From Invisible to Visible - Positive Deviance Initiative

social and behavioral change resulted in a significant reduction in pooled MRSA incidence, with
sustained decreases demonstrated over time; results also suggest post-intervention improvement in
the S. aureus antibiogram. These results were achieved without the use of hospital-wide active surveillance
or MRSA decolonization strategies.
Footnotes
i See Saco (2005).
ii In contrast to the U.S. where the MRSA problem continues to escalate, certain northern European countries
– notably Netherlands, Finland, and Denmark — have tamed MRSA. For instance, in Denmark, MRSA
infections peaked in the mid-1960s – accounting for about 35 percent of infections due to staph aureus, and
have dropped precipitously to account for only 1 to 2 percent of staph aureus infections over the past three
decades.
iii According to MRSA specialists this means that a Danish patient with a staph aureus infection can be “treated
with an old-fashioned beta-lactum antibiotic (like Methicillin) with faster response, higher cure rate, and
quicker hospital discharge at lower overall cost to society.”
iv Staph aureus is usually carried by people in their nose.
v
With a population just over 100,000, Billings is the largest city in a 500-mile radius that includes the U.S.
states of Montana, Idaho, Wyoming, South Dakota, and North Dakota, and the Canadian provinces of
Saskatchewan, and Alberta.
vi From 1879 to 1881 he was president of the Northern Pacific Railway. In 1848, during the California Gold
Rush, he moved to San Francisco, becoming the city’s first land claims lawyer. In California, he served as a
trustee of the College of California
(Later, the University of California at Berkeley). In Montana, Billings and his heirs purchased many failing
farms and reforested much of the surrounding hillsides around Billings with Norway Spruce, Scots Pine,
European Larch, and many native species.
vii This section draws upon Papa, Singhal, and Papa (2006).
viii See Sternin and Choo (2000).
ix See Zeitlin, Ghassemi, and Mansour (1990).
x Jerry Sternin passed away as this story was being finalized in December, 2008.
xi These foods were accessible to everyone, but community believed they were inappropriate for young
children
xii See Sternin and Choo (2000); Sternin, Sternin, and Marsh (1999).
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