Additionally, to determine if a universal screening strategy could be an alternative strategy, the cost-effectiveness needs to be evaluated, preferably for different MDRO prevalence rates. Moreover, even though our results do not clearly show that universal screening is more effective for specific patient populations, the added benefit of universal screening for specific patient populations (e.g., ICU) should be evaluated. Our results can also be used for modelling studies to identify the best approach. Conclusion Overall, our results indicate that the currently installed universal risk assessment combined with risk-based screening in a tertiary care center in the Netherlands is not successful in identifying MDRO carriers upon admission. The universal screening strategy identified significantly more new carriers. In our opinion, to improve the yield of the universal risk assessment, an updated version of the universal risk assessment would be the best approach in settings similar to ours, as the current risk factors are not identifying all ESBL-E carriers. Cost-effectiveness studies need to be performed to determine if a universal screening strategy could be a valid alternative strategy. 86 Chapter 2.3
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