The Plexus Institute and PDI Collaborate to Reduce (MRSA) Infections in US Hospitals
Location(s): Albert Einstein Medical Center (Philadelphia, PA) / Billings Clinic (Montana) / Franklin Square Hospital (Baltimore, Maryland) / Pittsburgh VA Hospital (Pennsylvania) / Johns Hopkins Hospital (Baltimore, MD) / University of Louisville Hospital (Kentucky)
Organization: Plexus Institute
“Where other processes are Outside Jobs Positive Deviance is an Inside Job.” - Jon Lloyd, MD.
Millions of people worldwide are suffering from infections acquired in hospitals and other healthcare settings. In the developing world, 1 in 4 patients may acquire such an infection, in developed countries up to 1 in 10. Hundreds of thousands die as a result of healthcare-associated infections.
Number of cases per year
Number of deaths per year
Cost per year
UK £ 1 billion
US $ 4.5 billion
US $ 1.5 billion
Data not available
Methicillin resistant Staphylococcus aureus (MRSA), sometimes referred to as a “superbug,” is an especially common and deadly bacteria responsible for many healthcare associated infections. Despite its relentless and exponential spread throughout the world, the successful eradication of MRSA in some Northern European countries and isolated American institutions led the Positive Deviance Initiative and Plexus Institute to explore the application of the Positive Deviance Approach in the healthcare facilities.
Using the Positive Deviance (PD) Approach, healthcare workers uncovered hundreds of “hidden” and newly discovered practices whose adoption led to fewer infection transmissions. PD created a “space” for people to rapidly discover and put in place simultaneous solutions, each well adapted to the unique environmental and cultural characteristics of the involved healthcare setting. Through the PD Approach, the spectrum of stakeholders expanded far beyond the customary doctor and nurse caregiver.
Stakeholders identified by participants included patients, visitors, ancillary care staff such as dietary, maintenance, transport and pastoral care workers, volunteers and security guards as well as doctors, nurses and healthcare technicians. All these “touchers” came recognize their contribution to infection transmission. Together they found solutions and planned actions. Discovery and Action Dialogs and Kick-Ups and Volunteer meeting were examples of dynamic and inclusive gatherings carried out the participants.
Data tracking the transmission rates among the first set of US hospitals was rigorously collected and evaluation by the United States Centers for Disease Control and Prevention (CDC). MRSA infections and transmission among these centers decreased by 30 -73%.
In August 2005 the PDI began collaborating with VAPHS to use PD to address the problem of MRSA infections. The PD approach enabled the hospital staff to improve their adherence to evidence-based precautions, referred to as the “MRSA Bundle,” (hand hygiene, active surveillance, contact isolation precautions and environmental cleaning) and to co-create additional precautions. This resulted in a 50% reduction in MRSA infection rates. The Veterans Health Administration (VHA)(VHS) subsequently expanded the program to 5 additional VA hospitals and has mandated the MRSA Bundle nationwide among 253 hospitals encouraging them to learn and use PD from the core group of 6 VA PD hospitals to enable better adherence to precautions.
Based on the success of the VAPHS MRSA-reduction program, the Plexus Institute, in collaboration with the PDI, secured a grant from the RWJ Foundation to expand the program to an additional 5 hospitals; Albert Einstein Medical Center (Philadelphia, PA), Billings Clinic (Billings, MT), Franklin Square Hospital Center (Baltimore, MD), The Johns Hopkins Hospital (Baltimore, MD), and University of Louisville Hospital (Louisville, KY).
Below are several related articles which detail the efforts of these hospitals to reduce MRSA infections.
- Publication: "Spanning Silos and Spurring Coversations: positive deviance for reducing infection levels in hospitals"
- Project Summary: (Delmarva Foundation) "Regaining Control of MRSA"
- Video: (PBS Newshour)"Mont. Clinic Aims to Deliver Health Care for Less"
- Video: (CBS) Fighting a Deadly Superbug
- Newsletter: (Plexus Institute) "Do What You Can, With What You Have, Where You Are: A Quest to Eliminate MRSA in the VA Pittsburgh Healthcare System"
- There are numerous videos available in our Video Library about the MRSA projects. To access those videos, please click here.
The Plexus Institute and PDI Collaborate to Reduce (MRSA) Infections in US Hospitals: View the gallery
From 2003 – 2008, USAID funded five international NGOs, (CARE, Catholic Relief Services (CRS), Mercy Corps (MC), Save the Children US (SC), and World Vision International (WVI)), to implement Positive Deviance in Indonesia as part of food security programs. Together, the five NGOs reached 9,997 children across the country. Of this number, 59.6% gained 200g between admission into the program (Day 1) and graduation from the program (Day 10). Of 4,847 participants who were weighed again at the end of the month, 45% had gained the recommended 400g. Results differed slightly (but not significantly) between implementers; however, they differed dramatically between different communities.
For the full report, click here.