From Invisible to Visible - Positive Deviance Initiative

David Allred, rehab services (left) Lynn Essex, RN, inpatient medical (right), taking time to stop MRSA by
disinfecting shared patient care equipment scrubbings are now routine in Billings Clinic hallways.
longer discuss infections as cases, it is important
to talk about real people, not faceless cases so we
can take more responsibility for our actions.”
Carlos Arce noted: “PD references continue to
emerge. We’re exploring new ways to use and
apply our PD experience. We currently have a
group of folks hoping to use PD to work on a
problem related to hypertension. I’ve been in several
meetings where someone has reflected,
‘Maybe we can use PD on this.’ It has become
another powerful option for us to create real and
positive change.”
Dr. Graham, the infectious disease physician, said
from the beginning he thought the focus on
MRSA would improve infection control in general,
and while that has not been specifically studied,
he believes intensified conscientiousness has
to have had an impact. “This has been like a consciousness
raising experience,” he said. “When
people ask me how, I say do you have two hours
so I can tell you?” He said the lessons learned
won’t die. “I guess we’ve known top down directives
don’t work” he said. “I think PD is a way you
get around intractable issues where you can’t just
tell people ‘this is what’s going to be done’.”
Interestingly, social changes may lead to changes
in the bacterial environment. In analyzing data
from Billings Clinic, Albert Einstein Medical
Center, Philadelphia, and University of Louisville
Hospital, Louisville, KY, three hospitals in the PD
MRSA initiative that had the necessary electronic
records, CDC analysts discovered a downward
trend toward intervention-associated reduction in
Methicillin resistance. While the data did not provide
the numbers scientists need to say something
has statistical significance, the downward trend in
antibiotic resistance was found in the post intervention
period at all three hospitals. Dr. Jernigan
of the CDC explains that because transmissions
of resistant bacteria were being reduced, the
resistant bacteria were playing a less important
role in infections that do occur, which are as a
result more treatable.
In all three hospitals where data was analyzed,
active surveillance of patients was practiced initially
only in target units, yet the drop in MRSA
incidence was house-wide. More research is needed
to determine how each element of the initiative
contributed to the reduction.
Another result of the initiative was the unplanned
diffusion of hand hygiene awareness and the
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