The U.S. Army Public Health Command has released an incomplete list of epidemiological consultation (EPICON) studies from the past decade to epiNewswire, without mentioning the fact that the titles of some studies were not on the list.
One politically-sensitive Army report excluded from the disclosed list is a 2005 EPICON study detailing the spread of multidrug-resistant Acinetobacter infections from contaminated military hospitals in Iraq throughout the military hospital system.
That report details evidence that that improper use of antibiotics and unsanitary conditions at U.S. military hospitals were responsible for the deadly outbreak of Acinetobacter infections among wounded troops, and that the outbreak had spread to civilian patients in the U.S. and Germany, killing several of them.
But for several years after the study’s completion, Army health officials continued to downplay the risk to civilians and to make misleading statements to soldiers and the public, claiming Acinetobacter infections were from Iraqi soil in soldiers’ blast wounds.
In reality, Acinetobacter “wound infections were relatively uncommon,” the 2005 Acinetobacter EPICON report states. “Pre-hospital, primary wound infections in-theater are not likely to have a significant role in transmission.”
In Iraq, military surgeons were using broad-spectrum antibiotics as prophylactics against infection, “introducing a greater risk of multi-drug resistant organisms (MDRO) evolving as a result,” the report notes.
Hand hygiene practices were inconsistently observed by military healthcare workers, the report states.
“Proper hand washing has been the single most important measure in controlling hospital spread of Acinetobacter,” the report states.
All seven military hospitals in Iraq were found to be “contaminated” with Acinetobacter, the report states.
Civilians were at much greater risk from infections than soldiers, the report states.
The report recommended adoption of standardized infection control practices at military hospitals and the air evacuation system, including disinfection and hand washing practices – and noted a pressing need for improved medical record-keeping “at all levels of care, particularly in-theater.”
A German hospital accepting U.S. troops on a referral basis, experienced an Acinetobacter outbreak that spread to German patients, the report states. That outbreak “reflects the potential importance that the outbreak can have, and probably has had, outside of the direct chain of evacuation,” the report states. Similar outbreaks had occurred in British hospitals where UK troops had been treated, the report notes.
Missing and incomplete medical records complicated the study, the report states.
“Relatively few surveillance and infection control data are available from in-theater, although progress has been made,” the report states. “Data quality from patient chart reviews indicates large variation in data available and no standardization.”
The “absence of good documentation either precludes any ability to draw scientific conclusions or significantly complicates investigations and analyses that are critical for prioritizing interventional resources and saving lives,” the report states.
epiNewswire’s Bryant Furlow first reported on an Acinetobacter outbreak among Iraqi and U.S. patients on the U.S. Navy’s hospital ship Comfort in July 2006, in the International Affairs Journal’s International Update newsletter.
In February 2007, Wired magazine writer Steve Silberman subsequently broke the story of Acinetobacter’s spread to Europe, Walter Reed Army Medical Center, and elsewhere. Silberman’s report details how the family of a U.S. Marine who died of his infection, was initially told he had died of his wounds.
That summer, citing two medical journal publications based on parts of the EPICON research effort, Reuters reported that “new research” showed that contaminated hospitals, not Iraqi soil, caused the Acinetobacter outbreak.
In reality, military medical officials had suspected as much since spring 2003, the EPICON report indicates — and had known it to be the case since the first, 2004 symposium on the project’s initial findings.
Steve Silberman. “The invisible enemy.” Wired magazine, February 2007.
Reuters Health. “Field hospitals source of soldier infections.” June 18, 2007.
Filed Under: Acinetobacter • Afghanistan • Army Medical Command (MEDCOM) • CTX-M • ESBL • Epidemiology • Extended-spectrum beta-lactamase • Hospital Infections • Iraq • U.S. Department of Defense (DoD) • antibiotic resistance • hospital-acquired infections • military medicine • public health • sunshine • war