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.

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A 42-year-old patient with multiple joint involvement including bilateral hip replacement and no movement of the knees or ankles required a custom made chair to enable her to be seated from a standing position by only allowing flexion of both hips. A motorized chair was designed and made that had a moveable footrest and seat unit powered by a linear actuator that allowed the patient to stand on the footrests when this unit was vertical and the seat angled at 45°. On activating the actuator by a joystick mounted on the armrest the footrests rolled forward along the floor whilst the seat fell to the horizontal in the final seated position. Two moveable axilla supports allowed the patient to share the load du ring seating between the shoulders and feet and away from the hips and knees as well as providing assurance against falling forward during upward movement of the seat. The problemThe patient is a 42-year-old female with multiple joint involvement because of juvenile polyarticular chronic arthritis (Stills disease). She has a range of active flexion at the knees of 0-20° for the left and 5-10° for the right with a valgus angulation of 10° for the left and 2° for the right. Both hips have a range of flexion of 30-70°, both being replaced seven years ago using conventional Charnley procedures involving trochanteric osteotomy and a low friction arthroplasty. One year ago the left hip was revised due to pain caused by loosening which involved revision arthroplasty using a long stem design of prosthesis and further shortening of the left leg. Her left leg has always been shorter and is currently 5.75in (14.5cm) less than the right leg, the shoe has been raised by this amount. Both her ankles are limited and painful in movement with a plantar-dorsal range of flexion of 15° on both sides. Her upper limbs are also severely affected with a 70° limit of abduction on both sides, with little strength in both arms to aid sitting and rising from a chair.With these clinical features it has been impossible to match any of the existing electrically and mechanically operated chairs to her needs to sit and rise with no arm assistance, no knee flexion and provide stability during the sitting or raising action. The majority of the self-lift chairs had