title: Infection Prevention in the Deployed Environment.
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.
authors.affiliation: Infectious Disease Service, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas.
authors.forename: Heather C
authors.initials: HC
authors.lastname: Yun
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
mesh_terms: D000151:Acinetobacter Infections / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D004756:Enterobacteriaceae Infections / Q000517:prevention & control*; D019983:Guideline Adherence; D006772:Hospitals, Military / Q000458:organization & administration*; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D054542:Iraq War, 2003-2011; D007858:Learning; D008889:Military Personnel; D017410:Practice Guidelines as Topic; D014481:United States