2008 Citizen Services

Rajiv Jain

Developed and led an initiative that reduced a type of life-threatening, hospital-acquired infections by 60 percent and has been replicated at all 153 VA hospitals and other hospitals across America and parts of the world.

When people go the hospital, they expect the visit to make them well, not sick. But the Institute of Medicine estimates that 2 million patients acquire infections in U.S. hospitals every year, and 100,000 of those patients die — often following what began as a routine procedure. Dr. Rajiv Jain and his team at the Department of Veterans Affairs’ Pittsburgh Healthcare System (VAPHS) are leading the effort to dramatically reduce that number. These efforts have already cut infections at the Pittsburgh facility by 60 percent and are providing a model for infection reduction that is being replicated across the country and in other parts of the world.

A significant cause of hospital-acquired infections is the virulent pathogen, Methicillin-Resistant Staphylococcus Aureus, commonly known as MRSA (pronounced Mer-sah). It cannot be killed by most antibiotics. It can cause debilitating illness, excruciating suffering and death. The cost of treating infections is quite significant. MRSA is rampant in health care facilities and medical experts consider it one of the nation’s most alarming public health threats. This “superbug” kills more people than AIDS, diabetes or Alzheimers, according to the Centers for Disease Control and Prevention (CDC). However, as Dr. Jain and his MRSA Prevention Team have proven, MRSA infections are preventable.

Dr. Jain and his team used a four-pronged prevention strategy, referred to as the MRSA Bundle—Hand Hygiene, Active Surveillance, Contact Precautions and Cultural Transformation. With the guidance and encouragement of Dr. Jain, infection control is now everyone’s job at the Pittsburgh hospital. Front-line staff and MRSA coordinators (a position created by Dr. Jain) review data weekly to determine how any transmissions occurred and identify barriers to controlling infection. Dr. Jain’s adaptation of “positive deviance,” an innovative approach to behavioral and culture change, is used to foster leadership support of staff-owned and -operated solutions.

The evidence is in. The plan is working. The number of MRSA infections at Dr. Jain’s hospital dropped from an average of 60 infections annually to 17 last year. The surgical unit at the hospital has cut its rate by 70 percent. The success of the MRSA Prevention Initiative has not only improved the safety and quality of life for patients, but it has also resulted in substantial cost savings and efficiencies.

People across the country, including teams at CDC, have taken notice of this success. Under Dr. Jain’s leadership, the MRSA Bundle has been implemented at all 153 VA hospitals, and the Department of Veterans Affairs is planning to expand this effort to its community living centers.

The Governor of Pennsylvania visited VA Pittsburgh to highlight the work done at the Hospital to reduce MRSA infections and has called on hospitals across the commonwealth of Pennsylvania to do the same.

Based in part on work by Dr. Jain and his team, three state legislatures broke new ground in 2007 by passing bills requiring hospitals to test high-risk patients routinely. Eighteen states now require hospitals to publish their infection rates.

This MRSA Prevention Initiative has attracted visitors to VAPHS from hospitals around the U.S. and abroad, including Germany and, most recently, the United Kingdom. The delegates from these countries come to learn more about VAPHS’ research and see first-hand the improvements achieved.

Dr. Rajiv Jain’s team’s accomplishments are remarkable, dramatically reducing the rates of a deadly affliction. But he is still not satisfied. He often says, “One infection is too many.” Hopefully, his efforts will inspire others to be more proactive in preventing these infections. He is certainly off to a great start.