Infection Control and Prevention After Dismounted Complex Blast Injury

During recent operations in Afghanistan, dismounted complex blast injuries (DCBI) have become increasingly common, and due to improvements in combat casualty care, these injuries are more survivable than they have been at any time in history. These patients are at high risk for infectious complications with infection rates as high as 50% in intensive care unit patients. The pathogens involved are often unique, including multidrug-resistant organisms and invasive fungi. This chapter summarizes the current literature on the epidemiology, microbiology, and outcomes of infectious complications in the predominantly DCBI combat casualty population and defines recommended measures for preventing these complications. These include wound management, use of antimicrobials, and both strategic and tactical infection prevention and control priorities. These recommendations are applicable throughout the continuum of casualty care with an emphasis on preventing infection beginning from the time of injury.