Patient safety

PROHIBIT - Prevention of Hospital Infections by Intervention & Training

Effectiveness of a programme to prevent catheter-related bloodstream infections (CRBSI) in a number of European hospitals

European hospitals were invited to participate in a cluster-randomized, stepped wedge trial to test the promotion of hand hygiene and a catheter bundle strategy, or both, for CRBSI reduction in intensive care units. Fourteen hospitals participated in the three-year study. Nurses and anaesthesiologists were trained in a workshop on best practice of CRBSI prevention and compliance assessment of hand hygiene and central venous catheter (CVC) insertion. The incidence of CRBSI was the primary outcome. Data were recorded through a web-based database called “OSIRIS”. After six months of baseline assessment, in July 2011 hospitals started to implement the intervention. Participants randomized to the hand hygiene intervention received an introduction to use the WHO hand hygiene multimodal improvement strategy. The hospitals randomized to the CVC bundle were trained by a team from the University of Geneva Hospitals and received instructions in the use of the online PROHIBIT training tool for catheter care (

A qualitative assessment to determine barriers and facilitators of the implementation of infection control practices was also undertaken in six hospitals. The methodology was developed by PROHIBIT investigators in close collaboration with the University of Michigan, USA. The selection of the six hospitals was based on the results of a screening questionnaire followed by telephone interviews with the onsite investigators. The study team visited the selected hospitals before the intervention and then 12 months into the implementation process.

The quantitative and qualitative results of these studies are still being analysed. They will provide high-quality evidence on the effectiveness of CRBSI prevention measures and in-depth understanding of the predictors for a successful or unsuccessful intervention of infection control practices.

The cluster-randomized, stepped wedge trial implementation was led by the National Institute for Public Health and the Environment, in The Netherlands, and the qualitative study (InDepth) by the University Hospital of Geneva, Switzerland.

See the insightful presentation by Dr Walter Zingg (Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland), coordinator of PROHIBIT, made for the 2014 WHO Teleclasses on Infection Control.