From Invisible to Visible - Positive Deviance Initiative

Making the Invisible Visible
“It’s as if we are in a canoe paddling across an ocean
toward No-MRSA land. We have a general sense of
direction. We have gained some oars. But we need
more rowers. While not everyone is in the boat yet,
enough are to make a difference.”
–Carlos Arce, director,
organizational and leadership development
Microbes and memes—the ideas and activities
that are the intellectual equivalent of
genes— share common traits. They are self-replicating
entities that multiply and spread, impacting
human communities with unpredictable
waves of change for good and ill. They are also
invisible to the naked eye.
With perseverance and sharpened perception,
however, the invisible can be illuminated. Just as
the ripples in the wake of the canoe make forward
progress discernable, other evidence of things
unseen guides and colors the vision of the travelers
to No MRSA Land.
Infection rates for the deadly pathogen
Methicillin resistant Staphylococcus aureus, also
known as MRSA, have been rising in most US
hospitals. But the sharp decline in infection rates
at Billings Clinic, documented by carefully gathered
data, gives evidence that an innovative prevention
effort has been abundantly productive.
Billings Clinic, a not for profit, multi-specialty
group practice and 272-bed hospital in Billings,
Montana, reduced housewide healthcare-associated
MRSA infections by 84% in the past two and a
half years, a spectacular achievement especially as
infection rates had increased relentlessly in previous
years.
CDC analysts determined that Billings Clinic has
achieved a highly statistically significant
decline—meaning it is highly likely that the drop
is associated with the MRSA-fighting initiative,
and did not happen by chance. An analysis of the
data, by John Jernigan, MD, MS, the CDC’s MRSA
expert, and colleagues at the CDC and Billings,
was presented at the March 2009 meeting of the
Society for Healthcare Epidemiology of America.
Interestingly, as MRSA rates dropped at Billings
and two other hospitals, the hospitals also saw a
decline in the percentage of Staph aureus infections
caused by the methicillin resistant variety,
Billings Clinic
Infection Control Surveillance Report
MRSA Healthcare-associated Infections Incidence rates
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