Escobar N M Olarte, Márquez I A Valderrama, Quiroga J Avila, Trujillo T Goretty, González F, Aguilar M I Garzón, Escobar-Pérez J
Hospital El Tunal E.S.E.,Bogotá Colombia.
Unidad de Investigación Básica Oral,Universidad El Bosque,Bogotá,Colombia.
Epidemiol Infect. 2017 Apr;145(5):981-989. doi: 10.1017/S095026881600306X. Epub 2017 Jan 9.
Positive Deviance (PD) is a process to achieve a social and cultural change. This strategy has been used for the control of methicillin-resistant Staphylococcus aureus (MRSA) infection in some health institutions in the United States, but has rarely been adopted in institutions from developing countries where resources are limited. We describe our experience of PD in the control of healthcare-associated infections (HAIs) due to MRSA in a Colombian hospital with the aim of reducing HAI rates through a cultural change in processes. A time-series study was conducted based on the MRSA-HAI rate and the number of months with zero MRSA infections before and after application of PD (2001-2012). On comparing the pre-intervention and intervention periods, the mean overall rates of MRSA-HAI was 0·62 and 0·36, respectively (P = 0·0005); the number of months with zero MRSA-HAIs were 3/70 and 12/74 (odds ratio 0·264, 95% confidence interval 0·078-0·897); the percentage of MRSA-HAIs was 53·2% and 41·0%. These results are consistent with other published data. Implementation of PD was associated with a significant reduction of MRSA-HAIs, it did not involve high costs and the changes have been lasting.
积极偏差（PD）是一种实现社会和文化变革的过程。该策略已在美国的一些医疗机构中用于控制耐甲氧西林金黄色葡萄球菌（MRSA）感染，但在资源有限的发展中国家的机构中很少采用。我们描述了我们在一家哥伦比亚医院中运用积极偏差控制MRSA所致医疗相关感染（HAIs）的经验，目的是通过流程中的文化变革来降低HAIs发生率。基于MRSA-HAIs发生率以及在应用积极偏差前后（2001-2012年）MRSA感染为零的月数进行了一项时间序列研究。比较干预前和干预期，MRSA-HAIs的平均总体发生率分别为0·62和0·36（P = 0·0005）；MRSA-HAIs为零的月数分别为3/70和12/74（比值比0·264，95%置信区间0·078-0·897）；MRSA-HAIs的百分比分别为53·2%和41·0%。这些结果与其他已发表的数据一致。积极偏差的实施与MRSA-HAIs的显著减少相关，它不涉及高成本且变革具有持久性。
