Hospitals in pursuit of excellence

Attacking MRSA Through Positive Deviance

The Problem

MRSA is a virulent bacteria that thrives in the health care setting, putting at great risk immuno-compromised patients. It is blamed for more than 18,000 deaths annually, according to the CDC. At Einstein, officials identified 107 cases of hospital-acquired MRSA in 2006, a rate of 0.535 infections per 1,000 patient days. Compared with matched patients who had not acquired MRSA, patients with MRSA infections had an 8.3 percent higher mortality, an increase in average length of stay of 19.75 days, and an increase of average variable costs of $33,347. An internal analysis revealed that no routine surveillance cultures for MRSA colonization were being performed, and that reliable implementation of practices to combat MRSA was uncommon.

The Solution

In May 2006, the hospital undertook the "Stop MRSA Acquisition and Spread in our Hospitals" initiative, known by its acronym SMASH. Using a concept known as positive deviance, Einstein instituted a bundle of practices, including identifying colonized and infected patients, placing these patients in isolation rooms, adhering to contact isolation precautions through the use of gowns and gloves and, especially, adherence to hand hygiene guidelines. Positive deviance says that for every group of people performing a similar function, there are certain individuals (positive deviants) whose attitudes, practices, strategies or behaviors allow them to accomplish tasks better than others.

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