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Positive deviance in infection prevention and control: A systematic literature review

Published online by Cambridge University Press:  11 November 2020

Mohammed A. Alzunitan Open the ORCID record for Mohammed A. Alzunitan [Opens in a new window] ,
Michael B. Edmond ,
Mohammed A. Alsuhaibani ,
Riley J. Samuelson ,
Marin L. Schweizer  and
Alexandre R. Marra
Mohammed A. Alzunitan*
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa, United States Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard–Health Affairs, Riyadh, Saudi Arabia
Michael B. Edmond
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Mohammed A. Alsuhaibani
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa, United States Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia
Riley J. Samuelson
Affiliation:
Hardin Library for the Health Sciences, University of Iowa Libraries, Iowa City, Iowa, United States
Marin L. Schweizer
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa, United States Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
Alexandre R. Marra
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa, United States Albert Einstein Jewish Institute for Education and Research, Hospital Israelita Albert Einstein, São Paulo, Brazil
*
Author for correspondence: Mohammed A. Alzunitan, E-mail: mohammed-alzunitan@uiowa.edu
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Abstract

Background:

Healthcare-associated infections (HAIs) remain a major challenge. Various strategies have been tried to prevent or control HAIs. Positive deviance, a strategy that has been used in the last decade, is based on the observation that a few at-risk individuals follow uncommon, useful practices and that, consequently, they experience better outcomes than their peers who share similar risks. We performed a systematic literature review to measure the impact of positive deviance in controlling HAIs.

Methods:

A systematic search strategy was used to search PubMed, CINAHL, Scopus, and Embase through May 2020 for studies evaluating positive deviance as a single intervention or as part of an initiative to prevent or control healthcare-associated infections. The risk of bias was evaluated using the Downs and Black score.

Results:

Of 542 articles potentially eligible for review, 14 articles were included for further analysis. All studies were observational, quasi-experimental (before-and-after intervention) studies. Hand hygiene was the outcome in 8 studies (57%), and an improvement was observed in association with implementation of positive deviance as a single intervention in all of them. Overall HAI rates were measured in 5 studies (36%), and positive deviance was associated with an observed reduction in 4 (80%) of them. Methicillin-resistant Staphylococcus aureus infections were evaluated in 5 studies (36%), and positive deviance containing bundles were successful in all of them.

Conclusions:

Positive deviance may be an effective strategy to improve hand hygiene and control HAIs. Further studies are needed to confirm this effect.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 3 , March 2022 , pp. 358 - 365
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Gilbert, GL, Kerridge, I. Hospital infection control: old problem—evolving challenges. Intern Med J 2020;50:105–107.Google ScholarPubMed
Weiner-Lastinger, LM, Abner, S, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol 2020;41:1–18.Google Scholar
Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Pub Health Rept 2007;122:160–166.Google Scholar
Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.Google ScholarPubMed
Yokoe, DS, Mermel, LA, Anderson, DJ, et al. Executive summary: a compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29:S12–S21.Google Scholar
Welsh, CA, Flanagan, ME, Hoke, SC, Doebbeling, BN, Herwaldt, L. Reducing health care-associated infections (HAIs): lessons learned from a national collaborative of regional HAI programs. Am J Infect Control 2012;40:29–34.Google ScholarPubMed
Marra, AR, D’Arco, C, de Arruda Bravim, B, et al. Controlled trial measuring the effect of a feedback intervention on hand hygiene compliance in a step-down unit. Infect Control Hosp Epidemiol 2008;29:730–735.Google Scholar
Gawande, A, America, BA. Better: A Surgeon’s Notes on Performance. New York: Metropolitan Books; 2007.Google Scholar
Positive Deviance Collaborative website. https://positivedeviance.org/. Accessed June 11, 2020.Google Scholar
Zeitlin, M. Nutritional resilience in a hostile environment: positive deviance in child nutrition. Nutrition Rev 1991;49:259–268.Google Scholar
Dynes, M, Stephenson, R, Rubardt, M, Bartel, D. The influence of perceptions of community norms on current contraceptive use among men and women in Ethiopia and Kenya. Health Place 2012;18:766–773.Google ScholarPubMed
Newby, KV, Parsons, J, Brooks, J, Leslie, R, Inglis, N. Identifying strategies to increase influenza vaccination in GP practices: a positive deviance approach. Fam Pract 2016;33:318–323.Google ScholarPubMed
Sreeramoju, P. Reducing infections “together“: a review of socioadaptive approaches. Open Forum Infect Dis 2019;6:ofy348.Google ScholarPubMed
Marsh, DR, Schroeder, DG, Dearden, KA, Sternin, J, Sternin, M. The power of positive deviance. BMJ Int 2004;329:1177–1179.Google ScholarPubMed
Dekker, SW, Breakey, H. ‘Just culture’: improving safety by achieving substantive, procedural and restorative justice. Safety Sci 2016;85:187–193.Google Scholar
Marra, AR, Guastelli, LR, de Araujo, CM, et al. Positive deviance: a new strategy for improving hand hygiene compliance. Infect Control Hosp Epidemiol 2010;31:12–20.Google ScholarPubMed
Perencevich, EN. Editorial commentary: deconstructing the veterans affairs MRSA prevention bundle. New York: Oxford University Press; 2012.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Group, P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.Google ScholarPubMed
Downs, SH, Black, N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of healthcare interventions. J Epidemiol Commun Health 1998;52:377–384.Google Scholar
O’Connor, SR, Tully, MA, Ryan, B, Bradley, JM, Baxter, GD, McDonough, SM. Failure of a numerical quality assessment scale to identify potential risk of bias in a systematic review: a comparison study. BMC Res Notes 2015;8:1–7.Google Scholar
Alderson, P, Green, S, Higgins, J. Assessment of study quality. Cochrane Rev Handbook 2004;4:52–59.Google Scholar
Awad, SS, Palacio, CH, Subramanian, A, et al. Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) prevention bundle results in decreased MRSA surgical site infections. Am J Surg 2009;198:607–610.Google ScholarPubMed
Marra, AR, Guastelli, LR, de Araújo, CM, et al. Positive deviance: a new strategy for improving hand hygiene compliance. Infect Control Hosp Epidemiol 2010;31:12–20.Google ScholarPubMed
Ellingson, K, Muder, RR, Jain, R, et al. Sustained reduction in the clinical incidence of methicillin-resistant Staphylococcus aureus colonization or infection associated with a multifaceted infection control intervention. Infect Control Hosp Epidemiol 2011;32:1–8.Google ScholarPubMed
Jain, R, Kralovic, SM, Evans, ME, et al. Veterans’ Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–1430.Google Scholar
Marra, AR, Guastelli, LR, de Araújo, CM, et al. Positive deviance: a program for sustained improvement in hand hygiene compliance. Am J Infect Control 2011;39:1–5.Google ScholarPubMed
Reason, P, Rykert, L, Gardam, M. Using positive deviance (PD) to reduce antibiotic resistant organisms: the Canadian PD project. BMC Proceedings 2011;5 suppl 6:O50.Google Scholar
Crump, M, Bryce, E, Ko, S, Busto, G. Unleashing the positive deviants at the frontline: More than just sparking change. Am J Infect Control 2012;40:e77.Google Scholar
Macedo Rde, C, Jacob, EM, Silva, VP, et al. Positive deviance: using a nurse call system to evaluate hand hygiene practices. Am J Infect Control 2012;40:946–950.Google ScholarPubMed
Gitterman, L, Reason, P, Gardam, M. Front line ownership approach to improve hand hygiene compliance and reduce health care-associated infections in a large acute-care organization. Can J Infect Dis Med Microbiol 2013;24:21B–22B.Google Scholar
Lindberg, C, Downham, G, Buscell, P, Jones, E, Peterson, P, Krebs, V. Embracing collaboration: a novel strategy for reducing bloodstream infections in outpatient hemodialysis centers. Am J Infect Control 2013;41:513–519.Google ScholarPubMed
Marra, AR, Noritomi, DT, Westheimer Cavalcante, AJ, et al. A multicenter study using positive deviance for improving hand hygiene compliance. Am J Infect Control 2013;41:984–988.Google ScholarPubMed
Bren, V, Anderson, J, Gillett, K, Grassel, K, Swendseid, L, Hansen, S. Use of positive deviance and electronic data collection in a hospital hand hygiene program. Am J Infect Control 2015;43:S63.Google Scholar
Escobar, NM, Márquez, IA, Quiroga, JA, et al. Using positive deviance in the prevention and control of MRSA infections in a Colombian hospital: a time-series analysis. Epidemiol Infect 2017;145:981–989.Google Scholar
Sreeramoju, P, Dura, L, Fernandez, ME, et al. Using a positive deviance approach to influence the culture of patient safety related to infection prevention. Open Forum Infect Dis 2018;5:ofy231.Google ScholarPubMed
Marra, AR, Guastelli, LR, de Araujo, CM, et al. Positive deviance: a program for sustained improvement in hand hygiene compliance. Am J Infect Control 2011;39:1–5.Google ScholarPubMed
Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.Google ScholarPubMed
Haas, J, Larson, E. Measurement of compliance with hand hygiene. J Hosp Infect 2007;66:6–14.Google ScholarPubMed
Macedo Rde, C, Jacob, EM, Silva, VP, et al. Positive deviance: using a nurse call system to evaluate hand hygiene practices. Am J Infect Control 2012;40:946–950.Google ScholarPubMed
Greenhalgh, T, Robert, G, Macfarlane, F, Bate, P, Kyriakidou, O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Qrtrly 2004;82:581–629.Google ScholarPubMed
Rogers, EM. Diffusion of preventive innovations. Addict Behav 2002;27:989–993.Google ScholarPubMed
Goldstein, J, Hazy, JK, Lichtenstein, BB. Complexity and the Nexus of Leadership: Leveraging Nonlinear Science to Create Ecologies of Innovation, First ed. New York: Palgrave Macmillan; 2010.Google Scholar
Marsh, DR, Pachón, H, Schroeder, DG, et al. Design of a prospective, randomized evaluation of an integrated nutrition program in rural Viet Nam. Food Nutr Bull 2002;23:34–44.Google ScholarPubMed
Marra, AR, Pavão Dos Santos, OF, Cendoroglo Neto, M, Edmond, MB. Positive deviance: a new tool for infection prevention and patient safety. Curr Infect Dis Rep 2013. doi: 10.1007/s11908-013-0372-y.Google ScholarPubMed
Spreitzer, GM, Sonenshein, S. Toward the construct definition of positive deviance. AM Behav Sci 2004;47:828–847.Google Scholar
Morgan, DJ, Murthy, R, Munoz-Price, LS, et al. Reconsidering contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus . Infect Control Hosp Epidemiol 2015;36:1163–1172.Google ScholarPubMed
Eliopoulos, GM, Harris, AD, Lautenbach, E, Perencevich, E. A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance. Clin Infect Dis 2005;41:77–82.Google Scholar
Stroup, DF, Berlin, JA, Morton, SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 2000;283:2008–2012.Google Scholar
Sreeramoju, P. Reducing infections “together”: a review of socioadaptive approaches. Open Forum Infect Dis 2019;6(2):ofy348.Google ScholarPubMed