Fighting MRSA by Engaging a Whole Medical Center Community


The Einstein Healthcare Network is a private, non-profit organization with seven major facilities and many outpatient centers in the greater Philadelphia region.


In 2007 CDC research showed MRSA was causing 94,000 serious infections and killing nearly 19,000 people annually. At the network’s 30-bed MossRehab in Elkins Park, PA, 29% of the patients were arriving with MRSA infections or colonization. The average extra cost for treating a patient with a MRSA infection is $25,000.

The Positive Deviance Approach 

In February 2006, Einstein joined an initiative by Plexus Institute and the Positive Deviance Initiative at Tufts University, supported by The Robert Wood Johnson Foundation, to use Positive Deviance (PD) to fight MRSA. PD does not require new drugs or technology. Through mentoring, coaching and behavior change, it encourages the cultural differences that help everyone in the care environment consistently adhere to known infection prevention protocols.

  • Units held frequent discussions to identify unusual strategies for success in consistent adherence and actions to remove barriers to adherence.
  • Dozens of simple prevention innovations emerged. Plexiglas® boxes outside patient rooms made supplies visible and colored tags on charts showed completed patient screening.
  • MRSA infection and transmission data let participants see evidence of their efforts.

Impact and Outcomes

The collaborations brought about new and lasting relationships, improved cooperation, and new ideas. Many reported more respectful interactions among care givers who reminded each other about infection protocols. Dramatically reduced infection rates have been sustained.

  • After one year of the initiative, the MRSA infection rate had declined 22%.
  • After three years, the PD MRSA initiative was expanded throughout the facility.
  • In 2011, 33 patients acquired MRSA infections and six died, compared with 105 infections and 24 deaths in 2005.
  • Reducing MRSA infections is saving nearly $2 million a year.
  • The percentage of staph infections caused by drug resistant bacteria declined.
  • Practices that reduce MRSA can reduce other infections.