The MRSA Reduction Quality Improvement Project began in Fall 2007, enlisting the participation of six (6) dialysis facilities, primarily in the Baltimore, Maryland area, in the application of an innovative behavior-based approach to change called Positive Differences (PD). Dialysis facilities were targeted because the Centers for Disease Control and Prevention (CDC) has found the risk of MRSA to be 100 times greater for dialysis patients than the general population and MRSA infection rates among dialysis patients are higher in the Baltimore, Maryland area than elsewhere in the nation. PD is based on the premise that in every community there are certain individuals or groups whose uncommon practices/behaviors enable them to find better solutions to problems than their neighbors who have access to the same resources. The PD process entails four steps: define, determine, discover, and design.

The project accomplished its goals with 100% of participating facilities using the PD methodology to generate stories of positive changes and for more than half of those participating facilities achieving a reduction in measured MRSA infection between October 2007 and March 2008.