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: Background 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. : Methods Point prevalence studies were conducted four times per annum and over the period from 1995 to 2007. : Results 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. : Conclusion 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. [ABSTRACT FROM AUTHOR]