HAVING MY SAY
• Clipping hair – Data supports pre-opera- recommendations for specific antibiotics. Locally, Dr. Morrison has become honored as one
tive clipping of hair versus shaving, mak- It is important to reference existing evi- of Washington, D.C.’s top doctors in Infectious
ing it the standard in many facilities. dence-based recommendations during the Diseases continuously since 1993. He is the Hos-
Clipping avoids the abrasions and trauma selection process. pital Epidemiologist for Inova Health System. He
to the skin associated with shaving, which serves as medical advisor for local Fire and Res-
can contribute to infection due to skin- Where do we go from here? cue as well as law enforcement pertaining to oc-
dwelling microorganisms. While the pur- Preventive measures to minimize and pre- cupational exposures.
chase of clippers constitutes an initial vent HAIs not only help reduce the finan-
increase in cost, facilities using the clip- cial burden on the healthcare system, but Dr. Morrison has published multiple articles in
ping method can reasonably expect a they also help improve patient outcomes. journals including the Annals of Internal Medi-
longer-term cost savings. While HAIs will still occur in even the most cine, Infection Control and Hospital Epidemiol-
• Patient warming – Temperature control diligent of facilities, the new HHS action ogy, Archives of Internal Medicine, and Clinical
is important to the immune system and plan and CMS payment guidelines draw Infectious Diseases. He has authored several chap-
therefore helps prevent wound infections attention to the serious need for proper pre- ters in medical textbooks. Dr. Morrison has re-
following procedures. Your facility may vention protocols. To reduce the incidence ceived multiple leadership and teaching awards
choose to utilize patient warming devices of costly HAIs in your facility, take into ac- from Inova Health System.
peri-operatively to prevent hypothermia count data supporting various infection
which could compromise the immune control processes and products and re- References
system. Studies have demonstrated a re- member that simple actions can have a sig- 1 U.S. Department of Health & Human Services. Healthcare-Associ-
duction in surgical site infections when nificant cumulative impact on your
ated Infections. Available at:
http://www.hhs.gov/ophs/initiatives/
hai.
normothermia is achieved during surgi- patients’ wellbeing and your hospital’s bot-
2 Centers for Disease Control and Prevention. Estimates on Healthcare
cal procedures.
12
tom line. HPN
Associated Infections. Available at:
http://www.cdc.gov/ncidod/
dhqp/hai.html.
• Barrier precautions, including gloves –
3 Weinstein RA. Nosocomial infection update. Emerg Infect Dis. 4
Use of maximal sterile barrier precautions Dr. Morrison received his MD degree at the 1998:416-420.
during the insertion of invasive vascular University of Virginia in 1980. Following in- 4 Nicholas Fletcher, D’Mitri Sofianos, Marschall Brantling Berkes and
catheters decreases the risk of catheter-re- ternship and residency training in internal
William T. Obremskey. J Bone Joint Surg Am. 2007: 89:1605-1618.
lated bloodstream infections. These pre- medicine, he received a Master of Science de-
5 Roger V. Ostrander, Michael J. Botte and Michael E. Brage. J Bone
Joint Surg Am. 87:980-985, 2005.
cautions include sterile gowns, sterile gree in Hospital Epidemiology and Infection
6 Centers for Disease Control and Prevention. Guidelines for the
gloves, masks and caps for the healthcare Control from the University of Virginia. He
Prevention of Intravascular Catheter-Related Infections. MMWR
2002:51 (No. RR-10).
practitioner and a sterile drape for the completed his Infectious Diseases training at
7 The Association of Perioperative Registered Nurses (AORN). Rec-
patient. Since microorganisms are prima- Emory University in Atlanta, Georgia in 1986. ommended Practices for Preoperative Patient Skin Antisepsis.
rily passed on by the hands between pa- Since that time, he has been in private practice
Perioperative Standards and Recommended Practices. 2008.
tients and healthcare employees, gloves of Infectious Diseases in Northern Virginia.
8 Small H, et al. Efficacy of Adding 2% CHG to 70% IPA for Skin
Disinfection Prior to Peripheral Venous Cannulation. Infection Con-
are central to preventing transmission. trol and Hospital Epidemiology. 2008; 29:963-965.
From a purchasing standpoint, take into Nationally, Dr. Morrison is a Fellow of the
9 Tepus D. Effectiveness of ChloraPrep in Reduction of Blood Cul-
account different glove materials and as- American College of Physicians (FACP), a Fel-
ture Contamination Rates in Emergency Department. J Nurs Care
Qual. 23:3:272-276.
sociated barrier protection when making low of the Infectious Diseases Society of America
10 Federal Register 2008;73:23551
a decision, along with cost per use. Even (FIDSA), and a Fellow of the Society for
11 Infect Control Hosp Epidemiol 2008;29:815 and 820.
when gloves are used, proper hand hy- Healthcare Epidemiology of America (FSHEA). 12 Pettis A. Temperature check for surgical site infection preven-
giene protocols must be followed. Alco- Regionally, Dr. Morrison is a Professor and Dis-
tion. Presented at: the 34th Annual Education Conference & Inter-
national Meeting of the Association for Professionals in Infection
hol-based waterless agents are excellent tinguished Senior Fellow at George Mason Uni- Control; June 24-27, 2007; San Jose, Calif.
for routine patient care unless the patient versity in the School of Public Policy. Further, 13 Surgical Care Improvement Project (SCIP). Measures: Infections.
harbors Clostridium difficile in which case he is an Assistant Clinical Professor of Medi-
Available at:
http://qualitynet.org/dcs/ContentServer?
level3=Measures&c=MQParents&pagename=Medqic
soap and water are required. cine in the Georgetown University School of
%2FMeasure%2FMeasuresHome&cid=1089815967030&
parentName=Topic.
• Prophylactic antibiotics – When risk of Medicine.
postoperative infection is present, preop-
erative administration of antibiotics can Additional Resources:
help to reduce risk. The Surgical Care Im-
provement Project (SCIP) offers guidance
• HHS action plan to prevent HAIs:
on improving the timing, selection and
http://www.hhs.gov/ophs/initiatives/hai/infection.html
duration of prophylactic antibiotic use to
CDC infection control guidelines:
reduce the incidence of surgical site infec-
http://www.cdc.gov/ncidod/dhqp/guidelines.html
tions.
13
In particular, SCIP suggests that
the first antibiotic dose be administered Association for Professionals in Infection Control and Epidemiology (APIC):
within an hour before the incision is made
http://www.apic.org
and that the antibiotic be discontinued
within 24 hours of elective surgery and
Infectious Diseases Society of America (IDSA):
http://www.idsociety.org/
48 hours for cardiac surgery. In regards to
The Society for Healthcare Epidemiology of America (SHEA):
antibiotic selection, SCIP acknowledges
http://www.shea-online.org/
the wealth of guidelines available with
www.hpnonline.com • HEALTHCARE PURCHASING NEWS June 2009 67
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