BACKGROUND

Infection has been a complication of war wounds throughout history. Infection prevention and control techniques in combat injuries, first widely practiced by Florence Nightingale in the Crimean War, have significantly advanced the care of the injured patient. The battlefield poses unique challenges in care for combat-related injuries. These include multiple patient transfers between hospitals and teams, the austere environment of theater medical care, and the difficulties arising during long distance aeromedical evacuation.1-3 Infections are frequent complications of combat casualties and are characterized by multi-drug resistant organisms (MDROs). MDROs are predominantly acquired through nosocomial transmission in the chain of tactical combat casualty care.4-5 These MDROs have been shown to originate from colonization of host nation patients which sets the stage for a more complicated healthcare environment. Infection prevention and control practices must be able to effectively adapt to these challenges and support the prevention and spread of infection by implementation of early and repetitive surgical wound care.

NOTE: Related Clinical Practice Guidelines (CPGs) published by the Joint Trauma System (JTS): Ventilator-Associated Pneumonia; Blunt Abdominal Trauma Splenectomy Post-Splenectomy Vaccination; Invasive Fungal Infection in War Wounds; War Wounds: Debridement and Irrigation; Acute Traumatic Wound Management in the Prolonged Field Care Setting. CPGs are posted at https://jts.health.mil/index.cfm/PI_CPGs/cpgs.