will only be one patient admitted to a room, only one patient can contaminate the environment. After the patient is discharged, the room can be cleaned and any contamination can be removed. However, there is no literature yet to support this assumption. In this thesis (chapter 3.2), we aim to determine the differences in environmental contamination, for the total bioburden and the presence of MDRO, between multipleoccupancy rooms and single-occupancy rooms. Moreover, we will determine the change over time and potential build-up of environmental contamination in the new hospital building over a three-year follow up-period. Universal risk assessment and risk-based screening To prevent spread of MDRO throughout hospitals, transmission-based precautions are installed for known carriers of MDRO, in addition to standard precautions. These additional precautions differ per type of microorganism, e.g., ESBL-E carriers are cared for in contact isolation (i.e., single-occupancy room, gloves and gowns), while patients known to carry MRSA are cared for in strict isolation (i.e., isolation room with ante room, gloves, gowns, surgical masks, and hair caps) (29). In the Netherlands, patients are not routinely screened for MDRO colonization upon admission. Yet, the risk on being colonized with a MDRO upon admission is determined for all patients through the MDRO universal risk assessment and, when patients are deemed at risk, a risk-based screening (30). This nationally implemented risk assessment consists of six questions: i) Is the patient a known carrier of a MDRO, ii) has the patient recently been treated in or admitted to a healthcare institution abroad, iii) did the patient stay in a healthcare facility known with a MDRO outbreak in the past two months, and if yes, was the patient approached for screening, iv) has the patient lived in an institution for asylum seekers in the past two months, v) does the patient live or work where pigs, veal calves or broilers are kept commercially, and vi) is the patient a partner, housemate or caregiver of someone who is MRSA positive? Additionally, at the Erasmus MC, the question “are you a professional seafarer” is added due to the finding that the prevalence of MRSA is higher among seafarers who are frequently visiting our hospital as they come from the nearby located port of Rotterdam (31). When the universal risk assessment indicates that a patient is deemed high risk to be a carrier (e.g., patient is a professional seafarer, or the housemate, caregiver or partner of a MRSA carrier), screening cultures (i.e., nasal, throat, and perineal/rectal cultures) are obtained and the patient is cared for in strict isolation until the results of the screening cultures are known. When a patient is deemed low risk (i.e., patient was admitted in a hospital abroad over two months ago, but did undergo surgery or had a wound), screening cultures are obtained, but the patient is not preemptively placed in isolation. When the patient is categorized as having no risk for MDRO carriage, no cultures are taken and the patient is not preemptively placed in isolation. The MDRO universal risk 14 Chapter 1
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