Infection control challenges in deployed US military treatment facilities

Personnel sustaining combat-related injuries in current overseas conflicts continue to have their care complicated by infections caused by multidrug-resistant organisms, including Acinetobacter, Klebsiella, and Pseudomonas. Although presumed to be due to multiple factors both within and outside of the combat theater, concern has been raised about the difficulties in establishing and maintaining standard infection control (IC) practices in deployed medical treatment facilities and in the evacuation of the injured back to the United States.

Level III facilities (hospitals capable of holding patients >72 hours) in Iraq and Afghanistan and the evacuation system from Iraq to the continental US were reviewed by an expert IC-infectious disease team.

All reviewed facilities had established IC programs, but these were staffed by personnel with limited IC experience, often without perceived adequate time dedicated to perform their duties, and without uniform levels of command emphasis or support. Proper hand hygiene between patients was not always ideal. Isolation and cohorting of patients to decrease multidrug-resistant organism colonization and infection varied among facilities. Review of standard operating procedures found variability among institutions and in quality of these documents. Application of US national and theater-specific guidelines and of antimicrobial control measures also varied among facilities.

Effective IC practices are often difficult to maintain in modern US hospitals. In the deployed setting, with ever-changing personnel in a less than optimal practice environment, IC is even more challenging. Standardization of practice with emphasis on the basics of IC practice (e.g., hand hygiene and isolation procedures) needs to be emplaced and maintained in the deployed setting.