An important strength of this study is that, to our knowledge, this is the first study to determine environmental sampling practices. This study has, however, several limitations. First, despite being distributed to a large network of relevant professionals, a relatively small number of respondents replied, and the majority were from three countries. Second, most respondents were either IPC practitioners or clinical microbiologists, and only one was a scientist. Third, we do not know the total number of individuals to whom the survey was sent, as it was distributed by various professional societies and groups. Furthermore, we were unable to determine variations according to professional background and the size of hospital. Therefore, the limited perspective captured by this survey may not be representative of true practices. The results of our study highlight the diversity and lack of consensus regarding environmental sampling practices and laboratory processing, both within and between countries. There is a need for national and/or international guidelines or advice regarding environmental sampling practices, to provide some consistency in sampling. Currently, there are guidelines on surface sampling in the food industry (11). However, there are obvious differences between the surfaces in healthcare buildings and in the food industry and the activities that occur in both settings. A standard of <5 colony forming units/cm2 for aerobic bacteria has been suggested for surfaces in hospitals, but this has not been universally agreed (12). Nonetheless, guidelines might optimize the benefits of environmental sampling, including a focus on what to sample and for what purpose, and how to minimize unnecessary costs. Then environmental sampling might be more effective and the results would be more comparable at a national and international level. However, perhaps information about environmental sampling on a larger scale is needed first. We also need to have a greater understanding of the motivation behind sampling the environment, what information is being sought by investigators, and how the results inform and shape IPC measures. 3 135 Environmental sampling practices of innate hospital surfaces
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