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The Complexity Matters blog features the Thursday Complexity Post as well as other complexity inspired news items.

 

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From the Front Lines: Kissing the Banana Trunk

Posted By Prucia Buscell, Thursday, October 16, 2014
In parts of Sierra Leone and much of West Africa, people have traditionally kept the bodies of loved ones in their homes for several days after death as mourners wash, caress, dress them and pray over them. Because the corpses of Ebola victims are highly contagious, the tradition has been a key vector in spread of the disease. Burial teams from the Red Cross and other organizations have been attacked trying to interfere with care of the dead. Some families have even hidden corpses to make sure proper rituals can be performed.

In a Psychology Today post, Steven Hayes, PhD, Foundation Professor of Clinical Psychology at the University of Nevada, writes that behavioral science is as important as medical science in discovering alternative rituals that honor both culture and safety.

Four years ago Beate Ebert, a German psychologist and others formed Commit and Act, a nonprofit in Sierra Leone devoted to bringing psychotherapy to people traumatized by a decade of civil war and violence. Hannah Bockarie, a social worker fluent in Krio, the local language, led workshops, evaluated through a partnering agreement with the University of Glasgow, to train indigenous counselors and health care workers. When Ebola hit, the organization was in a unique position to help. Hayes explains that Commit and Act, already known in the community, was able to educate people about Ebola and the practices needed to halt its spread. Bockarie also led local groups through therapeutic sessions that helped them come up with alternative burial customs that honored their values while allowing health care workers to safely dispose of bodies.

"A beautiful example one group came up with was substituting the corpse with a banana trunk," Hayes writes. "The body of the infected and now diseased person is burned. Relatives keep a banana trunk at home, and perform all the customary rituals on it, including kissing the banana trunk before burial. In the end the banana trunk is buried."

Hayes says he is awed and inspired by "a pathway forward" that could not have come from the outside, and that could not have been produced by military intervention nor dictated by foreign aid workers.

He explains that the evolutionary biologist David Sloan Wilson's Evolution Institute combined with Commit and Act to use Acceptance and Commitment Therapy (ACT) along with principles from the late economist Elinor Olstrom, who won a Nobel Prize in 2009 for works showing the skill of indigenous people in protecting common resources.

People who face a problem are the best poised to find ways to solve it. That's a key insight of Adaptive Positive Deviance. After the disclosure of the Ebola infection of a second nurse who worked at the Dallas hospital where a man died of the disease, health officials have aimed to promote caution without feeding panic. The second nurse flew on a commercial airline before she had symptoms and the CDC has asked all 132 passengers on her flight to self-monitor and call a CDC hotline. Some politicians propose a ban on travel to the U.S. from Western African countries. In Texas, a community college announced it was rejecting students from any country with confirmed cases of Ebola.

Officials don't know exactly how the two Texas nurses were infected, though multiple news reports have suggested infection control protocols in place at the hospital were insufficient for Ebola. National Nurses United, a nurses' union, said nurses at the hospital complained of confusion, frequently changing policies and protocols, inadequate protection from contamination and spotty training. Indeed the CDC has now recommended extra levels of protection for healthcare workers caring for Ebola patients, as well as detailed guidelines for the potentially hazardous process of removing contaminated protective gear. CDC Director Dr. Thomas R. Frieden has said the most important protection is for a site manager to oversee workers as they put on each piece of personal protective gear, and as they remove and properly dispose of each one. One hopes front line workers will be engaged in finding the best ways to adhere to new protocols.

When Plexus Institute led a multi-year initiative to stop MRSA infections, the protocols in use at the time differed from what is being recommended now for Ebola. But MRSA infection rates dropped dramatically when front line healthcare workers collaborated to developed methods that would achieve the most consistent adherence to the known protocols. The late Jasper Palmer, a patient transport worker at Einstein Medical Center in Philadelphia, devised a way to remove protective gear safely while also reducing the volume of contaminated trash. It became known as The Palmer Method. Watch here.

Tags:  buscell  complexity matters  culture  healthcare  MRSA 

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ResistanceMap Tracks Rise in Superbugs

Posted By Susan Doherty, Wednesday, March 16, 2011
Updated: Thursday, June 6, 2013

From the Robert Wood Johnson Foundation -

The rapid rise in antibiotic resistance during the past decade can now be visualized using ResistanceMap, a new online tool that lets you see regions of the country where the problem is particularly severe. Drug resistance is the ability of bacteria like Methicillin-resistant Staphylococcus aureus (MRSA) to survive a treatment course with an antibiotic.

ResistanceMap was created by Extending the Cure, a research project supported by RWJF's Pioneer Portfolio. The maps show some dramatic trends, including how resistance to popular antibiotics like methicillin and ciprofloxacin has risen sharply between 2000 and 2009 among common microbes. For example, the tool shows that MRSA rates rose sharply in the United States over that period, eventually reaching levels of resistance at or greater than 60 percent in the South East Central region of the country.

Read more on the RWJF web site

Tags:  app  MRSA  stopMRSA 

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Hospital Acquired Infections on the Increase

Posted By Susan Doherty, Tuesday, April 20, 2010
Updated: Thursday, June 6, 2013
From the April 14, 2010 article by Candy Lashkari

"Despite being reported over a decade ago, little has been done in America to reduce hospital born infections as per a Health and Human Services department quality report for 2009 to Congress. Hospital acquired infections seem to be on the increase according to the report when compared with statistics available for 2007. The situation is being seen as critical by many health care experts.”


Plexus Institute’s Lisa Kimball comments, "In 2006 in an effort spearheaded by Plexus Institute, six Beta Site hospitals, CDC, Positive Deviance Initiative, and Delmarva Foundation came together to pioneer the first use of Positive Deviance (PD) to reduce the transmission of MRSA (methicillin-resistant staphylococcus aureus) in healthcare organizations. The article, published by the Association for Professionals in Infection Control, presents the work of these hospitals, the results they achieved which include dramatic sustained reductions, a primer on PD, and suggestions for employing PD to prevent MRSA.” See Staff-Driven Cultural Transformation Diminishes MRSA attached.

Download File (PDF)

Tags:  MRSA  stopMRSA 

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Evolution of MRSA

Posted By Susan Doherty, Monday, February 1, 2010
Updated: Thursday, June 6, 2013

From the Rockefeller University Newswire -

An international team of researchers has used high resolution genome sequencing to track a particularly virulent strain of MRSA as it traveled between South America, Europe and Southeast Asia. The findings shed light on how these deadly bacteria are able to spread from patient to patient in a single hospital and, on a larger scale of geography and time, between countries and entire continents.

Tags:  MRSA  research  stopMRSA 

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Billings Clinic: High Quality Care at Lower Cost

Posted By Prucia Buscell, Thursday, August 13, 2009
Updated: Thursday, February 17, 2011
The PBS News Hour with Jim Lehrer has featured the Billings Clinic as an example of how high quality health care can be provided at relatively low cost.

In a special segment of the program, aired August 12, health correspondent Betty Ann Bowser visits the clinic, in Billings, Montana, and talks to doctors about the clinic's model of integrated patient care and clinic's participation in a Medicare project designed to reduce costs and improve patient outcomes. The segment opens with President Obama citing the Mayo Clinic and the Cleveland Clinic as examples of providers of high quality and lower cost care, and asks the question: what are they doing that's different?

Billings, which is modeled after the Mayo Clinic, is introduced as another facility that is doing differently, and better. With 3,500 employees, it is the largest multi-specialty medical group practice in the state, and treats 148,000 patients annually at a dozen locations. Physicians at Billings, even the high end specialists, are employees who are paid a salary, rather than working as independent contractors. Dr. Doug Carr, medical director, says that means doctors are paid for what they do forpatients, without regard to the type of insurance reimbursement the patient has or the number of tests ordered.

Two years into the Medicare project, the average annual expenditure per Medicare patient at Billings is $6,332, well below the national average of $8,304. Dr. Carr says coordinated care, including the benefits of a telemedicine program for patients at a distance, saved $1.5million in avoided hospitalizations.

The Billings Clinic was a beta site hospital in the Positive Deviance (PD) Methicillin resistant Staphylococcus aureus (MRSA) Prevention Partnership, spearheaded by Plexus Institute and funded by The Robert Wood Johnson Foundation. Nicholas Wolter, MD, the CEO of Billings Clinic, was one of the founders of Plexus Institute. From Invisible to Visible: Learning to See and Stop MRSA at Billings Clinic, the story of how the Billings Clinic used PD to reduce MRSA infections by 84 percent, is available at the Plexus Institute website in the e-library.

Tags:  buscell  complexity matters  healthcare  MRSA  positive deviance 

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Combatting Supergerms on CNN Health

Posted By Susan Doherty, Tuesday, July 7, 2009
Updated: Thursday, June 6, 2013
CNN Health looks at the latest in supergerm threats including MRSA.

"More worrisome, methicillin-resistant Staphylococcus aureus (MRSA) — bacteria that are resistant to methicillin, a common antibiotic — now kills more people in U.S. hospitals than HIV, AIDS, and tuberculosis combined. And, scarier still, the bug is becoming increasingly common outside of hospitals, affecting everyone from infants with ear infections to young, healthy athletes."

The article also includes strategies to stay safe. 

Tags:  health  MRSA  news  stopMRSA 

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MRSA and positive deviance

Posted By Susan Doherty, Friday, June 26, 2009
Updated: Thursday, June 6, 2013
Curt Lindberg, Plexus Institute’s chief learning and research officer, is quoted in the June 2009 issue of Briefings on Infection Control published by HCPro, Inc. Curt discusses the impact of using the Positive Deviance method in hospitals.

"[sites that participated in the Positive Deviance MRSA Prevention Partnership] were very interested in the methodology because they had all tried many of the typical and standard approaches to improving quality and MRSA prevention and were not seeing really good results from those efforts, so they were kind of frustrated and open to new approaches.”

"[Frontline staff] are the ones that have contact with patients and families, and are in and out of rooms, and are moving equipment around, so they know what’s going on, and it’s their actions and behaviors that directly affect infections and infection prevention.”

Tags:  MRSA  positive deviance  stopMRSA 

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Oprah’s Dr Oz on MRSA

Posted By Susan Doherty, Sunday, May 3, 2009
Updated: Thursday, June 6, 2013
Dr Oz discusses MRSA on a recent Oprah show. See the MRSA safety tips on the Oprah web site.

Tags:  MRSA  news  stopMRSA 

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House Staff Gym Disinfected After MRSA Report

Posted By Susan Doherty, Thursday, April 16, 2009
Updated: Thursday, June 6, 2013
From NBC4 in Washington, DC -

The [U.S.] House of Representatives staff gym got some special attention after an employee caught MRSA.

The extra sanitization was a precaution, according to Karissa Marcum, a representative of the House. It’s unknown how or where the employee contracted the infection, but since the employee is a member of the House Staff Fitness Center, the Office of the Attending Physician recommended the extra cleaning.

Tags:  MRSA  news  stopMRSA 

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Reducing Healthcare-Associated Infections

Posted By Susan Doherty, Wednesday, April 8, 2009
Updated: Thursday, June 6, 2013

From Congressional Testimony by Richard Besser, Acting Director, CDC

Committee: House Appropriations
Sub-Committee: Labor, Health and Human Services, and Education, and Related Agencies

CDC and its partners have translated successful pilot projects at the local level into regional and ultimately national implementation programs. CDC funded and collaborated with the Pittsburgh Veterans Affairs Medical Center to prevent MRSA infections using CDC recommendations. These efforts led to greater than 60 percent reductions in MRSA rates. Because of this success, healthcare facilities in southwestern Pennsylvania collaborated on the development of a regional MRSA initiative and subsequently, the Veterans Health Administration launched a national MRSA prevention initiative involving every Veterans Health Administration hospital in the country, modeled after Pennsylvania’s success. In order to increase adherence to CDC recommendations, CDC is working with several groups to assess the effectiveness of many other successful implementation strategies, such as Positive Deviance strategies. These and other prevention implementation examples demonstrate the savings in lives and healthcare costs that can result from national implementation of evidence-based HAI prevention programs.

The complete testimony is attached.

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Tags:  MRSA  news  stopMRSA 

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