admission, this prediction model, based on several risk factors, could determine the chance on MDRO carriage and determine if a patient should be screened and placed in pre-emptive isolation. However, to make such a model effective, data from different hospitals and general practitioners needs to be combined. Otherwise, gaps regarding risk factors will remain, limiting the added benefit of the model. Consequently, to make this model effective, a national electronic health record should be implemented. The hospital environment Our results of the environmental contamination seem to indicate that the cleaning protocol in our hospital is efficient. However, cleaning protocols vary between countries. We recommend performing an international survey to determine current cleaning protocols in hospitals, for both isolation and non-isolation rooms, and determine the impact on environmental contamination. With the information from this survey, the most used cleaning methods should be evaluated for efficiency. This information can then be used for a recommendation for guidelines for how to clean the hospital environment. As shown by our survey, there is no consensus for environmental sampling practices. In order to make environmental sampling more effective and results more comparable, we recommend evaluating the best sampling methods for different target microorganisms. The ESCMID study group of nosocomial infections (ESGNI), together with the Hospital Infection Society (HIS) are currently studying the role of sampling in outbreak management. A literature review should help identify the most commonly contaminated surfaces. This information can be used to determine which locations always need to be sampled. This is a first step towards a guideline. In recent years, the impact on single-occupancy rooms on the hospital-associated microbiota has been determined. However, there are still many knowledge gaps to be filled regarding this topic. We recommend determining the effect of single-occupancy rooms on the hospital-associated microbiota, and its consequent impact on transmission of HAI within the hospital environment. More insight into hospital-associated microbiota could help identifying important environmental niches for infection prevention and control and could provide more insight into the dissemination of resistance genes. Currently, the ENEMI study, as part of the PE-ONE consortium, is determining the effect of 100% single-occupancy rooms on the hospital-associated microbiota. The impact of 100% single-occupancy rooms To further determine the impact of 100% single-occupancy rooms, multiple things merit from additional research. First, our results reflect the effect of the transition to 100% singleoccupancy rooms during the three years after relocating. However, it is possible that the effect will change over time. Consequently, we recommend performing environmental sampling 5 and 10 years after relocating, to determine if the observed effects on environmental contamination were partly explained by the follow-up time, or if it is truly a long-lasting effect of the relocation. Secondly, literature on the impact of introducing 100% 198 Chapter 4
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