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Impact of a new hospital with close to 100% single-occupancy rooms on environmental contamination and incidence of vancomycin-resistant Enterococcus faecium colonisation or infection: a genomic surveillance study.

BACKGROUND: Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of nosocomial infection, driven by its ability to spread between patients and persist in the hospital environment. Here, we investigated the impact of a long-established cardiothoracic hospital moving to new premises with close to 100% single-occupancy rooms on the rates of environmental contamination and infection or colonisation by VRE.

METHOD: Prospective environmental surveillance for VRE was conducted at five time-points between April and November 2019, once in the original building, and four times in the new building. Flocked swabs (n=100/time-point) were used to sample bedspaces, bathrooms, computers and sluices in the critical care unit and the cardiothoracic ward. Environmental VRE was supplemented by clinical VRE isolates from the same time period, and underwent whole genome sequencing. Incidence rate ratios (IRR) of VRE infection/colonisation was determined for the one-year period before and after the hospital move, and compared to a nearby hospital.

FINDINGS: In the original location, the first environmental screen found 29% VRE positivity. The following four screens in the new location showed a significant reduction in positivity (1-6%, p<0·0001). The VRE infection/colonisation rates were halved in the new location (IRR 0·56, 95% CI 0·38-0·84), compared to the original location, contrasting to an increase in a nearby hospital (IRR 1·62, 95% CI 1·17-2·27) over the same time period. Genomic analysis of the environmental isolates was consistent with reduced transmission in the new hospital.

INTERPRETATION: The use of single-occupancy rooms was associated with reduced environmental contamination with VRE, and lower transmission and isolation of VRE from clinical samples. The cost effectiveness of single-occupancy room hospitals in reducing healthcare-associated infections should be reassessed in the context of operational costs of emerging pandemic and increasing antimicrobial resistance threats.

FUNDING: This publication presents independent research supported by the Health Innovation Challenge Fund (WT098600, HICF-T5-342), a parallel funding partnership between the Department of Health and Wellcome Trust. FC reports funding from the Wellcome Trust (LSHTM/Wellcome Institutional Strategic Support Fund Fellowship [204928/Z/16/Z]. KR was supported by an ESCMID Research Grant (ref. 15996).

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