title: Response to infection control challenges in the deployed setting: Operations Iraqi and Enduring Freedom.
abstract: BACKGROUND
  Infections caused by multidrug-resistant organisms (MDROs), including Acinetobacter, have complicated the care of military personnel injured in Operations Iraqi and Enduring Freedom. Cumulative data suggest that nosocomial transmission of MDROs in deployed medical treatment facilities (MTFs) has contributed to these infections. A 2008 review of deployed MTFs identified multiple factors impeding the performance of infection prevention and control (IC) practices. In response, efforts to emphasize IC basics, improve expertise, and better track MDRO colonization were pursued.
  
  
  METHODS
  Efforts to increase awareness and enhance IC in deployed MTFs were focused on educating leaders and deploying personnel, producing deployed IC resources, and standardizing level IV and V admission screening for MDRO colonization. A repeat mission in 2009 reviewed interval progress.
  
  
  RESULTS
  Increased awareness and the need for emphasis on basic IC practice, including hand hygiene, use of transmission-based (isolation) precautions, and cohorting of patients, were imparted to leaders and deploying personnel through briefings, presentations, and an All Army Activities message. Enhancement of IC expertise was implemented through increased standardization of IC practice, establishment of a predeployment IC short course, an IC teleconsultation service, and dedicated Internet resources. Standardization of admission colonization screening of personnel evacuated from the combat theater was established to better define and respond to the MDRO problem. A repeat review of the deployed MTFs found overall improvement in IC practice, including clear command emphasis in the Iraqi theater of operations.
  
  
  CONCLUSIONS
  Maintaining a strong IC effort in the deployed setting, even in a stabilized operational environment, is difficult. Use of innovative strategies to enhance expertise and practice were implemented to reduce MDRO infections.
authors.affiliation: Infectious Disease Service, San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA. duane.hospenthal@amedd.army.mil
authors.forename: Duane R
authors.initials: DR
authors.lastname: Hospenthal
authors.forename: Helen K
authors.initials: HK
authors.lastname: Crouch
authors.forename: Judith F
authors.initials: JF
authors.lastname: English
authors.forename: Fluryanne
authors.initials: F
authors.lastname: Leach
authors.forename: Jane
authors.initials: J
authors.lastname: Pool
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Conger
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Whitman
authors.forename: Glenn W
authors.initials: GW
authors.lastname: Wortmann
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.forename: Paul R
authors.initials: PR
authors.lastname: Cordts
authors.forename: W Bryan
authors.initials: WB
authors.lastname: Gamble
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D019983:Guideline Adherence; D006772:Hospitals, Military / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000592:standards*; D054542:Iraq War, 2003-2011; D008889:Military Personnel; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014193:Trauma Centers / Q000592:standards*; D014481:United States