Endemic MRSA (methicillin-resistant Staphylococcus aureus) colonization and infection has been shown to increase morbidity, length of stay and hospital cost. Prevention of transmission demands innovative approaches. Descriptive statistics were used to determine high-incidence units. On admission, patients with a history of previous admission to a healthcare institution within the past six months were screened for MRSA. Point prevalence studies were carried out on units with more than two nosocomial (hospital-acquired) MRSA patient isolates within a four-week period. A multidisciplinary team from Infection Control and clinical units determined potential contributing factors. Recommendations included increased organism-specific education for staff, environmental cleaning and elimination of sources of transmission. Control charts to monitor nosocomial incidence rates were provided to those units that historically had a high prevalence of MRSA infections and colonization. Compliance with the infection control isolation guidelines and screening guidelines was monitored by the service. There was a 60% decrease in nosocomial MRSA between 2000 and 2001. Unit feedback was extended throughout the hospital. This decrease has been sustained since 2001 with annual rates per 1000 patient-days of 0.61 for 2000, 0.21 for 2001, 0.24 for 2002, 0.25 for 2003, 0.35 for 2004 and 0.19 for 2005.