to determine if transmission of S. aureus occurred between patients and the hospital environment and vice versa. To prevent transmission from the environment to the patient, correct cleaning and disinfection of hospital surfaces is needed. This is confirmed by the study of Chen et al., in which they report on frequent transmission between the hospital environment and patients, early in their admission (37). They suggest that room disinfection after discharge of patients might be inadequate in preventing transmission of MDRO. In the study of Chen et al., all rooms where disinfected after patient discharge. However, in the Netherlands, disinfection is only indicated after discharge of a patient that was a known carrier of a MDRO or other specific pathogens (e.g., Clostridioides difficile). In all other situations, rooms are dry cleaned and with damp microfiber cloths and not disinfected. This could result in a high environmental contamination rate, since not all MDRO carriers are identified, and thus their rooms are not disinfected upon discharge. However, the current environmental contamination rates are not known. In this thesis (chapter 3.2) we aim to determine the environmental contamination with MDRO in patient rooms of the old and new hospital building. Aim and outline of this thesis The main aim of this thesis is to determine the effect of an intervention, the transition of the Erasmus MC to a new hospital building with 100% single-occupancy rooms and single occupancy rooms, on two elements of microbial safety; the odds on the acquisition of MDRO, and the extent of and effect on environmental contamination. A secondary aim of this thesis is to determine screening methods to identify patients colonized with MDRO upon admission. This thesis is divided in two main chapters: patient related and hospital environment related research. In chapter 2 we will focus on patients and acquisition of, colonization with, and screening for MDRO. In chapter 2.1, the effect of the intervention (the transition to 100% single-occupancy rooms) on the odds of acquisition of ESBL-E is determined in a prospective before-and-after study. The effect of the intervention on intra-hospital patient transfers is also investigated. In chapter 2.2, the travel behavior of patients is studied via a questionnaire upon admission, and the association between travel and MDRO colonization upon admission is determined. In chapter 2.3, we compare a universal screening strategy for MDRO upon admission to the currently installed universal risk assessment and riskbased screening upon admission for MDRO in a observational prospective cohort study. In chapter 2.4, we determine the carriage and acquisition rates of methicillin-susceptible S. aureus (MSSA) and MRSA in patients, and we determine transmissions between patients and the environment, and vice versa. 1 17 General introduction
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