According to a new report, a novel program to prevent methicillin-resistant Staphylococcus aureus (MRSA) infections using simple infection control techniques and behavioral change reduced the incidence of MRSA infections from 26 to 62 percent at participating hospitals. Epidemiologists at the Centers for Disease Control and Prevention (CDC) conducted the analysis and presented their findings at the Society for Healthcare Epidemiology of America's 19th Annual Scientific Meeting this past Saturday.

The three hospitals involved in the study screened all patients admitted to a pilot unit for MRSA, isolated all MRSA-positive patients, and had strict hand washing and infection control procedures. They also employed an approach called Positive Deviance; this model is based on the notion that every organization has certain people (called "Positive Deviants") who function more effectively than others with the exact same resources and conditions.  In this context, the Positive Deviance approach helps identify and spread effective MRSA prevention practices to every person who comes into contact with patients. Funding for the MRSA prevention program came from the Robert Wood Johnson Foundation (RWJF).

The CDC estimates that nearly 100,000 Americans acquire invasive MRSA infections each year and about 86 percent of invasive MRSA infections are associated with health care facilities. It is encouraging that simple, cost-effective approaches to changing caregiver behavior in hospitals, such as Positive Deviance, can have a significant impact on reducing MRSA infections.

For more information about MRSA, see our previous tips for preventing MRSA infections or post a question about MRSA on our online community.  

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An international study published in today’s Journal of the American Medical Association finds that following a simple checklist of steps can cut surgery deaths nearly in half and reduce complications by more than a third. When surgical teams used a checklist that contained such simple steps as confirming the patient’s name, marking the part of the body to be operated on, and checking that all instruments are accounted for at the end of the procedure, the rate of surgical deaths dropped from 1.5 percent of patients to 0.8 percent, a 47 percent decrease.

The large study of how to avoid blatant operating room mistakes was conducted at hospitals in Seattle; Toronto; London; New Delhi; Auckland, New Zealand; Amman, Jordan; Manila, Philippines; and Ifakara, Tanzania. The largest decreases in deaths and complications were in the developing countries, with the combined death rate for Jordan, India, Tanzania and the Philippines falling 52 percent. The study excluded heart surgeries and pediatric cases.

The World Health Organization developed the 19-point checklist as a way to standardize surgical procures, especially in developing countries where surgical environments may not be as well regulated as in the developed world. The checklist included checks on anesthesia, blood supply, sterile equipment, drugs, and even a roll call of the surgical team.

Most of the items on the list are elementary and not all the surgical teams were thrilled at the idea of using a list filled with blatantly obvious checkpoints. However, those who were initially skeptical became strong supporters of the checklist after seeing the outcome. Even the lead researcher in the study, a Harvard surgeon, was shocked by the results.

The study demonstrates that the process of painstakingly checking potential errors can help prevent careless mistakes. The study authors think that worldwide adoption of surgical checklists has the potential to prevent huge numbers of deaths and complications. The researchers also believe that such checklists could be used in other areas of medicine, such as everyday checkups and cancer treatment.

The surgical checklist has already been adopted by several countries including Britain, Ireland, Jordan, and the Philippines. In the U.S., the current standard is to use a three point checklist, but the Joint Commission that sets standards for hospitals says it is considering adopting more of the steps.

Have a question about surgery? Ask the experts at Healia Health Communities.


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