Figure 1. Timeline of nasal screening sampling, environmental sampling, and retrospective collection of S. aureus positive clinical cultures. Arrows indicate the 17 sampling moments of the environment. Dark grey indicates the timeline for samples related to included patients, light grey indicates the timeline for samples related to the hospital environment. Data collection S. aureus isolates identified from three sample types were included: 1) nasal screening samples taken from included patients, 2) clinical samples taken from selected patients admitted to our hospital, and 3) environmental samples. Nasal samples All patients admitted to participating wards were approached for participation (Figure 1). Inclusion criteria were ≥18 years and an expected hospital stay of ≥48 hours. After informed consent, nasal swabs were taken with flocked e-swabs (FLOQSwabs®; Copan, Italy) within 24 hours of admission and on the day of discharge. Patients missed at discharge were requested by mail to take the swab at home. Nasal samples taken between January 2018 and June 2018 were stored in -80°C after 0.3 mL 99.5% glycerol was added. From June 2018 onwards, samples were processed directly. Clinical cultures Isolates from all types of cultures (e.g. blood, liquor, skin) were included from patients included in the study together with patients with an epidemiological link to a positive patient room (Figure 1). Patients had an epidemiological link to the room when they were admitted to the ward of the positive room within three months prior to or after environmental sampling and when they had an S. aureus positive clinical culture. Epidemiological links were determined for S. aureus positive rooms between April 2018 and May 2020. Per patient, one MSSA and/or MRSA isolate per spa-type was included. For patients included in the study, S. aureus positive clinical cultures taken before or during their hospitalization were collected (Figure 1). 100 Chapter 2.4
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