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

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.

Data-Powered Positive Deviance during the SARS-CoV-2 Pandemic—An Ecological Pilot Study of German Districts

“…In this study, we conducted a novel, unique, and holistic approach to identify successful practices for controlling the transmission of the SARS-CoV-2 pandemic [ 39 ]. To identify Positive Deviants, we performed a comparison between all districts regarding their ability to keep the reproduction rate low while considering structural, mobility- and weather-related differences between them.…”

Psychologie und Förderung der Händehygiene-Compliance

“…Eine besondere Rolle spielen dabei Führungskräfte, die sowohl über die praktische Unterstützung ihrer Mitarbeiter bei der Leitlinienumsetzung als auch in ihrer Funktion als Vorbilder und Rollenmodelle wirksam sein können 63 , 64 . Auch in diesem Zusammenhang ist das Konzept der positiven Devianz für die Infektionsprävention adaptiert worden, also die Stärkung des sozialen Einflusses von Mitarbeitern mit besonders hoher Compliance 65 .…”

Applying the health capability profile to empirically study chronic hepatitis B in rural Senegal: a social justice mixed-methods study protocol

“…In addition, the HCP relates to the concept of positive deviance, which has been used to highlight positive, intentional departure from standard medical practice, 74 with recent applications to the prevention and control of infections 75 or to health equity issues 76 beyond the realm of healthcare and public health systems. The HCP allows for the identification of effective or positive examples in all domains that constitute a person’s health capability (including in areas such as health-related knowledge, beliefs, motivation or expectations).…”