Multidisciplinary consortia like PE-ONE are essential and rely heavily on the generosity of funders, in our specific case the board of directors of the Erasmus MC. To ensure the future of these consortia, this generosity of funders is pivotal, and we would like to acknowledge and thank the board of directors for funding PE-ONE. We conclude that single-occupancy rooms and private bathrooms provide a microbial safer environment compared to multipleoccupancy rooms and shared bathrooms. This is based on the decrease in intra-hospital patient transfers and their association with acquisition of ESBL-E, and on the observed decrease in environmental contamination and the anticipated effects this will have on transmission from the hospital environment to patients. Consequently, our recommendation for architects is to include 100% single-occupancy rooms in the design of future hospitals. Future perspectives This thesis provides important insights in the effect of transitioning to 100% singleoccupancy rooms and the impact on the microbial safety, on alternatives for screening practices for MDRO upon admission to the hospital, and on the need for guidelines for environmental sampling. However, there are still important gaps that need to be filled. Dynamics of MDRO within the hospital The true dynamics of MDRO within the hospital environment remain unknown. To gain more insight, we recommend performing a prospective study in which all patients admitted to a single, or multiple, departments are screened upon admission and upon discharge. Patients who have a long hospitalization period (>1 week) should be screened weekly during hospitalization. Additionally, environmental samples should be taken. The results of these samples should be used to determine transmission and transmission routes within the department. Additionally, this data could help identify which proportion of transmissions in the hospital currently remains unidentified, and how infection prevention and control interventions could be tailored to prevent these. Screening upon admission Our results identified gaps in the currently installed universal risk assessment combined with risk-based screening for MDRO upon admission. We recommend that a multi-center study should be performed, to identify the added value of universal screening upon admission. Simultaneously, risk factors for MDRO colonization need to be determined, for example by a questionnaire upon admission. With these data and the results of the universal risk assessment, the most important risk factors for MDRO colonization upon admission can be determined. Additionally, this will show the percentage of MDRO carriers who do not have any risk factors. These data could then be used to decide if the universal risk assessment should be updated, or if it is cost-efficient to introduce universal screening upon admission, or screening upon admission for specific patient populations. The ultimate goal would be a prediction model embedded within the electronic health records. Upon 4 197 Summarizing discussion
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