Literature on the impact of 100% single-occupancy rooms on environmental contamination with MDRO is lacking. However, as stated in the general introduction of this thesis, the hypothesis is that, since there will only be one patient admitted to a room, the contamination will be lower. The transition to 100% single-occupancy rooms also meant that a final cleaning after discharge could be introduced. While patient rooms were always cleaned after discharged, in multiple-occupancy rooms this would mean that only the patient specific surfaces were cleaned, as there were still patients admitted to the room. Although we did not observe a difference in the total bacterial contamination of the hospital environment, we did show a significant reduction in the environmental contamination with MDRO (41). Interestingly, sink drains were the most contaminated location in the old hospital building, but no contamination was observed in the new hospital building. This is partly explained by the fact that the old building had persistent colonization of the sink drains with VIM-positive Pseudomonas aeruginosa following an outbreak (81). However, not only P. aeruginosa was identified in sink drains in the old hospital building. This seems to be an effect of the relocation of the hospital building, where sinks and sink drains are new, and sinks had a different design compared to those in the old building, and potentially of awareness of usage. Additionally, we introduced sink plugs on all sink drains in the new hospital building and screens next to the sinks where needed. The sink plugs were installed in some sinks in the old hospital building, to decrease transmission of P. aeruginosa from sink drains to patients (82, 83). It is important to note that the difference in environmental contamination is not the result of differences in prevalence, as we did not observe differences in colonization rates upon admission to the hospital building between the old and the new hospital building (4). The decrease in environmental contamination is important, as the hospital environment is an important source of outbreaks (37). The introduction of 100% single-occupancy rooms will not eliminate the risk of transmission from the hospital environment to patients, but when the contamination rates are lower, it is likely that the frequency of transmission decreases. The COVID-19 pandemic has highlighted the need for pandemic preparedness. It is important to evaluate the added benefit of single-occupancy rooms in this light. During the COVID-19 pandemic, scarcity of rooms suitable for isolation was an important concern for many hospitals. However, in our hospital, every room was available as an isolation room. Additionally, with the emergence of other MDRO and Candida auris single-occupancy rooms are also a necessity, as the guideline is to isolate patients in single-occupancy rooms. It is possible that, with future epidemics or pandemics, 100% single-occupancy rooms may even become a necessity to care for large numbers of infectious patients. It is important to acknowledge that the introduction of 100% single-occupancy rooms affects more than just the microbial safety of the hospital environment. Therefore, the other studies within the consortium PE-ONE will determine the effects from a management point of view, on experiences from patients and staff, and evaluating work situations and efficiency. 196 Chapter 4
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