title: Is an increase of MRSA in Oslo, Norway, associated with changed infection control policy?
abstract: OBJECTIVE
  The objective was to describe the prevalence of MRSA in Oslo, Norway, before and after introduction of a new National MRSA Control Guideline.
  
  
  METHODS
  From 1993 to 2006, we prospectively collected clinical and microbiological data on all MRSA cases in Oslo, Norway. Two MRSA guidelines; a strict Ullevål Standard MRSA Guideline and a less strict National MRSA Control Guideline were compared.
  
  
  RESULTS
  During 1993-2006, 358 MRSA cases were registered in Oslo; 43.9% detected in Ullevål University Hospital, 21.2% in nursing homes, and 18.7% in primary healthcare. One out of three (30.4%) were import-associated, and one out of ten (11.2%) were healthcare personnel. From 2004 on, a new National MRSA Control Guideline was introduced in primary healthcare, served by the community infection control. From 2004 on, there was a 4-6-fold increase of MRSA in primary healthcare (p = 0.038) and nursing homes (p = 0.005). Increase of MRSA cases at Ullevål (p < 0.001) was import-associated or from outbreaks in primary healthcare. There was no increase of internal spread in the hospital.
  
  
  CONCLUSIONS
  These data indicate that perhaps a less strict national MRSA infection control guideline in Norway may be associated with the 4-6-fold increase of MRSA cases in the community after 2003.
authors.affiliation: aDepartment of Hospital Infections, Ullevål University Hospital, 0407 Oslo, Norway. bjorgmarit.andersen@ulleval.no
authors.forename: Bjørg Marit
authors.initials: BM
authors.lastname: Andersen
authors.forename: Mette
authors.initials: M
authors.lastname: Rasch
authors.forename: Gaute
authors.initials: G
authors.lastname: Syversen
mesh_terms: D004196:Disease Outbreaks; D017408:Guidelines as Topic; D006225:Hand / Q000382:microbiology; D006801:Humans; D017053:Infection Control / Q000331:legislation & jurisprudence* / Q000592:standards; D008403:Mass Screening / Q000379:methods; D016106:Methicillin Resistance / Q000502:physiology*; D009664:Norway / Q000453:epidemiology; D009666:Nose / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development / Q000302:isolation & purification