The devastating impact of the ongoing war in Ukraine, which reignited in 2022, has caused significant challenges for healthcare workers who are doing their best to treat the wounded.
The loss of life has been tragic. The use of drones to identify and target both injured soldiers and the frontline medical personnel taking care of them has resulted in significant delays in providing definitive care for the injured patients.
In previous conflicts, injured patients were immediately evacuated by helicopter to mobile Army surgical hospitals or forward surgical hospitals. In fact, the management of the injured soldier was very similar to the treatment that patients received in civilian trauma centers. It typically involved control of hemorrhage, extensive debridement of the nonviable tissue, and damage control surgery—which helps identify and control intra-abdominal bleeding and enteric contamination. Patients were immediately started on the appropriate antibiotic and airlifted to a regional medical center or military trauma center in the US.
Delays in treating and transporting patients, which has been a major compounding factor in the Ukrainian conflict, has demonstrated the importance of timely, rapid, and accurate diagnoses to treat life-threatening infections.
Currently, patients are usually moved at night (and later by train) to avoid being noticed and potentially fired upon by the drones. This delay can mean some patients are waiting anywhere from 16 to 24 hours from the time of injury to when they are appropriately treated. These setbacks can lead to prolonged contamination with bacteria from agrarian field contaminants.
Infection is a real problem in a patient who is hypotensive and has had significant hemorrhage. The chance of a systemic infection in this situation is then compounded by insufficient availability of antibiotics. The confluence of severe, hemorrhagic insults, hypotension, delays in evacuation, delays in transportation to definitive care, and unavailability of antibiotics has resulted in increased morbidity and mortality.
This array of factors has sharply focused the need to think about infection surveillance in healthcare-associated infections that patients can acquire while being treated in any acute care setting. The need for impactful guidance on how to proactively manage infections in healthcare, whether in conflict-laden regions or here at home in acute care settings, has never felt more important.
The National Quality Forum (NQF), an affiliate of The Joint Commission, has published a free resource that will help organizational leaders and care teams implement or improve hospital-onset bacteremia and fungemia (HOB) prevention, identification, and treatment initiatives. These bloodstream infections—in which bacteria or fungal pathogens are detected by blood culture specimens collected on day 4 or later of a hospital admission—can worsen a patient’s condition by potentially leading to sepsis and often can be fatal.
The resource, “Hospital-Onset Bacteremia and Fungemia Playbook,” includes basic and advanced identification strategies, relevant examples of HOB management with supporting documentation, and a sample framework for HOB root cause analysis.
Learn more about the playbook on the NQF website at NQF Reports.
Dr. Lenworth Jacobs Jr. is a professor of surgery at the University of Connecticut in Farmington and director of the Trauma Institute at Hartford Hospital, CT.
Disclaimer
The thoughts and opinions expressed in this column are solely those of Dr. Jacobs and do not necessarily reflect those of The Joint Commission or the ACS.
