Reduction Of Hospital-acquired Infections Research Articles

Hygiene and health: Effects, experiences, and expertise of “Clean India Campaign” from a tertiary care hospital

Background: The current happenings in the country for the good should be of importance in the crucial places and the critical phases of life, i.e., hospitals and during hospitalization, even for normal life processes. The current “Clean India Campaign” is a catalyst for hospitals for improvements in hygiene. Objective: The objective of this study is to define and describe the impact of multifaceted infection control and hygienic practices by all on hospital-acquired infections (HAIs) in the pediatric age group. Materials and Methods: Implementation of multifaceted infection control policies was ensured along with the health educationfor hygienic practices by all, including attendants of patients and patients when possible. These were rigorously enforced with the renewed enthusiasm since the launch of “Clean India Campaign” from January 2015. The setting was “Paediatric Wing” of a tertiary care hospital catering to a large army cantonment, and also, referred cases. The outcome measures were the incidence of HAIs. Results: The incidence rate of HAIs was 2.91% (July 2013-December 2014) and declined to 1.59% (January 2015-June 2016) (relative risk: 0.547, 95% confidence interval: 0.409-0.733; p=0.0001). The most significant decline in HAI in our study has been in that of gastrointestinal infections (RR: 0.428%, 95% CI: 0.241-0.761; p=0.0034). Overall, the results of preventiveactions were rewarding (RR: 0.547, 95% CI: 0.409-0.733; p=0.0001). Conclusion: The mission “Clean India Campaign” and the WHO’s vision “clean care is safer care” lead to prevention and reduction of HAIs. Implementation of multifaceted infection control interventions is impactful. Hygienic practices teaching should be for both caregivers and caretakers.

Why sensitive bacteria are resistant to hospital infection control.

Background: Large reductions in the incidence of antibiotic-resistant strains of Staphylococcus aureus and Clostridium difficile have been observed in response to multifaceted hospital-based interventions. Reductions in antibiotic-sensitive strains have been smaller or non-existent. It has been argued that since infection control measures, such as hand hygiene, should affect resistant and sensitive strains equally, observed changes must have largely resulted from other factors, including changes in antibiotic use. We used a mathematical model to test the validity of this reasoning. Methods: We developed a mechanistic model of resistant and sensitive strains in a hospital and its catchment area. We assumed the resistant strain had a competitive advantage in the hospital and the sensitive strain an advantage in the community. We simulated a hospital hand hygiene intervention that directly affected resistant and sensitive strains equally. The annual incidence rate ratio ( IRR) associated with the intervention was calculated for hospital- and community-acquired infections of both strains. Results: For the resistant strain, there were large reductions in hospital-acquired infections (0.1 ≤ IRR ≤ 0.6) and smaller reductions in community-acquired infections (0.2≤ IRR ≤ 0.9). These reductions increased in line with increasing importance of nosocomial transmission of the strain. For the sensitive strain, reductions in hospital acquisitions were much smaller (0.6 ≤ IRR ≤ 0.9), while communityacquisitions could increase or decrease (0.9 ≤ IRR ≤ 1.2). The greater the importance of the community environment for the transmission of the sensitive strain, the smaller the reductions. Conclusions: Counter-intuitively, infection control interventions, including hand hygiene, can have strikingly discordant effects on resistant and sensitive strains even though they target them equally, following differences in their adaptation to hospital and community-based transmission. Observed lack of effectiveness of control measures for sensitive strains does not provide evidence that infection control interventions have been ineffective in reducing resistant strains.

Why sensitive bacteria are resistant to hospital infection control

Background: Large reductions in the incidence of antibiotic-resistant strains of Staphylococcus aureus and Clostridium difficile have been observed in response to multifaceted hospital-based interventions. Reductions in antibiotic-sensitive strains have been smaller or non-existent. It has been argued that since infection control measures, such as hand hygiene, should affect resistant and sensitive strains equally, observed changes must have largely resulted from other factors, including changes in antibiotic use. We used a mathematical model to test the validity of this reasoning. Methods: We developed a mechanistic model of resistant and sensitive strains in a hospital and its catchment area. We assumed the resistant strain had a competitive advantage in the hospital and the sensitive strain an advantage in the community. We simulated a hospital hand hygiene intervention that directly affected resistant and sensitive strains equally. The annual incidence rate ratio ( IRR) associated with the intervention was calculated for hospital- and community-acquired infections of both strains. Results: For the resistant strain, there were large reductions in hospital-acquired infections (0.1 ≤ IRR ≤ 0.6) and smaller reductions in community-acquired infections (0.2 ≤ IRR ≤ 0.9). These reductions increased in line with increasing importance of nosocomial transmission of the strain. For the sensitive strain, reductions in hospital acquisitions were much smaller (0.6 ≤ IRR ≤ 0.9), while communityacquisitions could increase or decrease (0.9 ≤ IRR ≤ 1.2). The greater the importance of the community environment for the transmission of the sensitive strain, the smaller the reductions. Conclusions: Counter-intuitively, infection control interventions, including hand hygiene, can have strikingly discordant effects on resistant and sensitive strains even though they target them equally, following differences in their adaptation to hospital and community-based transmission. Observed lack of effectiveness of control measures for sensitive strains does not provide evidence that infection control interventions have been ineffective in reducing resistant strains.

Why sensitive bacteria are resistant to hospital infection control.

Large reductions in the incidence of antibiotic-resistant strains of Staphylococcus aureus and Clostridium difficile have been observed in response to multifaceted hospital-based interventions. Reductions in antibiotic-sensitive strains have been smaller or non-existent. It has been argued that since infection control measures, such as hand hygiene, should affect resistant and sensitive strains equally, observed changes must have largely resulted from other factors, including changes in antibiotic use. We used a mathematical model to test the validity of this reasoning. We developed a mechanistic model of resistant and sensitive strains in a hospital and its catchment area. We assumed the resistant strain had a competitive advantage in the hospital and the sensitive strain an advantage in the community. We simulated a hospital hand hygiene intervention that directly affected resistant and sensitive strains equally. The annual incidence rate ratio (IRR) associated with the intervention was calculated for hospital- and community-acquired infections of both strains. For the resistant strain, there were large reductions in hospital-acquired infections (0.1 ≤ IRR ≤ 0.6) and smaller reductions in community-acquired infections (0.2 ≤ IRR ≤ 0.9). These reductions increased in line with increasing importance of nosocomial transmission of the strain. For the sensitive strain, reductions in hospital acquisitions were much smaller (0.6 ≤ IRR ≤ 0.9), while community acquisitions could increase or decrease (0.9 ≤ IRR ≤ 1.2). The greater the importance of the community environment for the transmission of the sensitive strain, the smaller the reductions. Counter-intuitively, infection control interventions, including hand hygiene, can have strikingly discordant effects on resistant and sensitive strains even though they target them equally. This follows from differences in their adaptation to hospital- and community-based transmission. Observed lack of effectiveness of control measures for sensitive strains does not provide evidence that infection control interventions have been ineffective in reducing resistant strains.

2-118 - Reduction of Environmental Contamination Using a Novel Persistent Solution

BACKGROUND: If the patient environment is not adequately disinfected between patients, this can contribute to an increase in hospital acquired infections (HAI). Multiple studies have concluded that after conventional cleaning methods, hospital rooms were often left contaminated. Alternatives to traditional cleaning and disinfection need to be implemented to effectively eliminate the potentially pathogenic microorganisms, which may result in a reduction of HAIs. The objective of this study is to investigate the disinfectant efficacy and persistent capabilities of a novel solution consisting of 99.95% water and 0.05% quaternary ammonium compounds (quaternary HCL, hexadecyl-ammonium salts, and cetylpyridinium chloride).

Prevention of infection and management of multidrug-resistant organisms in the PICU

Nosocomial infections threaten hospitalized patients and can lead to complications in 25-50% of those admitted to intensive care units. Nosocomial infections increase both morbidity and mortality. Infection control has a particularly important role in pediatric intensive care units; it must take into account the specificity of critically ill pediatric patients' needs and environment. Multidrug-resistant organisms cause severe and extensive disease. The prevention and control of multidrug-resistant organisms is a national priority, one that will require that all care facilities and agencies assume responsibility. Evidence-based process improvement can lead to significant reductions in hospital-acquired infections in children. Most of the process and practices, when performed routinely and appropriately, can lead to reductions in hospital-acquired infections. This review addresses issues that characterize infection control in pediatric intensive care units.

Evidence-Based and Value-Based Decision Making About Healthcare Design: An Economic Evaluation of the Safety and Quality Outcomes.

This study describes a vision and framework that can facilitate the implementation of evidence-based design (EBD), scientific knowledge base into the process of the design, construction, and operation of healthcare facilities and clarify the related safety and quality outcomes for the stakeholders. The proposed framework pairs EBD with value-driven decision making and aims to improve communication among stakeholders by providing a common analytical language. Recent EBD research indicates that the design and operation of healthcare facilities contribute to an organization's operational success by improving safety, quality, and efficiency. However, because little information is available about the financial returns of evidence-based investments, such investments are readily eliminated during the capital-investment decision-making process. To model the proposed framework, we used engineering economy tools to evaluate the return on investments in six successful cases, identified by a literature review, in which facility design and operation interventions resulted in reductions in hospital-acquired infections, patient falls, staff injuries, and patient anxiety. In the evidence-based cases, calculated net present values, internal rates of return, and payback periods indicated that the long-term benefits of interventions substantially outweighed the intervention costs. This article explained a framework to develop a research-based and value-based communication language on specific interventions along the planning, design and construction, operation, and evaluation stages. Evidence-based and value-based design frameworks can be applied to communicate the life-cycle costs and savings of EBD interventions to stakeholders, thereby contributing to more informed decision makings and the optimization of healthcare infrastructures.

Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses' hand washing.

Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not significantly. A hand hygiene protocol for patients in the intensive care unit was associated with reductions in hospital-acquired infections and improvements in nurses' hand-washing compliance. Prevention of such infections requires continuous quality improvement efforts to monitor lasting effectiveness as well as investigation of strategies to eliminate these infections.

Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study

BackgroundPrevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been...

1518Hand Hygiene for Patients: an Initiative to Study and Promote Hand Hygiene Practice for Hospitalized Patients

1518Hand Hygiene for Patients: an Initiative to Study and Promote Hand Hygiene Practice for Hospitalized Patients

HOSPITAL-ACQUIRED INFECTIONS IN BELGIAN ACUTE-CARE HOSPITALS: FINANCIAL BURDEN OF DISEASE AND POTENTIAL COST SAVINGS

Introduction: Hospital Acquired Infections (HAIs) are considered to be one of the most serious patient safety issues in healthcare today. It has been shown that HAIs contribute significantly not only to morbidity and mortality, but also to excessive costs for the health care system and for hospitalized patients. Since possibilities of prevention and control exist, hospital quality can be improved while simultaneously the cost of care is reduced. The objectives of this study were to examine the prevalence and the excess costs associated with HAIs.Methods: A retrospective observational study was performed to estimate costs associated with hospital– acquired infections in Belgian hospitals, both in procedural admissions and in medical admissions. Hospital, diagnosisrelated group, age and gender were used as matching factors to compare stays associated with HAIs and stays without HAIs. Data were obtained from the Minimum Basic Data Set 2008 used by Belgian hospitals to register casemix data for each admission to obtain reimbursement from the authorities. Data included information from 45 hospitals representing 16,141 beds and 2,467,698 patient stays. Using the 2008 national feedback programme of the Belgian government, cost data were collected (prolonged length of stay, additional pharmaceuticals and procedures) and subsequently linked to the data set. By means of a sensitivity analysis we estimated potential monetary savings when a reduction in the incidence of HAIs in hospitals having a higher rate of hospital-acquired infections in comparison to other hospitals would be realized.Results: In our sample 5.9% of the hospital stays were associated with a hospital-acquired infection. In the procedural admission subset this was the case for 4.7% of the hospital stays. The additional mean cost of the hospital-acquired infection was € 2,576 for all stays (P < 0.001) and € 3,776 for procedural stays (P < 0.001). The total burden of disease in Belgium is estimated at € 533,076,110 for all admissions and € 235,667,880 for the subset of procedural admissions. The excess length of stay varied between hospitals from 2.52 up to 8.06 days (Md 4.58, SD 1.01), representing an associated cost of € 355,060,174 (66,61% of the total cost). The cost of additional medical procedures and additional pharmaceutical products was estimated at € 62,864,544 (11.97%) and € 115,151,939 (21.60%) respectively. Overall, our results showed that considerable variability between hospitals regarding the incidence of HAIs (3.77-9.78%) for all hospital stays is present, indicating a potential for improvement. We provide a full overview of the potential monetary savings when reductions in HAIs are realized by applying different thresholds. For instance, if all Belgian hospitals having a higher rate of hospital-acquired infections improve their rate to the level of the hospital corresponding to percentile 75 (= 7.5% HAI) savings would be € 17,799,326.Conclusion: HAIs are associated with important additional healthcare costs. Although not all hospital-acquired infections can be prevented, an opportunity to increase cost-effectiveness of hospital care delivery presents itself. This study is the first to estimate the annual economic burden of HAIs for Belgium at a national level, incorporating all associated hospital costs. Apart from the fact that the cost of prolonged length of stay is of major importance, we have also shown that the cost of additional procedures and pharmaceutical products cannot be neglected when estimating the financial burden of HAIs.

Chlorhexidine Gluconate

Despite infection-prevention initiatives, hospital-acquired infections (HAIs) are still a common occurrence. Chlorhexidine gluconate (CHG) is an important antibacterial agent. Research indicates that the intervention of bathing with CHG can reduce the number of HAIs. Chlorhexidine gluconate is known to reduce the bioload of several bacteria, including multiple strains of methicillin-resistant Staphylococcus aureus. Research regarding the intervention of bathing with CHG was assessed and found to reduce central line-related blood stream infections, ventilator-associated pneumonia, and vancomycin-resistant enterococci. The reduction in HAIs was found to be greater as compared to bathing with soap and water. The reduction of these HAIs will allow for a saving of resources, finances and staff time, which may ultimately be passed on to the patient. While further research is indicated, a strong conclusion is drawn that bathing with CHG reduces the number of HAIs.

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Introduction: High Reliability Organizations (HROs) are organizations that avoid catastrophes despite existing in highly complex, unforgiving environments where normal accidents frequently occur. As part of an overarching initiative to eliminate all serious harm, our hospital embarked on a journey to become a HRO. The PICU is at the center of our hospital system and interacts with nearly every other clinical service in the hospital. The majority of deaths in our hospital occur in the PICU. Improving processes of care in the hospital at large are likely to have a significant impact on the morality rate in our PICU. Hypothesis: Hospital-wide improvement efforts to eliminate all serious harm over the last ten years correlate with decreased PICU Standardized Mortality Ratio (SMR). Methods: We reviewed our PICU database to determine PICU SMR, which is the observed mortality divided by the predicted mortality. The predicted mortality is based upon the Pediatric Risk of Mortality (PRISM)-II severity of illness score. Over the last ten years, we conducted a portfolio of improvement projects directed at improving outcomes at our hospital, including reduction of hospital-acquired infections, implementation of electronic health record, improved recognition of clinical deterioration, prevention of codes outside the PICU, error prevention training, and standardizing OR to PICU handoffs. These improvement projects have resulted in significant reductions in hospital-acquired infections (central-line associated bloodstream infections, ventilator-associated pneumonia, surgical site infections, and catheter-associated urinary tract infections), serious safety events, adverse drug events, and codes outside the PICU. Results: The PICU SMR decreased significantly over the last ten years from a baseline of 0.9 in 2001 to 0.6 in 2010. Over these ten years, hospital-wide SMR has also decreased. Conclusions: Quality transformation leads to improved outcomes, and the PICU Standardized Mortality Ratio may be used as a surrogate outcome measure for system-wide improvement efforts.

Ventilator-Associated Pneumonia: Depends on Your Definition

Reduction of hospital-acquired infections is a patient safety goal and regularly monitored by Performance Improvement committees. There is discordance between the ventilator-associated pneumonia (VAP) rate reported by the Infection Control Committee (ICC) and that observed by our Trauma Service. To investigate this difference, a retrospective evaluation of cases of VAP diagnosed on a single service was undertaken. A prospectively collected database was queried for VAP in intensive care unit patients between January 2010 and June 2011. This was compared with the list of mechanically ventilated patients provided by the ICC. Comparison for criteria used to diagnose pneumonia, ventilator day of the diagnosis, was recorded. The ICC identified two VAPs from 136 potential patients compared with the Trauma Service identifying 36 VAPs. A difference in diagnostic criteria between the ICC and the Trauma Service focused on use of the National Nosocomial Infection Survey (NNIS) algorithm versus quantitative microbiology from bronchoalveolar lavage specimens. Thirty-five of 36 Trauma Service VAPs were not identified as VAPs by the NNIS algorithm as a result of the chest radiographs. Application of differing definitions of VAP results in markedly different VAP rates. The difference has significant implications as infection rates are increasingly reported as a quality metric.

Can we use severity assessment tools to increase outpatient management of community-acquired pneumonia?

Outpatient management of community-acquired pneumonia (CAP) has several potential advantages, including significant cost-savings, a reduction in hospital-acquired infections and increased patient satisfaction. Despite the benefits, it is often difficult to identify which patients may be managed in the community without compromising patient safety. CAP severity scores, such as the pneumonia severity index (PSI) and the British Thoracic Society CURB65/CRB65 scores are designed to identify groups of patients at low risk of mortality who may be suitable for outpatient care.This review discusses the strengths and weaknesses of severity scores for use in determining site of care for patients with pneumonia.Use of the PSI in emergency departments has been shown to increase the proportion of patients treated in the community without increasing patient mortality or hospital readmissions. The CURB65 and CRB65 scores are less complex alternatives to the PSI that have been shown to perform similarly for prediction of 30-day mortality.All 3 scores identify populations at low risk of mortality who may be eligible for outpatient care. Nevertheless, a number of factors not included in severity scores may prevent discharge of these patients, including social factors, co-morbidities and severity markers not captured by severity scores. The limitations of severity scores are discussed along with recent attempts to improve predictive tools, with the development of new biomarkers and alternative scoring systems.

Germ Simulation: A Novel Approach for Raising Medical Students Awareness Toward Asepsis

Medical student procedural training has become increasingly limited amid concerns for patient safety. Because simulation education has been shown to be effective for early skills training, we used germ simulation for teaching hand hygiene principles and aseptic technique in urinary catheterization (UC). We hypothesized that posttraining, students would demonstrate proficiency comparable to surgery residents. Seventy-five clinical clerks, second-year medical students, underwent the simulation training. Sixty-four volunteered to have their asepsis scores compared with 21 residents who were credentialed for UC placement. We used simulated germs to objectively quantify effectiveness of hand washing and maintenance of aseptic technique during UC. A task-specific check list was also used for assessing UC skills. Students completed a posttraining feedback survey. Compared with residents, students after simulation training washed their hands with equal effectiveness at baseline (P = 0.2), maintained better sterility (P = 0.05), and had a higher technical proficiency score during UC (P < 0.001). Students believed that it was a great idea to use simulated germs to highlight effectiveness of hand washing (100%) and they indicated that they would pay extra attention when washing hands (97%). We describe a novel approach to germ simulation and a training approach to teach aseptic technique in UC. Students reported a heightened awareness of the importance of hand hygiene and aseptic precautions during UC. Further studies are needed to see if this could lead to a reduction in hospital-acquired infections.

Chlorhexidine Gluconate Bathing: Does it Decrease Hospital-Acquired Infections?

Chlorhexidine Gluconate Bathing: Does it Decrease Hospital-Acquired Infections?

Can Bundles Be Effective for Both Clinical and Design Interventions?

Can design professionals learn from the current trend in medicine to implement bundles of interventions to address particular situations? Practitioners - both clinical and design professionals - hunger for useful information from research that gives clear direction for aspects of their complicated practices. Meanwhile, researchers strive to narrow their focus to improve the likelihood of confidence in the findings, and as a result much of what is known is narrowly precise and does not provide guidance to address the complexity of a multi-organ human condition, or a physical environment composed of multiple elements. In each case, it is difficult to tease out a single aspect or factor that can be identified as the cause of a condition that could be corrected if only the actual cause could be known. Much reporting of serious research does not clearly explain the practical implications of findings. Translating research into practice is an issue for both clinicians and design professionals.We are seeing growing support for the use of clinical bundles or clusters of interventions intended to solve real problems in medical practice (AHRQ, 2002). One reason they can be successful is that no single initiative produces the complete result desired, and another is that the combination is demonstrably highly effective. Checklists from other fields, such as aviation, produce consistency and ensure a high level of process compliance for safer, more predictable outcomes. A clinical example is the Ventilator Bundle (Institute for Healthcare Improvement, 2005), promoted as a way to reduce the incidence of ventilator-associated pneumonia. If four interventions are used together, the results are significant, but may not be able to tell whether elevating the head of the bed, daily sedation vacations, ulcer prophylaxis, or deep venous thrombosis prophylaxis was responsible for a specific or quantifiable part of the difference.Peter Pronovost, MD, PhD, the prominent patient safety and clinical improvement physician from Johns Hopkins who received a MacArthur genius grant in 2009, has just published Safe Patients, Smart Hospitals (Pronovost & Vohr, 2010). It describes the development of clinical checklists based on short lists of seven or fewer interventions shown in the literature to be effective, which when used together produce a desired result. The development of lists or bundles of interventions is described for the original successful central line infection initiative that Pronovost pioneered, as well as for a ventilator-associated pneumonia checklist and a surgical site infection checklist. In each case, the collection of initiatives known to have an impact on the problem produced measurable - often dramatic - improvement in addressing the problem.A few years ago I had the pleasure of working together with Pronovost and others on the faculty of the critical care collaborative for the Institute for Healthcare Improvement (IHI). The IHI rapid cycle change Model for Improvement involves a Plan-Do-Study-Act cycle of quick efforts to learn how to improve process (Langley, Nolan, Nolan, Norman, & Provost, 2009). Simple exercises to test improvement ideas were sometimes promoted as one doctor-one nurseone patient-one day studies to get an early answer and to guide increasingly larger efforts. A major part of the IHI collaborative's effectiveness came from its broad promulgation of bundles of evidence-based initiatives that were being tried successfully at or more sites.As an architect, I wonder if there might be an analogous parallel in the design of healthcare environments. Can we consider combinations of design interventions, any of which may not deliver the intended result at a statistically significant level, but for which as a group of interventions consistently significant outcomes might be produced? Are there bundles or clusters of design concepts that would deliver reductions in hospital-acquired infections, patient falls, medication errors, or staff injuries? …

Should the UK government's deep cleaning of hospitals programme have been evaluated?

Background: In September 2007, the UK government announced a £57.5m programme of `deep cleaning' for every NHS hospital in England. The programme was met with some scepticism and this paper provides an outline economic evaluation of the programme. Methods: We use information on costs of the programme, the opportunity cost of closing wards for cleaning and cost savings and health gains resulting from cleaning to model the reduction in the annual hospital acquired infection (HAI) rate required for the programme to be cost-effective. We compare our results with the potential headroom available, based on the available evidence and the beliefs of 15 experts. Findings: If wards are closed for two days for cleaning, an annual HAI reduction of 7.8% (21,000 fewer non-fatal infections and 355 fewer deaths nationwide) would be required at a cost-effectiveness threshold of £30,000 per Quality Adjusted Life Year. This figure does not compare favourably with the effectiveness estimates of &lt;1% obtained from the available evidence on cleaning and the pooled prior beliefs of 15 experts. Interpretation: Our analysis shows that as it is very unlikely the deep cleaning programme would have been cost-effective, a full evaluation would not have been a good use of public funds.

Hospital-acquired infections before and after healthcare reorganization in a tertiary university hospital in Norway

To evaluate hospital-acquired infections (HAIs) in somatic (all admissions other than psychiatric) and psychiatric patients admitted to a tertiary university hospital in Oslo, before and after reorganization of the Norwegian healthcare system in 2002. Point prevalence studies were conducted four times per annum and over the period from 1995 to 2007. A total of 57,360 patients were studied over the whole time period: 80.5% in somatic wards and 19.5% in psychiatric wards. The HAI rate was 6.9%, of which 8.1% were somatic and 1.9% psychiatric. 13.4% of operated patients had HAI, including 6.2% due to surgical wound infections. In somatic wards, 0.6-1% were re-admitted with HAI, 15.2-23% had infections and 18-23% used antibiotics. There was a reduction in HAI until 2002. From 2003 on, HAI increased (P = 0.010) in somatic wards (P = 0.002), in non-operated patients (P = 0.024) and in extra costs. In 2002, the Norwegian healthcare system was reorganized. This reorganization led to a 30% increase in somatic patients treated from 2003 to 2007 (P = 0.054), 27% increase in the total workload per work position (P = 0.024) and 23.5% decrease in internal service work. A declining trend of HAI was observed from 1995 to 2002 at the tertiary university hospital in Norway. In 2002, the Norwegian healthcare system was reorganized. From 2003 to 2007, HAI increased significantly as did the number of somatic patients and workload at our hospital.