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Status Update on Infection Prevention and Control at Deployed Medical Treatment Facilities
Alice E Barsoumian1, Steffanie L Solberg2, Ashley S Hanhurst3
1Infectious Disease Service, Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
Introduction:
Infections with multidrug resistant organisms that spread through nosocomial transmission complicate the care of combat casualties. Missions conducted to review infection prevention and control (IPC) practices at deployed medical treatment facilities (MTFs) previously showed gaps in best practices and saw success with targeted interventions. An IPC review has not been conducted since 2012. Recently, an IPC review was requested in response to an outbreak of multidrug resistant organisms at a deployed facility.
Materials And Methods:
A Joint Service team conducted onsite IPC reviews of MTFs in the U.S. Central Command area of operations. Self-assessments were completed by MTF personnel in anticipation of the onsite assessment, and feedback was given individually and at monthly IPC working group teleconferences. Goals of the onsite review were to assist MTF teams in conducting assessments, review practices for challenges and successes, provide on the spot education or risk mitigation, and identify common trends requiring system-wide action.
Results:
Nine deployed MTFs participated in the onsite assessments, including four Role 3, three Role 2 capable of surgical support, and two Role 1 facilities. Seventy-eight percent of sites had assigned IPC officers although only 43% underwent required predeployment training. Hand hygiene and healthcare associated infection prevention bundles were monitored at 67% and 29% of MTFs, respectively. Several challenges including variability in practices with turnover of deployed teams were noted. Successes highlighted included individual team improvements in healthcare associated infections and mentorship of untrained personnel.
Conclusions:
Despite successes, ongoing challenges with optimal deployed IPC were noted. Recommendations for improvement include strengthening IPC culture, accountability, predeployment training, and stateside support for deployed IPC assets. Variability in IPC practices may occur from rotation to rotation, and regular reassessment is required to ensure that successes are sustained through times of turnover.
Insights
Multidrug-resistant organism infections pose risks to combat casualties. Recent reviews of infection prevention and control (IPC) practices in deployed military treatment facilities (MTFs) revealed persistent challenges and recommended enhanced training and support.
Area of Science:
- Military Medicine
- Infectious Diseases
- Public Health
Background:
- Nosocomial transmission of multidrug-resistant organisms (MDROs) complicates care for combat casualties.
- Previous infection prevention and control (IPC) reviews identified gaps in deployed medical treatment facilities (MTFs), with targeted interventions showing success.
- An IPC review was necessitated by a recent MDRO outbreak at a deployed facility, as no comprehensive review had occurred since 2012.
Purpose of the Study:
- To conduct onsite IPC reviews of MTFs within the U.S. Central Command area of operations.
- To identify challenges and successes in current IPC practices.
- To provide immediate education and risk mitigation, and to detect system-wide trends.
Main Methods:
- A Joint Service team performed onsite IPC assessments at nine deployed MTFs (Role 1, 2, and 3).
- MTF personnel completed self-assessments prior to the onsite reviews.
- Feedback was provided individually and during monthly IPC working group teleconferences.
Main Results:
- Seventy-eight percent of MTFs had assigned IPC officers, but only 43% received required predeployment training.
- Hand hygiene and healthcare-associated infection (HAI) prevention bundles were monitored at 67% and 29% of sites, respectively.
- Key challenges included practice variability due to team turnover; successes included individual team improvements in HAI reduction and mentorship.
Conclusions:
- Ongoing challenges in deployed IPC persist despite noted successes.
- Recommendations include strengthening IPC culture, accountability, predeployment training, and stateside support.
- Regular reassessments are crucial to sustain improvements amidst personnel rotation and turnover.
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