Positive Deviance Decreased Infection Rates in Canadian Hospitals


Investigators from the Ontario Agency for Health Protection and Promotion, Canada and from the University Health Network in Toronto, Ontario, Canada, sought to determine if positive deviance (PD) can reduce healthcare-associated resistant organisms, specifically methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), and C. difficile.

Five acute care hospitals were recruited to implement PD at six sites. Data on four-month resistant organism-related infection rates, the volume of alcohol handrub and soap used, and the number of gowns and gloves used, were collected at baseline and then for 12 months prospectively. Social network mapping was conducted at the project start and end. Qualitative staff interviews were conducted at the project end. The percent change from baseline in quarterly resistant organism-related infection rates were measured from September 2009 to December 2010. Process measures were collected and measured in a similar fashion.

Reason, et al. report that of the six sites, five implemented PD as planned, while one was unable to, largely due to organizational restructuring. Three of the five sites sustained decreases in resistant organism-related infection rates of 25 percent, 41.2 percent and 63.9 percent. Rates at the fourth site were unchanged, while the fifth site had a VRE outbreak, which resulted in a large increase in the overall resistant organism-related infection rate. HA-MRSA decreased by 100 percent at two hospital sites; HA-VRE decreased by 100 percent at two sites; and healthcare-acquired C. difficile decreased at three sites by 53 percent, 51.9 percent and 23 percent. The one site that measured hand hygiene compliance had a 53.2 percent rate increase. Interestingly, decreasing resistant organism-related infection rates did not clearly correlate with the process indicators.

Reason, et al. conclude that PD has been successfully used in a number of settings facing complex problems and that they have shown it to be successful in reducing resistant organism-related infection rates in Canadian acute-care facilities where the organizational climate allowed it to be implemented. Their research was presented at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland, June 29-July 2, 2011.

Reference: P Reason, L Rykert and M Gardam. Using positive deviance (PD) to reduce antibiotic resistant organisms: the Canadian PD project. Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):O50doi:10.1186/1753-6561-5-S6-O50

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