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Infection Prevention in the Deployed Environment
Heather C Yun1, Clinton K Murray
1Infectious Disease Service, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas.
Abstract:
Up to 50% of combat injured patients from recent conflicts have suffered infectious complications, predominantly with multidrug-resistant (MDR) bacteria acquired nosocomially in the chain of tactical combat casualty care. These bacteria have ranged from MDR Acinetobacter baumannii-calcoaceticus associated with Operation Iraqi Freedom (OIF), to extended spectrum beta-lactamase producing Enterobacteriaceae from operations in Afghanistan. Experience from interventions at Level III facilities demonstrate that basic infection control (IC) procedures, such as improvements in hand hygiene, use of ventilator associated pneumonia bundles, and antimicrobial stewardship, can improve outcomes even in austere environments. While some systematic interventions have been implemented to mitigate this risk, including development of the Deployed Infection Control Course, the Multidrug-Resistance Surveillance Network, and the Trauma Infectious Disease Outcomes Study, ongoing vulnerabilities remain. Deployed microbiology capabilities should be strengthened, theater-level IC standard operating procedures should be implemented, and a joint, theater-level expert IC consultant should be appointed to be responsible for directing IC activities from Levels I to IV.
Insights
Combat casualties face high rates of multidrug-resistant (MDR) bacterial infections. Implementing basic infection control (IC) measures and strengthening deployed microbiology can significantly improve patient outcomes in military settings.
Area of Science:
- Infectious Diseases
- Military Medicine
- Public Health
Background:
- Combat-injured patients experience high rates of infectious complications, often caused by multidrug-resistant (MDR) bacteria acquired nosocomially.
- Specific MDR bacteria like Acinetobacter baumannii-calcoaceticus and extended-spectrum beta-lactamase producing Enterobacteriaceae have been identified in recent conflicts.
Purpose of the Study:
- To review the challenges of infectious complications in combat casualties.
- To highlight the effectiveness of basic infection control (IC) measures in austere environments.
- To recommend strategies for mitigating the risk of MDR infections in deployed settings.
Main Methods:
- Review of infectious complications in combat casualties from recent conflicts.
- Analysis of interventions at Level III facilities, including infection control procedures.
- Evaluation of existing systematic interventions and identification of ongoing vulnerabilities.
Main Results:
- Basic infection control (IC) procedures, such as hand hygiene and antimicrobial stewardship, improve outcomes even in austere environments.
- Despite implemented interventions, vulnerabilities in preventing and managing nosocomial infections persist.
- Deployed microbiology capabilities and theater-level IC standard operating procedures require strengthening.
Conclusions:
- Infection control (IC) is critical for managing combat-injured patients, particularly those with multidrug-resistant (MDR) bacterial infections.
- Enhancing deployed microbiology, implementing theater-level IC standard operating procedures, and appointing expert IC consultants are essential.
- A comprehensive, theater-level approach to infection control is necessary to address ongoing vulnerabilities.
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