adopted, and to identify which elements of the guidelines are followed by the healthcare workers in daily routine. Information about HAI-rates will be retrieved if available. This survey, based on a questionnaire, is done in collaboration with the NCPs among representative samples of 30 hospitals in each European country. WP4 – In-depth qualitative survey Lead: UniGECollaborations: CUB, ICL, APHM, RIVM, NCE, JUMC; UMich Among a representative sample of hospitals participating in WP5, the objective of WP4 is to determine key factors for success or failure in the implementation of good practices in HAI-prevention. This work package is a mixed methods approach as it uses the technique of qualitative research and quantitative outcome data from WP5. Questionnaires and onsite interviews will help to obtain in-depth information about functioning of hospitals and how this relates to adoption and implementation of guidelines and recommendations. WP5 – Randomized controlled trial of CLABSI-prevention Lead: RIVMCollaborations: JUMC, UKL-FR, UniGE, WHO; UMCG The objective of WP5 is to test the effectiveness of bundle strategies and hand hygiene in the prevention of central line-associated bloodstream infections. The setting is a stepped-wedge cluster-randomization in intensive care units among 15 European hospitals. Up to now, 15 hospitals have been selected after a call for tender, representing Eastern and Western European countries. WP6 – Dissemination of PROHIBIT findings Lead: UniGECollaborations: CUB, ICL, JUMC, NCE, RIVM, UKL-FR, WHO, ECDC, JHSP Timeframe Collaborations European Centres for Disease Control ECDC Universitair Medisch Centrum Groningen UMCG University of Michigan Ann Arbor, USA UMich Johns Hopkins School of Public Health,JHSP Baltimore, USA Partners University of GenevaUniGEGeneva, Switzerland Rijksinstituut voorRIVMBilthoven, Netherlands Volksgezondheid en Mileu Charité UniversitätsmedizinCUBBerlin, Germany Berlin Universitätsklinikum FreiburgUKL-FRFreiburg, Germany Imperial College LondonICLLondon, UK World Health OrganizationWHOGeneva, Switzerland Jagiellonian Medical CollegeJUMCKrakow, Poland Orszagos EpidemiologaiNCEBudapest, Hungary Központ Centre Hospitalier RégionalAPHMMarseille, France de Marseille Walter Zingg Fabricio Jantarada Infection Control Programme University of Geneva Hospitals Rue Gabrielle Perret-Gentil 4 1211 Geneva, Switzerland walter.zingg@hcuge.chwalter.zingg@hcuge.ch fabricio.daLiberdadeJantarada@hcuge.chfabricio.daLiberdadeJantarada@hcuge.ch P +41 22 372 33 64 P +41 372 39 85 F +41 372 39 87 www.prohibit.unige.ch