Landrum Michael L, Murray Clinton K
From the Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA.
J Trauma. 2008 Feb;64(2 Suppl):S123-7; discussion S127-8. doi: 10.1097/TA.0b013e31816086dc.
Since the onset of military operations in Iraq and Afghanistan, there has been a marked increased in multidrug resistant bacterial infections among combat casualties. We describe the rates of ventilator-associated pneumonia (VAP) before and after the implementation of aggressive infection control measures at the Air Force Theater Hospital in Iraq.
All patients admitted to the intensive care unit (ICU) were followed prospectively for the development of VAP. Baseline VAP rate was determined in May 2006, and preventive measures were implemented by June 2006. Interventions included hand hygiene, contact barrier precautions, patient and staff cohorting, chlorhexidine oral care, and reducing the duration and spectrum of surgical antimicrobial prophylaxis. Additionally, each ICU tent was closed periodically for cleaning and disinfection. Daily inspections provided ongoing staff education and enforcement of procedures. Monthly VAP rates were calculated and compared for trend.
There were 475 ICU admissions from May 2006 through August 2006 for a mean admission rate of 119 per month. The rate of VAP per 1,000 ventilator days was 60.6 in May, 31.6 in June, 21.3 in July, and 11.1 in August (p = 0.029). Targeted surveillance in November and December revealed VAP rates of 11.6 and 9.7, respectively. Notably, the most common bacteria, Acinetobacter, had improved antimicrobial susceptibilities after the interventions.
Implementation of aggressive infection control procedures in a combat military hospital was associated with a significant decrease in the rate of VAP. Despite the numerous challenges in theater, infection control can have measurable and sustainable impact in a combat theater hospital.
自伊拉克和阿富汗军事行动开始以来，战斗伤员中多重耐药细菌感染显著增加。我们描述了伊拉克空军战区医院实施积极感染控制措施前后呼吸机相关性肺炎（VAP）的发生率。
对所有入住重症监护病房（ICU）的患者进行前瞻性随访，观察VAP的发生情况。2006年5月确定基线VAP发生率，并于2006年6月实施预防措施。干预措施包括手部卫生、接触隔离预防、患者和工作人员分组、洗必泰口腔护理以及缩短手术抗菌预防的持续时间和范围。此外，每个ICU帐篷定期关闭进行清洁和消毒。每日检查持续为工作人员提供教育并执行程序。计算每月VAP发生率并比较其趋势。
2从006年5月至2006年8月，共有475例患者入住ICU，平均每月入住率为119例。每1000个呼吸机日的VAP发生率在5月为60.6，6月为31.6，7月为21.3，8月为11.1（p = 0.029）。11月和12月的目标监测显示VAP发生率分别为11.6和9.7。值得注意的是，干预后最常见细菌鲍曼不动杆菌的抗菌敏感性有所改善。
在战斗军事医院实施积极的感染控制程序与VAP发生率显著降低相关。尽管战区存在诸多挑战，但感染控制在战斗战区医院可产生可衡量且可持续的影响。
