Hospital-acquired device-associated infections at a deployed military hospital in Iraq

BACKGROUND: To date, there have been no published studies describing rates of device-associated infections over extended periods at deployed military hospitals. We describe the rates of utilization and device-associated infections at the Air Force Theater Hospital (AFTH) in Iraq. METHODS: This is a retrospective review of infection control (IC) records at the AFTH intensive care unit (ICU) from November 2006 through December 2007. Monthly device utilization and infection rates (per 1000 device days) were analyzed for trend and compared with pooled means for US trauma ICUs. RESULTS: Central line utilization rates were constant (mean, 64%) with central line- associated bloodstream infection (CLAB) rates of 0 to 7.7 (US rate 4.6) except from September to December 2007, when the rate ranged from 7.4 to 29.3. An IC program reduced ventilator-associated pneumonia (VAP) rates to a baseline of 9.7 to 11.6. However, VAP rates rose to 13.3 to 56.3 in the 4-month period of January through April 2007 and 14.3 to 28.2 during September through December 2007. Neither CLAB nor VAP rates correlated with ICU admissions. The urinary catheter-associated urinary tract infection rate was 0 to 6.7 (US rate 5.5). Overall, Staphylococcus aureus was the predominant organism during May through October 2007 and Acinetobacter in November and December 2007. CONCLUSIONS: Substantial variability exists in the rates of CLAB and VAP in the AFTH. Potential explanations are staff turnover and prolonged stays among non-US personnel who may serve as a reservoir for ongoing infections. Identification of barriers to IC may help inform the process of creating and implementing effective IC strategies in deployed military hospitals.