July 8, 2016


Affecting 5-10% of hospitalised patients and up to 33% to those admitted to the intensive care units, healthcare-associated infections (HAIs) remain a serious concern.

The ESICM-endorsed EVIDENCE project aimed to investigate the knowledge of healthcare workers (HCW) regarding the prevention guidelines of HAIs. Utilising several questionnaires, they evaluated: ventilator-associated pneumonia (1,2) surgical site infections (3) and catheter-related blood stream infections (4). After the dissemination of the questionnaires, EVIDENCE project evolved and implemented a web-based course to improve HCW knowledge concerning HAIs prevention and enhance critical thinking in their students (5). 

The e-course was made available in Dutch, English, Portuguese, Spanish and Turkish and was divided into 7 chapters: 1) evidence-based practice; 2) HAIs and importance of prevention; 3) Hand hygiene; 4) Catheter-associated urinary tract infection; 5) Central line-associated blood stream infections; 6) Ventilator-associated Pneumonia; 7) Surgical Site Infection. The course also included a pre-test (T0), a post-test immediately after finishing the course (T1) and a post-test 3 months after the end of the course without access to course contents (T2).

3587 volunteers were enrolled from 79 countries. Of these, 2590 completed T0, 1410 completed T1 and 1011 completed T2. The median study time was 194 min (IQR 96-306). Participants included nurses, physicians, other specialists and HCW and students.

The investigators obtained very positive results, evidencing an immediate learning effect of 24% (IQR 12-34%) and an overall residual effect of 18% (IQR 8-28%). A learning time of 200 minutes was associated with the maximum immediate learning effect, whilst >300 minutes was needed for the achievement of maximum residual effect.

The variables related to higher immediate learning effect were longer study time, longer work experience and living in a country with high or very high human development index; variables related to a higher residual effect were longer study time, female gender and longer work experience. The highest T0 scores were in hand hygiene and the lowest were surgical site infection. Topics with greatest immediate learning effect (T1) were surgical site infection and theoretical questions; while the lowest was hand hygiene. Finally, in T2 the topics with highest scores were ventilator-associated pneumonia and practical questions and the lowest was surgical site infection.

A limitation of this study is the lack of clinical outcomes. However, the results of the EVIDENCE project demonstrated that moderate time invested in a low-cost e-course with good usability features and exercises for self-evaluation can enhance knowledge on HAI prevention with highly positive results, and perhaps impact adherence.  While "…it is well documented indeed that knowledge does not guarantee adherence. It is much more important, though, to realise that a lack of knowledge, per definition, impedes adherence”(7).

Article review was submitted by Mireia Llaurado on behalf of the N&AHP Committee.


1.     Labeau S, Vandijck D, Rello J, Adam S, Rosa A, Wenisch C, et al. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among European intensive care nurses. J Hosp Infect. 2008;70(2):180–5. 

2.     Labeau S, Vandijck DM, Claes B, Van Aken P, Blot SI. Critical care nurses’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: an evaluation questionnaire. Am J Crit care. 2007;16(4):371–7. 

3.     Labeau SO, Witdouck SS, Vandijck DM, Claes B, Rello J, Vandewoude KH, et al. Nurses’ knowledge of evidence-based guidelines for the prevention of surgical site infection. Worldviews Evid Based Nurs. 2010;7(1):16–24. 

4.     Labeau SO, Vandijck DM, Rello J, Adam S, Rosa A, Wenisch C, et al. Centers for Disease Control and Prevention guidelines for preventing central venous catheter-related infection: results of a knowledge test among 3405 European intensive care nurses. Crit Care Med. 2009;37(1):320–3. 

5.     Labeau SO, Vandijck DM, Brusselaers N, Vandewoude K, Vogelaers DP, Blot SI. Web-based resources for critical care education. The EVIDENCE Crash Course: a Web-based interactive e-course on infection prevention for critical care clinicians. Crit Care Med. 2011;39(9):2202–3. 

6.     Labeau SO, Rello J, Dimopoulos G, Lipman J, Sarikaya A, Oztürk C, et al. The Value of E-Learning for the Prevention of Healthcare-Associated Infections. Infect Control Hosp Epidemiol. 2016;Published online 13 May 2016. Doi: 10.1017/ice.2016.107

7.    Labeau SO, Vandijck DM, Brusselaers N, De Wandel D, Vogelaers DP, Blot SI. Reduction of ventilator-associated pneumonia: enhancing knowledge is important. Intensive Care Medicine 2009; 35 (10): 1818-1819.

Comment on this news