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CDC analysis finds unique social and behavior intervention helps reduce MRSA rates up to 62 percent
March 23, 2009'Positive deviance' efforts turn the tide on antibiotic-resistant infections
Princeton, NJ - The Robert Wood Johnson Foundation (RWJF) and the Plexus Institute (Plexus) 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 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's 19th Annual Scientific Meeting on Saturday, 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 health care.
The three hospitals (Billings Clinic, Billings, MT; Albert Einstein Medical Center, Philadelphia, PA; 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 health care-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.
Spitfire Strategies
CDC's analysis was presented at a special late-breaker session during the Society for Healthcare Epidemiology of America's 19th Annual Scientific Meeting on Saturday, 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 health care.
The three hospitals (Billings Clinic, Billings, MT; Albert Einstein Medical Center, Philadelphia, PA; 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 health care-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.
Spitfire Strategies
MRSA Current Events and MRSA News RSSU.S. and European Experts Applaud Creation of New Transatlantic Task Force on Global Antibiotic Resistance Threat
Experts on both sides of the Atlantic applaud President Barack Obama and Swedish Prime Minister Fredrik Reinfeldt, representing the European Union (EU) Presidency, for establishing a transatlantic task force to address antibiotic resistance, an urgent and growing problem that threatens patient safety and public health worldwide.
Henry Ford Hospital study: A MRSA strain linked to high death rates
A strain of MRSA that causes bloodstream infections is five times more lethal than other strains and has shown to have some resistance to the potent antibiotic drug vancomycin used to treat MRSA, according to a Henry Ford Hospital study.
U of T researchers create microchip that can detect type and severity of cancer
U of T researchers have used nanomaterials to develop a microchip sensitive enough to quickly determine the type and severity of a patient's cancer so that the disease can be detected earlier for more effective treatment.
How manuka honey helps fight infection
Manuka honey may kill bacteria by destroying key bacterial proteins. Dr Rowena Jenkins and colleagues from the University of Wales Institute - Cardiff investigated the mechanisms of manuka honey action and found that its anti-bacterial properties were not due solely to the sugars present in the honey.
Mounting a multi-layered attack on fungal infections
Unravelling a microbe's multilayer defence mechanisms could lead to effective new treatments for potentially lethal fungal infections in cancer patients and others whose natural immunity is weakened.
Genes key to staph disease severity, drug resistance found hitchhiking together
Scientists studying Staphylococcus bacteria, including methicillin-resistant S. aureus (MRSA), have discovered a potent staph toxin responsible for disease severity.
Researchers map how staph infections alter immune system
Infectious disease specialists at UT Southwestern Medical Center have mapped the gene profiles of children with severe Staphylococcus aureus infections, providing crucial insight into how the human immune system is programmed to respond to this pathogen and opening new doors for improved therapeutic interventions.
Soap-sniffing technology encourages hand washing to reduce hospital-acquired infections, save money
Using sensors capable of detecting drugs in breath, new technology developed at University of Florida monitors health-care workers' hand hygiene by detecting sanitizer or soap fumes given off from their hands.
One in four nursing home residents carries MRSA
MRSA is a major problem in nursing homes with one in four residents carrying the bacteria, a study by Queen's University Belfast and Antrim Area Hospital has found.
Study finds unexpected bacterial diversity on human skin
The health of our skin - one of the body's first lines of defense against illness and injury - depends upon the delicate balance between our own cells and the millions of bacteria and other one-celled microbes that live on its surface.
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