Methods Study design This prospective observational before-and-after study was performed in the Erasmus MC, a university hospital in Rotterdam, the Netherlands. Environmental sampling was performed between April 2018, and May 2021. The relocation to the new hospital building took place during the study period, at May 18, 2018. Samples were taken at two moments in the old hospital building; two weeks and one week before relocating (Figure 1). In the new hospital building, samples were taken at 15 different moments; two weeks, one week and one day before relocating patients, and one day, one week, two weeks, one, three, six, nine, 12, 15, 18, 24, and 36 months after relocating patients (Figure 1). Figure 1. Timeline of the study. Arrows indicate the sampling moments in the old and the new hospital building. Study setting Old hospital building The old hospital building of the Erasmus MC opened in 1961, consisted of 1200 beds, and had mainly two- and four-patient rooms and shared bathrooms. Exceptions were the adult Intensive Care Unit (ICU), which consisted of only single-occupancy rooms; the isolation ward, which consisted of single-occupancy rooms with anterooms and private bathrooms, and three hematology wards, which consisted of mainly single-occupancy rooms with anterooms and private bathrooms. Additionally, hematology ward I had one three-patient room, hematology ward II had two two-patient rooms, and hematology ward III had two two-patient and two three-patient rooms, all with attached bathrooms. Two of the hematology wards were located at another location in Rotterdam; the Erasmus MC Cancer Institute, location Daniel den Hoed. The Cancer Institute also relocated to the new hospital building on May 18, 2018. 150 Chapter 3.2
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