Wound infections in Iraq and here

In August of last year we wrote a post, Festering wounds of Iraq. It was about an antibiotic resistant organism, Acinetobacter baumannii, proving very troublesome in wound infections in soldiers. A. baumannii resides in the soil and is a problem world-wide, not just an Iraqi problem. But it is also a problem specifically related to the war in Iraq. Wound infections with this organism are more likely to occur at the time of injury under battle conditions or to be acquired in emergency treatment settings. Preventing this infection in stateside hospitals has also been a challenge. Without the original wounds, there is no infection either.

In August we quoted from an article in Forbes:

Preventing the bacteria's spread has required doctors to take extreme care, putting all patients who are returning from the theater of war into isolation. "It's one of those pathogens that once it gets into a population and a chain of care, it can set up shop. Trying to contain the spread of this infection to other people is very difficult," says Andrew Shorr, a doctor who recently left Walter Reed for Washington Hospital Center. "What has happened over the past 18 months is every patient who shows up, we assume they're positive until they are demonstrated negative." (Forbes)

Walter Reed Army Hospital knows this is a major problem for returning soldiers. Meticulous attention to hygiene is one of the few known methods to reduce the incidence of this very dangerous infection. So it was especially dismaying to receive the following email, from a reader:

I was reading through your posts from last August, right after the Forbes story on Acinetobacter Baumanii from Iraq. My husband came back with this in July of 2003. I have been following this very closely. The military did little to contain this. Protocol was not followed by many when we were at Walter Reed. The severity of the situation was not passed on to the civilian hospital my husband was sent to. They left dirty dressings lying around the room on the window sills, in the regular trash can. Cleaning people and many others were in and out of his room even though he was in isolation. I didn't even know he was in isolation (thought he just had a private room) until the day he was leaving and the head floor nurse told me I should have been in full dress as well as anyone else entering the room. Acinetobacter baumanii is common up and down the east coast, Texas, Arizona. One woman in north Georgia was told she had it, on top of a MRSA infection, and when she called the CDC to find out what it was they told her they were not "authorized" to talk about it. I received a message last Friday regarding an ICU nurse at NNMC who was apparently perfectly healthy, started feeling bad at work and in 24 hours was in a community hospital, intubated with acinetobacter infection. This is very scary and no one wants to admit it or talk about it. My husband was poisoned with Amikacyn that it wasn't even senstive too. I am so angry about this.

Several things deserve comment. Walter Reed is apparently sending patients with A. baumannii infections to community hospitals without proper notification or instructions. This community hospital, in turn, is not following elementary procedures to reduce the deadly plague of hospital acquired infections that is literally killing otherwise healthy people admitted for minor problems. They are potentially liable. This woman's husband is suffering from a war related illness that has ramified to serious proportions. It is a reminder of the inherent deadliness of war, even when the military medical services are salvaging injured soldiers that would have died in previous conflicts. Saving their lives on the battlefield is not the entire story.

The many disgraceful stories of pathetic aftercare of veterans speaks volumes about what the Department of Defense thinks of the cannon fodder that has outlived its usefulness to them.
The wounds of all kinds from this war, mental and physical, will fester for decades to come. It will kill our soldiers here as surely as the IEDs kill them there.