Statistical analyses Responses to the survey were analyzed in total, and within and between countries. Regarding analyses between countries, the following categories were used: 1) the Netherlands, 2) the United Kingdom (UK) and Ireland, and 3) other countries. Response rates differed for each question. Unanswered questions were categorized as ‘not applicable’, ‘missing’ or ‘no’ based on the question involved. For example, when a respondent reported not using direct sampling methods, any answers to questions regarding which direct methods were used were not included, as the respondent had already indicated that this method was not used. All analyses were performed in SPSS version 28 (IBM Corp., Armonk, New York, USA). Results Eighty-nine respondents completed at least part of the survey. Forty-six respondents (51.7%) were clinical microbiologists, and 35 respondents (39.3%) were infection prevention and control (IPC) practitioners. Eight respondents had another role. Eighty-eight respondents (98.9%) worked in an acute care or specialized hospital, one respondent (1.1%) worked in a health centre. Respondents were from 21 different countries, with a range of one to 22 respondents from any one country. The majority of respondents (57.3%) were from the Netherlands (n=22, 24.7%), the UK (n=17, 19.1%), and Ireland (n=12, 13.5%). Six out of 89 respondents were from non-European countries (Hong Kong N=3, India N=2, United States of America N=1). Most respondents self-reported having good to excellent knowledge on sample collection (73/89, 82.0%), and questions in the section regarding sampling practices were answered by 58 (65.2%) respondents. Thirty-two of 58 (55.2%) respondents sampled the environment to find the source of an ongoing outbreak, 13/58 (22.4%) routinely sampled the environment for monitoring reasons, and 2/58 (3.4%) respondents never sampled the environment. Regarding sampling protocols, 42/56 (75.0%) respondents reported that they always or usually had a sampling protocol. Respondents reported that areas to be sampled were determined both prior to entering the area and while in the area to be sampled, instead of solely prior to or while in the area (30/56, 53.6%). Sample locations No sample was universally sampled for any target microorganism (Figure 1). However, for certain sites, there was consensus within countries not to sample certain locations for a target microorganism. UK respondents never sampled the privacy curtain for any microorganisms, and Dutch respondents never sampled the mattress and patient locker for Pseudomonas spp. Amongst Dutch, UK, and Irish respondents, there was consensus not to sample the showerhead, shower drain, and toilet bowl for MRSA. Other countries did report sampling these sites. Dry sites were mainly sampled for CPE, except in the Netherlands, where these sites were most frequently sampled for VRE. Wet or damp sites were mainly assessed for the presence of CPE in the UK and Ireland, and to detect both CPE and Pseudomonas spp. in the Netherlands and in other countries (Figure 1). 132 Chapter 3.1
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