Ventilator associated pneumonia in a military deployed setting: the impact of an aggressive infection control program

Since the onset of military operations in Iraq and Afghanistan, there has been a marked increased in multidrug resistant bacterial infections among combat casualties. We describe the rates of ventilator-associated pneumonia (VAP) before and after the implementation of aggressive infection control measures at the Air Force Theater Hospital in Iraq.

All patients admitted to the intensive care unit (ICU) were followed prospectively for the development of VAP. Baseline VAP rate was determined in May 2006, and preventive measures were implemented by June 2006. Interventions included hand hygiene, contact barrier precautions, patient and staff cohorting, chlorhexidine oral care, and reducing the duration and spectrum of surgical antimicrobial prophylaxis. Additionally, each ICU tent was closed periodically for cleaning and disinfection. Daily inspections provided ongoing staff education and enforcement of procedures. Monthly VAP rates were calculated and compared for trend.

There were 475 ICU admissions from May 2006 through August 2006 for a mean admission rate of 119 per month. The rate of VAP per 1,000 ventilator days was 60.6 in May, 31.6 in June, 21.3 in July, and 11.1 in August (p = 0.029). Targeted surveillance in November and December revealed VAP rates of 11.6 and 9.7, respectively. Notably, the most common bacteria, Acinetobacter, had improved antimicrobial susceptibilities after the interventions.

Implementation of aggressive infection control procedures in a combat military hospital was associated with a significant decrease in the rate of VAP. Despite the numerous challenges in theater, infection control can have measurable and sustainable impact in a combat theater hospital.