assessment and the results of the risk-based screening was retrospectively collected from the patient’s electronic health records (EHR) between 2018 and 2022. Inclusion of patients for universal screening During the study period, adult patients admitted to the participating departments at the Erasmus MC with an expected hospitalization period of ≥48 hours, and who could speak and read in Dutch, were approached for participation in the MOVE study (12). Patients who were admitted multiple times during the study period were allowed to participate multiple times. Patients were not approached if they were admitted in the weekend/during holidays, if they were legally not able to decide about participating, or if they were in end-of-life stage (12). After obtaining written informed consent, a nose and perianal sample were taken on the day of admission by trained members of the study team, or by the patient, with clear verbal instructions from trained members (11). For patients admitted directly to the intensive care unit (ICU), passive informed consent was accepted (i.e., information regarding the study was provided to the patient or their family, and consent was assumed if they or their family did not explicitly object). The result of the admission screening as part of the MOVE study was not shared with the patient, nor with the treating physician, as approved by the medical ethical committee. Consequently, a positive universal screening culture did not result in isolation or otherwise change of care. Universal risk assessment combined with risk-based screening The universal risk assessment combined with risk-based screening is a national mandatory assessment (2). All patients admitted to Dutch hospitals are asked several questions upon admission to determine their risk of being colonized with MDRO (Supplementary file 1). These questions are 1) is the patient a known carrier of a MDRO, 2) has the patient recently been treated in or admitted to a healthcare institution abroad, 3) did the patient stay in a healthcare facility known with a MDRO outbreak in the past two months, and if yes, was the patient approached for screening, 4) has the patient lived in an institution for asylum seekers in the past two months, 5) does the patient live or work where pigs, veal calves or broilers are kept commercially, and 6) is the patient a partner, housemate or caregiver of someone who is MRSA positive? Additionally, in the Erasmus MC, the question “Is the patient a professional seafarer?” was added, after identifying that seafarers from the nearby harbor had higher carriage rates (13). When patients are deemed at risk according to the assessment, screening cultures (i.e., nasal, throat, and perianal for MRSA; throat and rectal samples for other MDRO) are taken. Additionally, the patient is places in pre-emptive isolation. When a patient has had an hospitalization abroad that was more than two months ago, but has undergone surgery there or a wound is still present, screening cultures are taken, but the patient is not placed in isolation (Supplementary file 1). When the risk-based screening cultures are negative, pre-emptive isolation measures are lifted. When the screening cultures are positive, pre-emptive isolation measures are adapted to the type of MDRO. When an MDRO is identified, isolation with additional IPC measures are always initiated according to the Dutch national MDRO guideline (14). Results of the risk assessment, results of screening cultures, and consequent implications for isolation measures, were reported in the patient’s electronic health records (EHR). These results were retrospectively collected from the EHR from patients included in the MOVE study. 80 Chapter 2.3
RkJQdWJsaXNoZXIy MTk4NDMw