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Evaluation of Potential Environmental Contamination Sources for the Presence of Multidrug-Resistant Bacteria Linked to Wound Infections in Combat Casualties

Published online by Cambridge University Press:  02 January 2015

Edward F. Keen III ,
Katrin Mende ,
Heather C. Yun ,
Wade K. Aldous ,
Timothy E. Wallum ,
Charles H. Guymon ,
David W. Cole ,
Helen K. Crouch ,
Matthew E. Griffith  and
Bernadette L. Thompson
...Show all authors
Edward F. Keen III
Affiliation:
San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas
Katrin Mende
Affiliation:
San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas Infectious Disease Clinical Research Program, Uniformed Services University of the Health Science, Bethesda, Maryland
Heather C. Yun
Affiliation:
San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas Uniformed Services University of the Health Science, Bethesda, Maryland
Wade K. Aldous
Affiliation:
AMEDD (Army Medical Department) Center and School, Fort Sam Houston, Texas
Timothy E. Wallum
Affiliation:
US Army Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, Texas
Charles H. Guymon
Affiliation:
US Army Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, Texas
David W. Cole
Affiliation:
Blanchfield Army Community Hospital, Fort Campbell, Kentucky
Helen K. Crouch
Affiliation:
San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas
Matthew E. Griffith
Affiliation:
San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas Uniformed Services University of the Health Science, Bethesda, Maryland
Bernadette L. Thompson
Affiliation:
San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas
Joel T. Rose
Affiliation:
AMEDD (Army Medical Department) Center and School, Fort Sam Houston, Texas
Clinton K. Murray*
Affiliation:
San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas Uniformed Services University of the Health Science, Bethesda, Maryland
*
Infectious Disease Service, San Antonio Military Medical Center, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234 (clinton.murray@amedd.army.mil)
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Abstract

Objective.

To determine whether multidrug-resistant (MDR) gram-negative organisms are present in Afghanistan or Iraq soil samples, contaminate standard deployed hospital or modular operating rooms (ORs), or aerosolize during surgical procedures.

Design.

Active surveillance.

Setting.

US military hospitals in the United States, Afghanistan, and Iraq.

Methods.

Soil samples were collected from sites throughout Afghanistan and Iraq and analyzed for presence of MDR bacteria. Environmental sampling of selected newly established modular and deployed OR high-touch surfaces and equipment was performed to determine the presence of bacterial contamination. Gram-negative bacteria aerosolization during OR surgical procedures was determined by microbiological analysis of settle plate growth.

Results.

Subsurface soil sample isolates recovered in Afghanistan and Iraq included various pansusceptible members of Enterobacteriaceae, Vibrio species, Pseudomonas species, Acinetobacter Iwojfii, and coagulase-negative Staphylococcus (CNS). OR contamination studies in Afghanistan revealed 1 surface with a Micrococcus luteus. Newly established US-based modular ORs and the colocated fixed-facility ORs revealed no gram-negative bacterial contamination prior to the opening of the modular OR and 5 weeks later. Bacterial aerosolization during surgery in a deployed fixed hospital revealed a mean gram-negative bacteria colony count of 12.8 colony-forming units (CFU)/dm2/h (standard deviation [SD], 17.0) during surgeries and 6.5 CFU/dm2/h (SD, 7.5; P = .14) when the OR was not in use.

Conclusion.

This study demonstrates no significant gram-negative bacilli colonization of modular and fixed-facility ORs or dirt and no significant aerosolization of these bacilli during surgical procedures. These results lend additional support to the role of nosocomial transmission of MDR pathogens or the colonization of the patient themselves prior to injury.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 9 , September 2012 , pp. 905 - 911
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012 

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