Have a look what is happening in the operating rooms. Time for cleaning up is getting shorter every day. Before we had around 100 beds in a normal ward, now its cut down to 40–50 beds, but we are still treating as many patients as they were 10 years ago. Get in and get out. A bed is never empty. And I have my doubts as to whether these disinfectant wipes are an ideal solution. I think the time pressure is there and already a problem. (4-7).

The highest infection rates are in intensive care units, but it is certainly always clean. In the OR smears are made at regular intervals. I think this is still the safest. Unless they have very septic cases and those cases where the pus runs from the abdomen. On the hospital ward that is where I think it is not very hygienic. In intensive care so they can get almost all antibiotics, and that is where the transmission of nosocomial infections at the highest, and where there are more immunosuppressed patients. (4-1)

From our end in the clinic, it is the hospital-acquired infections that are acquired in the hospital and last for 2–3 days, possibly even later. They are often preventable through effective hygiene measures and can be much better than they would be with antibiotics. (4-3)

Our laboratory is outsourced, but once we had also invited a microbiologist to provide training, and he made a comparison of the germs in hospital with those generally presented in the other hospitals. It was good information. (4-3)

Many things change as well over the years, procedures change. Too often, there is a deficit in this information. (4-3)

Guidelines vary and are specific to each hospital. We have a very committed leader in this area, who takes a lot of trouble to log and actually follow information from each recommending commission, which often revise their information. We have a commission that discusses and revises information which is then put online for reference and so that all staff can gain insight. We also have disclosure on which department prescribe show much and how expensive it is. This is useful in individual cases, and to follow the development of resistance and hygiene. So, it is all kept very transparent. (3-3)

Pharmaceutical advertising is very important. There are at least two variants. There are those that visually present with more or less exciting images and colours. And these accordingly make you curious so that you might read some fine print and look more closely to find out what the stuff is. I find this to be the more pleasant variant. Because you immediately recognize it as such and may or may have to look closer. Medical journals on the other hand may contain interesting content, but there it's hard for you to determine what the content is. Is it a short conference report? Is it a topic that interests me? A professor on a topic I am interested in? Is it really is objective? And that's the annoying thing, because then it is difficult to distinguish. (3-7)

They also know as who is receptive. Then they just leave the bag there and just want a signature and a seal. Much is given at each and every day, many just want a short word. I've been doing this at the reception counter. Very rarely do I give them an appointment. For me there are 4 to 5 representatives each day. (1-1)

Pharmaceutical representatives give me bags full (of antibiotic samples)! (1-1)

In the moment when the pressure in the outpatient setting is relatively high, even from marketing, then certain things are pushed. Something has changed in prescribing in the outpatient setting; this is what will notice from practice in the clinic. Prescribing practice, what is underlying it, this is often not transparent. (4-6)

Until three years ago, I was still prescribing Cotrim in the urology setting. It was still cheap, at about €3. Back then, gyrase-inhibitors had a starting price of about €12. Then health regulations led to compulsory levies, which introduced a fixed fee of €8. Since then, Cotrim increased from €3 to €12—the same as the gyrase-inhibitors. Until then, the threshold for prescribing gyrase-inhibitors for UTIs was relatively high, and I prefered to prescribe Cotrim. But since the price drop, I prescribe Cotrim less and more quickly look to prescribing gyrase-inhibitors. (1-4)

Yes, I would think that costs are different for antibiotics than for other treatments. Simply because the duration of (antibiotic) treatment is short. When I prescribe an antibiotic, and even if it is an expensive one, then I know it takes 10 days or 2 weeks, so the treatment is limited from the outset. When I prescribe someone a drug for high blood pressure, which in the quarter costs 150€, then I am affected each quarter. Thus, the antibiotics—treatment when it comes to price, is certainly not as problematic as the high blood pressure treatment or other therapies I am prescribing. (2-1)

We have experienced changes: like short stays in hospital. Hospitals are simply the most dangerous places for patients. The sooner the patient is out of the hospital the better. The more minimal invasive interventions are, the lower the probability for wound infections. (3-7)

Recent medical interventions are indeed more complex and daring; cardio-haematology, oncology. We are also treating acute myelogenous leukaemia, which accounts for a lot of consumption of antibiotics. You also can't ignore that in certain areas treatments are simply too complex. The result is also that inappropriate consumption is higher. This is the price for medical progress. Bypasses for 80 year olds, do an ACVB and then they still catch pneumonia, lie for weeks in intensive care. This is the reality now. We believe in all sorts of advances; but we'll see the resulting effects soon enough. (4-1)