Billings Clinic Data Presented at National Conference Shows Effectiveness of Positive Deviance to Reduce MRSA

Billings, MT (March 24, 2009) - Billings Clinic is one of three sites that provided data for a national study to analyze the effectiveness of positive deviance (PD) to reduce methicillin-resisitant Staphylococcus aureas (MRSA).  Results show a major reduction of healthcare-associated infections of the deadly pathogen. CDC's analysis, which included Billings Clinic data, was presented on March 21, 2009 at the annual scientific meeting for the Society of Healthcare Epidemiologists of America (SHEA).

"From January 1, 2005 to December 31, 2008, we were able to decrease the presence of MRSA at Billings Clinic by 84%," said Camilla Saberhagen, MD, Department of Infectious Disease at Billings Clinic.  "Our statistical analysis shows that these results are directly related to our efforts to decrease MRSA using the positive deviance approach."

The Robert Wood Johnson Foundation and Plexus Institute on March 23, 2009,  announced results from an analysis conducted by a MRSA prevention team at CDC which documented  reductions in MRSA incidence at the participating hospitals- Billings Clinic, Albert Einstein, and University of Louisville.  The measure is a MRSA incidence density based on clinical culture data in existing electronic databases at the hospitals. These participating hospitals had the electronic data necessary for the study. CDC's analysis was presented at a special late-breaker session during the Society for Healthcare Epidemiologists of America's 19th Annual Scientific Meeting on Saturday, March 21. The CDC team concluded that successful implementation of the multi-faceted MRSA prevention program using PD resulted in significant MRSA reduction with sustained decreases demonstrated over time.
 
In 2006, Billings Clinic joined an initiative with Plexus Institute, the CDC, the Positive Deviance Initiative at Tufts University and five other healthcare organizations to examine the effects of using the social and behavioral change process called Positive Deviance (PD). PD is based on the premise that, in every organization or community, there are people who solve problems better with peers who have exactly the same resources.  The PD process engages frontline hospital staff in discovering, creating and spreading those practices. In other words, PD seeks to bridge the gap between what healthcare providers know and what they do. The goal is for every person in the healthcare organization who comes in contact with patients or supports the care of patients to take effective infection-control measures at all times.

"It is the cultural transformation that PD has created that has sustained the continuous decline of MRSA infections in these hospitals," says Monique Sternin, the co-founder of the Positive Deviance Initiative. "PD was instrumental in changing relationships across departments and units and the way people work together."

Primary funding for the PD MRSA Prevention Partnership came from The Robert Wood Johnson Foundation's Pioneer Portfolio, which supports innovative ideas that may lead to breakthrough improvements in the future of health and healthcare. The healthcare organizations in the Plexus PD MRSA  Prevention Partnership are Billings Clinic, Billings, MT; Albert Einstein Medical Center, Philadelphia, PA; Franklin Square Hospital Center, Baltimore, MD; University of Louisville Hospital, Louisville, KY; The Johns Hopkins Hospital, Baltimore, MD; and VA Pittsburgh Healthcare System.

The intervention consisted of active MRSA surveillance, or screening of all patients admitted to and discharged from inpatient units; isolation and contact precautions for all patients found to carry MRSA and those already infected; and rigorous adherence to all known infection control precautions.

"Proven infection prevention practices have been known for years, yet most healthcare 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."     

Each hospital's approach to reducing MRSA infections with PD was different, as is the nature of the intervention. Billings Clinic used Improvisational learning, or "Improv," to engage front line employees and to create an experience where they could discover for themselves how  to overcome barriers that prevent them from practicing known infection control procedures - setting up an isolation room, donning gowns and gloves without contaminating them, then removing them safely, and handling difficult conversations. The use of Improv provided a safe place to practice without a script in the way real life unfolds.

"PD involves all stakeholders-maintenance, dietary, escort, all the support services, volunteers, patients, families-all the people involved in the problem are also part of the solution," says Jon Lloyd, MD, senior clinical advisor for Plexus Institute. "Letting staff discover that solutions already existed  in the practices and ideas of front line staff  created opportunities for them to spread what was already working. The staff was involved in decision making. They owned the process and the data generated, and the results were community ownership at all levels of the hospital."

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.