Background Healthcare-associated infections (HAI), specifically those due to multidrug-resistant microorganisms (MDRO), are considered a worldwide threat to healthcare (1). In hospitals, infection prevention and control (IPC) measures are implemented to prevent the spread of MDRO. However, for these measures to be effective, timely identification of patients colonized with MDRO is essential. A common IPC measure to increase timely identification is targeted screening of patients based on a universal risk assessment upon admission, followed by risk-based screening (2). Upon admission, patients are asked several questions to determine the risk of being colonized with an MDRO and screened when they are considered at risk (2). Another strategy is universal screening upon admission. Universal screening strategies have been performed for methicillin-resistant Staphylococcus aureus (MRSA), however, with conflicting results. While some studies report the method not to be cost-effective, or only effective when having a high prevalence, it has also been reported that universal screening was effective in decreasing MRSA prevalence and incidence (3-6). Regarding carbapenemase-producing organisms, it was shown that universal screening might be a cost-effective strategy to reduce transmission (7-9). To our knowledge, the effect of a universal screening strategy for multiple MDRO upon admission has yet to be determined. Recently, a Dutch study showed that the nationally implemented MDRO risk assessment only identifies a small portion of all MDRO carriers, while it was associated with a high workload for healthcare workers (10). The results of that study were confirmed by another Dutch hospital (11). Consequently, it should be considered if other strategies are more effective. In a previous large prospective cohort study (the MOVE study), we performed universal screening for MDRO upon admission (12). These patients were also screened with the universal MDRO risk assessment, in compliance with standard-of-care. Consequently, we are in the unique position to have patients of whom we have results of both universal screening and of the universal risk assessment combined with risk-based screening. We aimed to determine the yield of universal screening for MDRO and compare this to the yield of the currently installed universal risk assessment combined with risk-based screening, to determine the successfulness of both strategies to identify unknown MDRO carriers. Methods Study design and setting The observational prospective cohort study (the MOVE study) was performed from January 1, 2018, until September 1, 2019, at the Erasmus MC University Medical Center (Erasmus MC) in Rotterdam, the Netherlands. The study design and setting were described previously (12). This study was approved by the medical ethical committee of the Erasmus MC (MEC2017-1011) and was not subject to the Medical Research Involving Human Subjects Act. Written informed consent was obtained from all participating patients. The study was registered in the Dutch National Trial Register (NL8406) (12). Patients in the MOVE study were prospectively included. For these included patients, data on the universal risk 2 79 Comparing universal screening and universal risk-assessment for MDRO
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