{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T18:36:36Z","timestamp":1774118196265,"version":"3.50.1"},"reference-count":33,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":853,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2012,9]]},"abstract":"<jats:sec id=\"S0195941700031519_abs1\"><jats:title>Objective.<\/jats:title><jats:p>To determine whether multidrug-resistant (MDR) gram-negative organisms are present in Afghanistan or Iraq soil samples, contaminate standard deployed hospital or modular operating rooms (ORs), or aerosolize during surgical procedures.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700031519_abs2\"><jats:title>Design.<\/jats:title><jats:p>Active surveillance.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700031519_abs3\"><jats:title>Setting.<\/jats:title><jats:p>US military hospitals in the United States, Afghanistan, and Iraq.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700031519_abs4\"><jats:title>Methods.<\/jats:title><jats:p>Soil samples were collected from sites throughout Afghanistan and Iraq and analyzed for presence of MDR bacteria. Environmental sampling of selected newly established modular and deployed OR high-touch surfaces and equipment was performed to determine the presence of bacterial contamination. Gram-negative bacteria aerosolization during OR surgical procedures was determined by microbiological analysis of settle plate growth.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700031519_abs5\"><jats:title>Results.<\/jats:title><jats:p>Subsurface soil sample isolates recovered in Afghanistan and Iraq included various pansusceptible members of Enterobacteriaceae,<jats:italic>Vibrio<\/jats:italic>species,<jats:italic>Pseudomonas<\/jats:italic>species,<jats:italic>Acinetobacter Iwojfii<\/jats:italic>, and coagulase-negative<jats:italic>Staphylococcus<\/jats:italic>(CNS). OR contamination studies in Afghanistan revealed 1 surface with a<jats:italic>Micrococcus luteus<\/jats:italic>. Newly established US-based modular ORs and the colocated fixed-facility ORs revealed no gram-negative bacterial contamination prior to the opening of the modular OR and 5 weeks later. Bacterial aerosolization during surgery in a deployed fixed hospital revealed a mean gram-negative bacteria colony count of 12.8 colony-forming units (CFU)\/dm<jats:sup>2<\/jats:sup>\/h (standard deviation [SD], 17.0) during surgeries and 6.5 CFU\/dm<jats:sup>2<\/jats:sup>\/h (SD, 7.5;<jats:italic>P<\/jats:italic>= .14) when the OR was not in use.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700031519_abs6\"><jats:title>Conclusion.<\/jats:title><jats:p>This study demonstrates no significant gram-negative bacilli colonization of modular and fixed-facility ORs or dirt and no significant aerosolization of these bacilli during surgical procedures. These results lend additional support to the role of nosocomial transmission of MDR pathogens or the colonization of the patient themselves prior to injury.<\/jats:p><\/jats:sec>","DOI":"10.1086\/667382","type":"journal-article","created":{"date-parts":[[2012,8,6]],"date-time":"2012-08-06T19:04:23Z","timestamp":1344279863000},"page":"905-911","source":"Crossref","is-referenced-by-count":21,"title":["Evaluation of Potential Environmental Contamination Sources for the Presence of Multidrug-Resistant Bacteria Linked to Wound Infections in Combat Casualties"],"prefix":"10.1017","volume":"33","author":[{"suffix":"III","given":"Edward F.","family":"Keen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrin","family":"Mende","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather C.","family":"Yun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wade K.","family":"Aldous","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy E.","family":"Wallum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles H.","family":"Guymon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Cole","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen K.","family":"Crouch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew E.","family":"Griffith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernadette L.","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel T.","family":"Rose","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clinton K.","family":"Murray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700031519_ref007","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(11)70059-7"},{"key":"S0195941700031519_ref020","doi-asserted-by":"publisher","DOI":"10.1086\/589585"},{"key":"S0195941700031519_ref022","doi-asserted-by":"publisher","DOI":"10.1111\/j.1462-2920.2004.00664.x"},{"key":"S0195941700031519_ref011","doi-asserted-by":"publisher","DOI":"10.1086\/518170"},{"key":"S0195941700031519_ref005","doi-asserted-by":"crossref","first-page":"417","DOI":"10.5858\/2010-0182-SA.1","article-title":"The 2010 Haiti earthquake: a pathology perspective aboard the USNS Comfort","volume":"135","author":"Hussey","year":"2011","journal-title":"Arch Pathol Lab Med"},{"key":"S0195941700031519_ref008","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00220-10"},{"key":"S0195941700031519_ref026","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1965.01320150160033"},{"key":"S0195941700031519_ref031","doi-asserted-by":"publisher","DOI":"10.1086\/653617"},{"key":"S0195941700031519_ref003","doi-asserted-by":"publisher","DOI":"10.3201\/eid1401.070878"},{"key":"S0195941700031519_ref010","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318163c40b"},{"key":"S0195941700031519_ref033","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318227ac4b"},{"key":"S0195941700031519_ref019","doi-asserted-by":"publisher","DOI":"10.1086\/510680"},{"key":"S0195941700031519_ref023","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.01763-09"},{"key":"S0195941700031519_ref001","doi-asserted-by":"publisher","DOI":"10.1086\/595011"},{"key":"S0195941700031519_ref014","doi-asserted-by":"publisher","DOI":"10.1086\/518966"},{"key":"S0195941700031519_ref015","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-04-3908"},{"key":"S0195941700031519_ref021","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED.171.9.821"},{"key":"S0195941700031519_ref004","doi-asserted-by":"publisher","DOI":"10.1053\/jhin.2002.1205"},{"key":"S0195941700031519_ref029","doi-asserted-by":"publisher","DOI":"10.1016\/j.burns.2009.10.013"},{"key":"S0195941700031519_ref012","doi-asserted-by":"publisher","DOI":"10.1086\/660015"},{"key":"S0195941700031519_ref016","volume-title":"Recovery of multidrug-resistant bacteria from swabs stored for 1 and 4 weeks to mimic long-distance shipping conditions","author":"Mende","year":"2011"},{"key":"S0195941700031519_ref017","volume-title":"Patient safety component: protocol: multidrug-resistant organism (MDRO) and Clostridium dijficile-associated disease (CDAC) module. 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