other studies have not shown an underestimation of the contamination rates. Thirdly, we only determine presence of HRMO, and not the abundance in which they were present. However, since the concentration of nosocomial pathogens is generally low, they are often only detectable with broth enrichment, which makes determining the abundance impossible (43). Fourth, we did not correct for the timing and compliance of cleaning or disinfection. During the three-year follow-up, rooms were sampled 15 times, and at different time points during the day. Some rooms were sampled directly after daily or final cleaning, while other rooms were sampled before cleaning. Since rooms were located throughout the hospital and thus cleaned at different moments, and we looked at the median CFU counts, we believe that our results are representative for the environmental contamination of our hospital. Finally, we did not determine how our results correlate with the incidence of healthcare-associated infections (HAI). Conclusion We observed significantly less HRMO in the single-occupancy rooms in the new hospital building over the three-year follow up, while CFUs were not impacted. This finding shows that, with regard to environmental contamination, single-occupancy rooms are favorable over multiple-occupancy rooms. These finding should be taken into account when considering hospital designs for renovations or the construction of hospitals. Future research should focus on the effect of changes in environmental contamination on the incidence of HAI. Additionally, the effect of single-occupancy rooms on environmental contamination in countries with higher HRMO prevalence should be determined. Finally, the impact of transitioning to single-occupancy rooms on other environmental aspects, such as the microbiome, should be studied further. 164 Chapter 3.2
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