Prevalence of healthcare-associated infections and antimicrobial use among inpatients in a tertiary hospital in Fiji: a point prevalence survey.

BACKGROUND: Healthcare-associated infections (HAIs) and antimicrobial use (AMU) are important drivers of antimicrobial resistance, yet there is minimal data from the Pacific region. We sought to determine the point prevalence of HAIs and AMU at Fiji's largest hospital, the Colonial War Memorial Hospital (CWMH) in Suva. A secondary aim was to evaluate the performance of European Centre for Diseases Prevention and Control (ECDC) HAI criteria in a resource-limited setting. METHODS: We conducted a point prevalence survey of HAIs and AMU at CWMH in October 2019. Survey methodology was adapted from the ECDC protocol. To evaluate the suitability of ECDC HAI criteria in our setting, we augmented the survey to identify patients with a clinician diagnosis of a HAI where diagnostic testing criteria were not met. We also assessed infection prevention and control (IPC) infrastructure on each ward. RESULTS: We surveyed 343 patients, with median (interquartile range) age 30 years (16-53), predominantly admitted under obstetrics/gynaecology (94, 27.4%) or paediatrics (83, 24.2%). Thirty patients had one or more HAIs, a point prevalence of 8.7% (95% CI 6.0% to 12.3%). The most common HAIs were surgical site infections (n = 13), skin and soft tissue infections (7) and neonatal clinical sepsis (6). Two additional patients were identified with physician-diagnosed HAIs that failed to meet ECDC criteria due to insufficient investigations. 206 (60.1%) patients were receiving at least one antimicrobial. Of the 325 antimicrobial prescriptions, the most common agents were ampicillin (58/325, 17.8%), cloxacillin (55/325, 16.9%) and metronidazole (53/325, 16.3%). Use of broad-spectrum agents such as piperacillin/tazobactam (n = 6) and meropenem (1) was low. The majority of prescriptions for surgical prophylaxis were for more than 1 day (45/76, 59.2%). Although the number of handwashing basins throughout the hospital exceeded World Health Organization recommendations, availability of alcohol-based handrub was limited and most concentrated within high-risk wards. CONCLUSIONS: The prevalence of HAIs in Fiji was similar to neighbouring high-income countries, but may have been reduced by the high proportion of paediatric and obstetrics patients, or by lower rates of inpatient investigations. AMU was very high, with duration of surgical prophylaxis an important target for future antimicrobial stewardship initiatives.

Non-odontogenic beta-hemolytic necrotizing fasciitis of the face.

A case report of a severe, rapidly aggressive necrotizing fasciitis of the facial tissues demonstrates the need to consider anatomic, systemic, and bacterial factors in evaluating this disease. Early diagnosis is critical for optimum management. Surgical debridement is the cornerstone of treatment and must be complemented with aggressive supportive therapy and antibiotics. In this instance of non-odontogenic beta-hemolytic necrotizing fasciitis of the face, aggressive care resulted in management of the disease process to a point where the patient's perioral wounds stabilized and were not of immediate significance to her death.

Ambient ultraviolet radiation and skin cancer incidence.

Environmental ultraviolet radiation (UVR) was monitored for one year at Durham (latitude 55 degrees N) using a stationary, horizontal sensor, and a sensor rotating in a vertical plane designed to simulate the random motion of subjects outdoors. From these data it was possible to calculate the personal solar UVR representative of populations living at different geographical locations and experiencing varying patterns of cloud cover. The conclusion was that present monitoring programmes that record ambient solar UVR in a horizontal plane at different locations as input data to studies on the epidemiology of skin cancer are appropriate for obtaining a relative estimate of the population exposure in locations with different climatic conditions, providing, of course, that the outdoor exposure habits of different populations are comparable.

A new type of erythemal radiometer for use in phototherapy.

A new type of radiometer is described which, when exposed to ultraviolet radiation lamps, displays the time required to achieve a minimal erythema. The radiometer incorporates a switch on the front panel to allow for the erythemal sensitivity of different sun-reactive skin types. The instrument was exposed to a number of different lamp/filter combinations commonly used for phototherapy, and in each case indicated an exposure time to within +/- 10% of that determined by combining the spectral irradiance with the erythema action spectrum. Good agreement was also obtained between the exposure times necessary to achieve 24 h minimal erythema in Caucasian subjects of different sun-reactive skin types, and those exposure times predicted by the erythemal radiometer.

Parinaud oculoglandular syndrome and cat-scratch fever.

The clinician should examine for conjunctival inflammation when preauricular adenopathy exists. Parinaud oculoglandular syndrome is probably caused by many different antigens, including CSD. Biopsy of the affected node is seldom indicated but may be necessary to help rule out neoplastic disease.

Delayed healing of mandibular fracture in idiopathic myxedema.

Lack of adequate amount of thyroid hormone may interfere with healing. A patient in whom a fracture of the mandible failed to heal in the 2 years following surgical treatment is presented. When thyroid hormone supplementation was introduced, the fracture progressed to union. The physical findings of hypothyroidism and the role of thyroid hormone in healing are discussed.