Hospital acquired infections, especially antimicrobial resistant (AMR) pathogens increase Irish hospital patient stays and their mortality. Some AMR pathogens such as vancomycin resistant Enterococcus faecium (VREfm) are endemic in Irish hospitals. The infection prevention and control (IPC) measures implemented to reduce MRSA have not stopped the proliferation of VREfm. Other priority AMR pathogens: AMR Escherichia coli and Klebsiella spp, including carbapenem resistant enterobacteriales, are now at low levels of infection but they will rise as all others have over the past 20 years. We need to identify all reservoirs of persistent AMR pathogens within our hospitals to develop or apply IPC measures to minimise patient infections. This project will identify the potential of hospital sanitary ware to harbour AMR pathogens, provide the data needed to identify if they have transferred to infect patients and identify the AMR elements transferring between pathogens. Utilising four hospitals will enable the cross-hospital and within hospital comparisons of the WHO list priority AMR pathogens. Whole genome sequencing (WGS) is a powerful tool to compare the relatedness of AMR pathogens within our hospitals. This project will utilise WGS of AMR pathogens isolated from the sanitary ware and compare them with the bloodstream infections of Irish hospital patients over the same timeframe. The data and analysis will provide the IPC teams with the evidence required to implement additional IPC measures within these areas. We cannot remove the sanitary ware from our patients’ rooms but we must also ensure that their use does not increase AMR infection levels. This study will impact the health of the hospital patient population through a better understanding of whether patients hospital bathrooms impacts the potential to acquire an AMR bloodstream infection (BSI) in hospital. It will aid epidemiologists by providing the largest WGS pathogen database from Irish BSI and sanitary ware.