title: Combined interventions are effective in MRSA control.
abstract: BACKGROUND
  A large healthcare-associated epidemic mainly caused by one methicillin-resistant Staphylococcus aureus (MRSA) strain broke out in Pirkanmaa County, Finland, in 2001. This study describes the impact of infection control and screening practices on the epidemic.
  
  
  METHODS
  The number of hospital-acquired (HA)-MRSA findings obtained from clinical and screening samples during the epidemic was calculated. Strains were typed by pulsed-field electrophoresis (PFGE) or spa typing. Strain type distribution was studied in relation to sample type, year of the epidemic and site of transmission. Several infection control interventions were launched stepwise and screening protocols were expanded.
  
  
  RESULTS
  A total of 4118 cases were identified during 2001-2014, of which 3527 were classified as HA. One strain (spa t067) dominated in the epidemic. HA-MRSA cases decreased constantly from the year 2011. The number of new HA-MRSA cases was 57% less in the year 2014 (n = 171) as compared with the year 2011 (n = 399). The proportion of the epidemic strain declined significantly over the years. Screening samples comprised 71% (2439/3527) and clinical samples 29% (1034/3527) of HA-MRSA findings. The number of HA-MRSA cases found from clinical samples started to decrease when screening was expanded. An increase in hand-rub consumption was associated with a decrease in transmissions in Tampere University Hospital (TAUH).
  
  
  CONCLUSIONS
  Implementation of universal screening together with several other interventions is effective in containing an MRSA epidemic. The proportion of other than Pirkanmaa epidemic (PE)-MRSA strain findings increased throughout the period, indicating the changing epidemiology of MRSA.
authors.affiliation: From the Department of Internal Medicine, Infectious Disease Unit, Tampere University Hospital , Tampere , Finland.
authors.forename: Elina
authors.initials: E
authors.lastname: Jokinen
authors.forename: Janne
authors.initials: J
authors.lastname: Laine
authors.forename: Reetta
authors.initials: R
authors.lastname: Huttunen
authors.forename: Pertti
authors.initials: P
authors.lastname: Arvola
authors.forename: Jaana
authors.initials: J
authors.lastname: Vuopio
authors.forename: Laura
authors.initials: L
authors.lastname: Lindholm
authors.forename: Risto
authors.initials: R
authors.lastname: Vuento
authors.forename: Jaana
authors.initials: J
authors.lastname: Syrjänen
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D005387:Finland / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
keywords: Epidemic; hand hygiene; infection control; methicillin-resistant Staphylococcus aureus (MRSA) in humans; surveillance