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For Immediate Release
For Information Contact:
Patricia Montone Charvat

Maryland Patient Safety Center
Leads Pioneering Work in MRSA Prevention

Baltimore, Maryland, June 25, 2007 - As concerns rise over Methicillin-resistant Staphylococcus Aureus (MRSA) infections in hospitals nationwide, the Maryland Patient Safety Center is leading a promising new effort to eradicate transmission of the deadly strain.

According to Margaret M.Toth, M.D., the Delmarva Foundation’s Chief Quality Officer, the Center has had MRSA in its sights since its founding three years ago.  “For decades we have seen MRSA rates relentlessly increasing.   We knew this was not due to a lack of serious concern among health care workers and institutions – it had to be a flaw in our strategy.” 

MRSA infection is generally spread from the hands, clothing, and equipment of health care workers and others in the hospital setting.  Previous efforts have focused on reducing MRSA through traditional hand washing campaigns, hospital policies, and best practice implementations. These efforts, however, have often failed.

“Our approach involves stimulating changes in human behavior and habits so that health care professionals automatically default to using precautions that prevent transmission,” said Dr. Toth.   “It’s an innovative strategy called “Positive Deviance (PD)”– that has its origins in the developing world.” 

Positive Deviance (PD) is a problem-solving approach unlike traditional methods of prevention that include education, awareness, and regulatory compliance.  It is based upon the philosophy that certain groups or individuals in a community have the skills to solve a problem better than other groups or individuals who have access to the same resources—the solutions and practices developed are then shared within the community by the community. For example, using PD, hospitals bring together health care professionals from a particular area in the hospital to brainstorm ways in which to prevent MRSA transmission—the ideas generated from this group are then adopted as routine practices by that area within the hospital, which eventually spreads throughout the whole organization.

In the last 12 months, a pioneering group of area hospitals have participated in three major PD tests, with guidance from Jerry and Monique Sternin, founders of the approach.   

Dr. Toth co-leads, as a principal investigator, a Plexus Institute MRSA project involving The Johns Hopkins Hospital and Franklin Square Hospital Center as two of the six national “beta” sites. Fifteen additional Maryland and District of Columbia hospitals have trained in this approach as part of a CareFirst Blue Cross/Blue Shield and Robert Wood Johnson Foundation funded Maryland Patient Safety Center pilot of PD on a larger scale. The Baltimore Veterans Administration (VA) Health Center has also been funded to test PD as a part of the National VA “Getting to Zero” project.  

The results so far are promising. Hospital teams have expanded traditional boundaries by reaching out to everyone involved with patients to uncover existing practices that yield better results and rapidly create new ideas to stop MRSA transmissions.  This inclusive, action-oriented approach is leading to rapid and widespread changes in practice and culture.  

 “Everyone cares deeply about this problem and everyone is getting involved,” said Mary Jozwik, Vice President of Patient Safety and Quality at Baltimore Washington Medical Center, a participant in the positive deviance program.  Physicians ensure orthopedic patients are screened and cleared of infection before receiving joint replacements. Those participating are not limited to just nurses and physicians.  “Our information technology (IT) team took the initiative to research and implement keyboard cleaning strategies and use creative screen savers to provide reminders throughout the facility. Unit clerks keep a watchful eye on staff and visitors to ensure they maintain infection precautions.”

Mercy Medical Center has made reduction of MRSA transmission within hospitals a major organization-wide priority.  Updated data regarding infection with MRSA is shared weekly with staff, who have become actively involved in the effort.

Doctors, nurses and environmental services workers at the Franklin Square Hospital Center remind each other to use protective gowns and adhere to strict hand washing practices.   Similar innovative strategies are in place at Union Memorial Hospital, the Shore Health System, Harbor Hospital and St. Joseph Medical Center leading to the first signs of decreasing MRSA infection in decades.

“Our next step is to extend an invitation to all area hospitals to explore PD,” said Bill Minogue, M.D, Executive Director of the Maryland Patient Safety Center.  “We are not stopping with hospitals. We recognize MRSA as a public health issue that affects nursing homes, dialysis centers, correctional institutions, and a wide variety of crowded settings—our plan is to spread this strategy through our hospitals to as many of these settings as possible.”


About the Maryland Patient Safety Center
The Maryland Patient Safety Center, created by the General Assembly and established in 2004 by the Maryland Health Care Commission, brings together hospitals and health care providers to improve patient safety and health care quality for all Marylanders. It is a joint venture between the Maryland Hospital Association and Delmarva Foundation and is funded by these two organizations, hospitals, and grants.