Infection Prevention and Control (IPC)

It is beyond the scope of this CPG to cover cleaning, disinfection, sterilization techniques, and the management of potentially infectious medical waste for all patient care environments and equipment. For these activities, it is recommended to reference CDC resources,31 service specific guidelines, such as Army Techniques Publication (ATP) 4-02.10,32 and specialized guidance on viral hemorrhagic fever (VHF).33-35  There is an Infection Control in the Deployed Setting course open to all branches noted in Appendix D. This CPG will primarily focus on transmission-based precautions for a variety of biothreats based on the CDC guidelines for isolation precautions.36  It is always best practice to follow the CDC guidelines; however, military medical personnel may have to adapt Personal Protective Equipment (PPE) based on the operational environment, consultation with infectious disease specialists, available resources, and the Commander’s risk tolerance. Remember that transmission-based precautions always include standard precautions. A summary of concepts/recommendations to consider are contained in Table 3.

VHFs that have a risk of person-to-person transmission include Ebola, Marburg, Lassa, Crimean- Congo Hemorrhagic Fever (CCHF) and the South American Hemorrhagic Fevers (Junin, Machupo, Chapare, Guanarito, and Sabia viruses).37  There are other VHFs that are not typically transmitted person-to-person, and these include Dengue, Yellow Fever, Rift Valley Fever, and most Hantaviruses (except Andes virus). Andes virus is a Hantavirus that is endemic in rodents in South America and has been associated with person-to-person transmission.38,39

Medical care of patients infected with VHFs that have a risk of person-to-person transmission require unique engineering controls, environmental controls, administrative controls, and PPE. As a result, management of VHF patients’ merits creation of a separate JTS CPG. Please reference the World Health Organization (WHO) VHF Handbook,33 WHO IPC Guideline for Ebola and Marburg Disease34 and CDC VHF35 web pages for more exhaustive discussions on this topic. Healthcare workers caring for patients with VHF must receive comprehensive training and demonstrate competency in performing VHF-related infection control practices and procedures. It is recommended that all roles of care consider planning for and exercise recognition, isolation, quarantine, and initial management of VHF patients.

It is imperative that medical personnel are knowledgeable and maintain good habits of IPC during routine patient care even during deployments to more austere environments to include field hospitals and shipboard medical bays.  Both hand hygiene and respiratory hygiene cannot be compromised and should be enforced at all levels of triage and care. Medical personnel should also be versed and trained in the appropriate use of PPE and how to don and doff their PPE in the setting of the care of a contagious patient. By maintaining good habits in IPC during routine care, a medical team stands to be more ready and protected against a suspected biothreat.