From Baghdad to Bethesda: Infection Control Considerations for Iraqi-War Related Injuries

ISSUE: Literature from the Vietnam War, Iran-Iraq War, and field reports from Landsthul Regional Medical Center and USNS Comfort, identified multidrug-resistant acinetobacter (MDRA) and other gram-negative rods (GNR) as war-zone community-acquired pathogens both colonizing and infecting war casualties. PROJECT: Infection control professionals (ICPs) formed a multidisciplinary team to design a surveillance protocol for patients admitted with injuries from the Iraqi War theatre. Surveillance cultures of skin (axilla) and wound sites were collected at time of admission. Patients remained in an established cohort with contact precautions until final culture results were released from the laboratory. RESULTS: Between April and August 2003, 55 war casualties met admission criteria to the hospital. A total of 11 patients (20%) were identified with MDRA. Patients were maintained on contact precautions throughout length of stay, preventing transmission to other patients and averting a nosocomial outbreak of MDRA within the facility. LESSON LEARNED: Communication with frontline healthcare workers in the war theatre is essential to prevent transmission of multidrug-resistant pathogens through the spectrum of military treatment facilities (MTFs). Surveillance screening protocols for patients admitted from areas of global conflict are instrumental in the early identification of multidrug-resistant pathogens and instituting appropriate transmission-based precautions. NOTE: The views expressed in this article are those of the author(s) and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.