'Positive Deviance' Aids MRSA Reduction Efforts
SAN DIEGO — Implementation of a multifaceted methicillin-resistant Staphylococcus aureus prevention program at three hospitals triggered significant reductions in MRSA incidence that ranged from 26% to 62%.
“There are few reports of successful multicenter interventions to reduce endemic MRSA in U.S. health care settings,” lead investigator Katherine Ellingson, Ph.D., said at the annual meeting of the Society for Healthcare Epidemiology of America.
One novel approach to implementation is positive deviance, a concept that “highlights uncommon but effective solutions to persistent problems using existing resources. Once identified, solutions that work are scaled up to change new behavior.”
In the context of MRSA prevention, positive deviance “encourages hospital employees to uncover, create, and diffuse effective infection-control solutions that work in the context of a given ward or a given hospital,” said Dr. Ellingson, an epidemiologist with the Centers for Disease Control and Prevention.
In 2006 six hospitals partnered with the CDC and the Plexus Institute, a nonprofit based in Bordentown, N.J., to implement MRSA prevention programs in acute care settings. Hospitals used a combination of strategies, including enhanced emphasis on hand hygiene, contact precautions for known MRSA carriers, environmental cleaning, selective application of active surveillance testing, and positive deviance.
As a way to foster positive deviance at the hospitals, hundreds of frontline workers “were asked for their ideas on how to stop MRSA transmission, who among them was practicing good infection control, and what actions they could take to improve adherence to precautions,” according to a report available at the Web site of the Plexus Institute, which funded the study with the Robert Wood Johnson Foundation.
When a group of clinicians visited one of the hospitals participating in the study, it saw an example of positive deviance in action. As recounted in the report, the group members “saw a physician entering an isolation room without washing his hands or donning gowns and gloves. A housekeeper politely reminded the physician to wash his hands and handed him a gown and gloves. The physician complied.”
The hospitals shared electronic data for objective, third-party evaluation of the impact of the prevention efforts. At the meeting, Dr. Ellingson presented complete data from three of the six hospitals that took part in the analysis: the 272-bed Billings (Mont.) Clinic (hospital A), the 844-bed Albert Einstein Network in Philadelphia (hospital B), and the 404-bed University of Louisville (Ky.) Hospital (hospital C).
The study's primary objective was to analyze the impact of the interventions on the incidence of MRSA in hospitalized patients. The researchers extracted 12-32 months of data from the preintervention period and 20-24 months of data from the postintervention period.
When Dr. Ellingson and her associates compared the preintervention period with the postintervention period, they observed a 31% reduction in MRSA incidence in hospital A, a 62% reduction in hospital B, and a 26% reduction in hospital C. All three reductions were statistically significant.
Though the results are encouraging, Dr. Ellingson acknowledged the study had several limitations.
Positive deviance 'highlights uncommon but effective solutions to persistent problems.' DR. ELLINGSON
