Key Ways to Prevent Infection When There is No "Building": Aspects for the Field.

BACKGROUND: Infection control is a critical aspect in the continuum of surgical care. Much of what is outlined in the literature pertains to hospital-based practice, with only recent attention paid to the more austere environments, particularly those faced during humanitarian or combat operations.

OBJECTIVE: This manuscript provides a brief historical review of the development of infection control practices and further identifies and outlines several aspects necessary to successful program applications in austere environments.

RESULTS: Hand hygiene remains the simplest form of infection control. Use of alcohol-based hand sanitizer is a logistically reasonable option for most circumstances, mitigating the requirement for clean running water to facilitate more traditional "soap and water" methods of hand disinfection. Environmental decontamination, patient cohorting, and patient isolation based on existing colonization/infection also has demonstrated efficacy in controlling cross-contamination and is feasible in most austere environments. Finally, senior leadership engagement with deliberate planning, antimicrobial stewardship, and vigorous quality and process improvement algorithms have resulted in reduced rates of critical infections in these settings.

CONCLUSIONS: Basic tenets of infection control can be achieved even in resource-poor environments. Meticulous attention to adhering to these principles, with support from senior medical and operational leadership, facilitates improvements in infection control outcomes. There remains, however, a need for additional robust outcomes data regarding best practices in these environments.