Introduction Healthcare-associated infections (HAI) are a worldwide problem, lengthening hospital stay, morbidity, and mortality in affected patients; all considerably increasing healthcare costs. One of the leading bacteria causing HAI is Staphylococcus aureus. S. aureus is an opportunistic pathogen that colonizes the nose and skin, but can cause a range of infections, e.g., skin and surgical site infections (1). Additionally, S. aureus is an important cause of both community- and hospital-acquired bacteremia, with a mortality rate between 15-25% (2, 3). Nasal carriage of S. aureus is a risk factor for acquiring HAI (4). Approximately one third of the population is a carrier of methicillin-susceptible S. aureus (MSSA), however, the prevalence of methicillin-resistant S. aureus (MRSA) carriers in the Netherlands is much lower, 0.03-0.17% (5, 6). Of all S. aureus infections, 80% are endogenous (7, 8). Hence, it is estimated that only 20% of S. aureus infections is exogenous. The latter patient group, although not well understood, tend to have longer hospitalizations following bacteremia and a higher risk of mortality compared to patients with endogenous infections (7). Consequently, preventing acquisition of S. aureus in the hospital is essential. Acquisition can occur via contact with colonized patients or personnel, but also via direct or indirect contact with contaminated surfaces (9). While the clinical relevance of S. aureus and the ability to contaminate surfaces are known, the dynamics within the hospital environment and between the hospital environment and patients are relatively unknown. Therefore, we aimed to determine these dynamics within our hospital by examining carriage and acquisition of S. aureus in patients, and to determine environmental contamination rates by S. aureus. Finally, we aimed to identify transmissions between patients and the environment. Methods Setting and study design This observational study (the MOVE study) was performed at the Erasmus MC University Medical Center in Rotterdam, the Netherlands (Erasmus MC), from January 1, 2018, until May 31, 2021 (Figure 1), and included prospective screening of patients and the environment. Patient data were retrospectively collected from January 2013 until August 2020. During the study period, in May 2018, the Erasmus MC relocated to a newly constructed hospital with 100% single-occupancy rooms and private bathrooms (10, 11). Participating departments were the adult intensive care unit (ICU), cardiology, gastroenterology and hepatology, general surgery, hematology, internal medicine, nephrology, neurology, neurosurgery, orthopedics, and plastic surgery, in both hospital buildings. 2 99 Dynamics of S. aureus in patients and the hospital environment
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