Effect of transitioning to 100% single-occupancy rooms and private bathrooms One of the research questions of this thesis was if the transition to a newly constructed hospital with 100% single-occupancy rooms and private bathrooms would lead to a microbiologically safer hospital. We determined if ESBL-E acquisition during hospitalization was impacted by the relocation to the new hospital building (Chapter 2.1), and if the bacterial contamination of the hospital environment was impacted (Chapter 3.2). Regarding the acquisition of ESBL-E during hospitalization, we did not see a significant difference between the old hospital building with multiple-occupancy rooms, and the new hospital building with 100% single-occupancy rooms. However, we did observe a significant decrease in the number of intra-hospital patient transfers. Additionally, we determined a significant correlation between being transferred during hospitalization, and acquiring an ESBL-E. This association was also found by Pasricha et al. (15). Consequently, the transition to single-occupancy rooms did seem to impact the acquisition of ESBL-E through the effect on intra-hospital patient transfers. The reason why these transfers decreased from 24.9% of patients to 14.0% of patients, is that introducing 100% single-occupancy rooms eliminates a number of reasons for these transfers. For example, relocating due to social circumstances, when a patient needs to be placed in contact isolation, or for small procedures (69). The impact of transitioning to single-occupancy rooms on intra-hospital patient transfers was already shown for an intensive care unit, and our research has confirmed that this effect is also observed on other departments (4, 70). Previous research has been inconclusive about the effect of single-occupancy rooms. Some studies showed that acquisition of MDRO was significantly impacted by the relocation, while other studies found no effect (71-79). The majority of these studies were performed on either an ICU or a neonatology intensive care unit. Additionally, only four observed the effect of transitioning to 100% single-occupancy rooms instead of mainly single-occupancy rooms (72-75). All of these studies showed that single-occupancy rooms could decrease nosocomial infections. The impact of transitioning to single-occupancy rooms on ESBL-E was only determined in an ICU by Levin et al. (76). They did not show that transitioning to singleoccupancy rooms impacted acquisition of ESBL-E. However, they only showed acquisition in a very small number of patients and the study did not have the power to determine statistical differences. They did observe a decrease of 8% of patients to 2% of patients who acquired an ESBL-E (76). In 2019, the study of McDonald et al. looked at the effect of transitioning to a hospital with 100% single-occupancy rooms (80). They identified that this relocation was associated with a decrease in newly identified colonization with MRSA and with VRE, and with a decrease in VRE infections. The relocation did not seem to impact MRSA infection rates, or infections with Clostridioides difficile. Due to the low observed prevalence of MDRO colonization upon admission and low acquisition rates during hospitalization in our hospital, we could only determine prevalence and acquisition rates for ESBL-E. However, considering the results of previous research, is likely that the transition could impact the transmission and acquisition of other types of MDRO. 4 195 Summarizing discussion
RkJQdWJsaXNoZXIy MTk4NDMw