The Robert Wood Johnson Foundation (RWJF) and the Plexus Institute today announce results from an analysis of a multifaceted methicillin-resistant Staphylococcus aureus (MRSA) prevention program that employed positive deviance (PD), a novel approach to social and behavioral change, to trigger significant reductions in MRSA incidence ranging from 26 percent to 62 percent at participating hospitals. In addition, as MRSA rates dropped, the hospitals saw a decline in the proportion of Staphylococcus aureus infections caused by methicillin-resistant bacteria, signifying that hospitals can make headway in the fight against drug-resistant superbugs.
"Reports of successful multicenter interventions to reduce endemic antimicrobial resistance problems among U.S. hospitals are extremely rare," says John A. Jernigan, MD, MS, an epidemiologist at the national Centers for Disease Control and Prevention (CDC) and part of the CDC team that conducted the analysis. "These extremely encouraging findings add to a growing body of evidence that hospitals can make a difference in their endemic MRSA rates, and further might be able to improve the chances that infected patients have the best possible treatment options available. It shows that hospitals can make an important difference in antimicrobial resistance even at a time when the availability of new antibiotics has stagnated."
CDC's analysis was presented at a special late-breaker session during the Society for Healthcare Epidemiology of America (SHEA)'s annual scientific meeting on March 21.
In 2006, Plexus, in collaboration with the Positive Deviance Initiative and the CDC, began its MRSA prevention program to examine the effect of using PD in hospitals. PD is based on the premise that, in every organization or community, there are people who solve problems better than peers who have exactly the same resources. The PD process engages frontline hospital staff in discovering and spreading those practices. In other words, PD seeks to engage every person in the health care environment to identify what makes it possible for everyone who comes in contact with patients to take effective infection-control measures at all times.
Primary funding for the PD MRSA Prevention Partnership came from RWJF's Pioneer Portfolio, which supports innovative ideas that may lead to breakthrough improvements in the future of health and healthcare.
The three hospitals (Billings Clinic, Billings, Mont.; Albert Einstein Medical Center, Philadelphia; and University of Louisville Hospital, Louisville, Ky.) that were included in the Partnership and the CDC analysis each undertook activities that included: screening all patients admitted to a pilot unit for MRSA; isolating all patients who tested positive; and rigorously adhering to hand hygiene and contact precautions. The PD approach was included to help all staff members find the best ways to carry out these goals and identify and eliminate barriers to achieving them in their particular institutions.
"Proven infection prevention practices have been known for years, yet most health care organizations have been unable to achieve consistently high rates of adherence to these practices. As a consequence, MRSA has become pervasive in almost all hospitals in this country," says Curt Lindberg, DMan, chief learning and science officer of Plexus. "This is the first time the 'what' of proven infection prevention practices has been combined with the 'how' of positive deviance. The results achieved by the hospitals demonstrate the power of this novel combination."
Although each hospital's approach to reducing MRSA infections through PD was different, as is the nature of the intervention, a compelling example of results comes from Albert Einstein Medical Center, where a patient escort developed a unique method of disposing of his soiled gloves and gown. The escort figured out that by quickly sliding out of the gown, inverting it, folding it tightly and precisely stuffing it into a medical glove, he was able to compress the potential biohazard into a wad the size of a baseball prior to proper disposal, thereby eliminating it as a transmission threat. The technique has since been adopted by others throughout the facility.
It is estimated that nearly 100,000 people develop invasive MRSA infections each year, resulting in approximately 19,000 deaths. Of these infections, about 86 percent are healthcare-associated.
"It is innovative activities, such as PD, that may have a transformative impact on infection control efforts, suggesting that MRSA and possibly other drug-resistant infections need not be inevitable. They can be prevented and rates can be turned around," notes Rosemary Gibson, M.Sc., RWJF senior program officer.