WASHINGTON, DC—A House subcommittee questioned military officials about efforts to prevent and control multidrug-resistant infections at MTFs. “The incidence of drug-resistant infections is a national and global problem … DoD and the services must remain vigilant in their efforts to monitor and prevent these infections,” said Rep Vic Snyder, D-AR, a physician who chairs the House Armed Services Oversight and Investigations Subcommittee.
Snyder said that these infections had “decreased significantly” in military hospitals in the past few years, but noted that the problem has not gone away. “According to the Department of Defense, over 3,300 servicemembers developed Acinetobacter infections from 2004 to 2009.”
Jack Smith, MD, an official in the Office of the Assistant Secretary of Defense for Health Affairs, acknowledged that multidrug resistant organisms (MDROs) are a “serious problem” for the military, and said that DoD has been “actively engaged” in measures to screen, survey, prevent, and control these infections in MTFs at home and abroad.
MDROs and Injured Servicemembers
While most civilian US hospitals report MDRO infections among those with a long hospital stay, such as the elderly with multiple complicated medical problems, military hospitals experience cases of MDRO infection in its young, combat-injured patients, according to Air Force Col James Collier.
Col Duane Hospenthal, MD, the infectious diseases consultant to the Army Surgeon General, told the subcommittee that infection and colonization of MDRO, especially MDR Acinetobacter baumannii-calcoaceticus complex, has “complicated the care” of injured servicemembers returning from Iraq and Afghanistan. “The source of these bacteria in our returning combat-injured personnel has not been fully elucidated. It appears, most likely, these bacteria are spread nosocomially both in the combat theater, along the long journey back to, and within, military medical centers in the US.”
Facilities in theater are doing a better job of ensuring that standard infection control practices are being met, according to Navy Capt Gregory Martin, the Navy’s specialty leader for infectious diseases. “Earlier on in the war things were a little less organized, as far as what we knew was going on. Now, the focus on infection control is much more evident in all of these facilities.”
In addition to adhering to routine practice and participation in civilian healthcare standards, Hospenthal said MHS has responded with specific efforts directed to returning injured military personnel. These efforts include admission MDRO colonization screening when injured servicemembers are admitted at major medical centers, the development of specific guidelines to prevent infections in the combat-injured, efforts to improve infection prevention and control in combat theaters, and the establishment of the MDRO Repository and Surveillance Network System.
Addressing and Tracking MDROs
Officials also described efforts to track and follow patients with MDRO infections. A study is taking place called the Trauma Infectious Diseases Outcomes Study (TIDOS), funded primarily by the Navy, that has been established to study interventions and outcomes in the combat-wounded that develop MDRO infections. The study began enrolling patients in June of 2009 and follows patients through their transition to the VA system. “Our patients, their families, and our clinicians would like to know what can be done to limit the harm that these infections inflict on our wounded warriors,” Martin explained.
DoD is also participating in CDC’s National Healthcare Safety Network (NHSN), which is a system that collects data from healthcare facilities across the US to note adherance to practices known to be associated with the prevention of healthcare associated infections. The data is used to improve patient safety.
Thirty-three MTFs are participating in the program. MTFs began submitting data to NHSN in December of 2009 and after a year’s worth of data, the MTFs will be able to compare their device-associated infection rates with other healthcare facilities across the US, according to Smith’s testimony.
Surveillance of MDROs, however, remains a challenge. “If we had a single thing to track and follow around it would be a whole lot easier … Even CDC does not see this as something that you can easily put your arms around,” noted Hospenthal.
Hospenthal said that the data collected by screening servicemembers for MDROs at the four major medical centers in the military that receive combat-injured personnel should help with surveillance.
Describing DoD’s surveillance of MDROs as “a developing system of surveillance,” Smith said that “it certainly has gotten better and better over time.”
Snyder also wanted to know the level of funding DoD has for targeting MDRO research. Smith said that DoD had $13.68 million allocated for research related to MDROs this year. Snyder responded that it seems this money “would be stretched” to address MDRO research. Smith, however, said while it is a vital interest to the military, DoD had to “balance” its research funding in this area with other areas of military research interests.