Implementing flexible bronchoscopy in least developed countries according to international guidelines is feasible and sustainable: example from Phnom-Penh, Cambodia.

BACKGROUND: Flexible bronchoscopy is pivotal for the diagnosis of most respiratory diseases. A flexible bronchoscopy unit (FBU) was created in 2008 in the Preah Kossamak university hospital (Phnom Penh, Cambodia) through a cooperation program between a French and a Cambodian team. In 2009 we conducted an assessment of the compliance of the FBU to international standards and found that most of French and British guidelines were fully applied or adapted to local practice. The aim of the current work was to assess FBU again 6 years later, in order to determine if compliance to international guidelines was sustainable. METHODS: The 2015 evaluation was conducted identically to 2009. All recommendation items from the French and the British Thoracic Societies guidelines were assessed individually. Each recommendation was assigned a status expressing the level at which it was respected in Cambodia: applied, adapted, not applied and not evaluable. An endoscope microbial sampling was performed as recommended by the French Ministry of Health. RESULTS: Between 2009 and 2015, the pattern of international recommendations in the Cambodian FBU did not change. Notably the rates of applied French evaluable recommendations remained stable: respectively 58% vs 57%. Main changes in French guidelines occurred in adapted items that became applied (n = 5/15) while 4 previously adapted/applied items became not applied. Furthermore, all microbial analyses showed sterile results. CONCLUSIONS: Our results show that implementation of a high quality FBU in a least-developed country is feasible. In addition, the performance is maintained in the long-term.

Active prospective surveillance study with post-discharge surveillance of surgical site infections in Cambodia.

Barriers to the implementation of the Centers for Disease Control and Prevention (CDC) guidelines for surgical site infection (SSI) surveillance have been described in resource-limited settings. This study aimed to estimate the SSI incidence rate in a Cambodian hospital and to compare different modalities of SSI surveillance. We performed an active prospective study with post-discharge surveillance. During the hospital stay, trained surveyors collected the CDC criteria to identify SSI by direct examination of the surgical site. After discharge, a card was given to each included patient to be presented to all practitioners examining the surgical site. Among 167 patients, direct examination of the surgical site identified a cumulative incidence rate of 14 infections per 100 patients. An independent review of medical charts presented a sensitivity of 16%. The sensitivity of the purulent drainage criterion to detect SSIs was 83%. After hospital discharge, 87% of the patients provided follow-up data, and nine purulent drainages were reported by a practitioner (cumulative incidence rate: 20%). Overall, the incidence rate was dependent on the surveillance modalities. The review of medical charts to identify SSIs during hospitalization was not effective; the use of a follow-up card with phone calls for post-discharge surveillance was effective.