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

Abstract

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.

The burden of hospital-acquired infections (HAI) in sub-Saharan Africa: a systematic review and meta-analysis

“…The most common type of HAI in this study was SSI, followed by BSI, a finding that corroborates with previous prevalence surveys 36 , 76 and a systematic review. 9 These findings differ from the epidemiology of HAI in higher income countries where respiratory tract infections are the most common type of infection seen.…”

Epidemiology, antimicrobial resistance and outcomes of Staphylococcus aureus bacteraemia in a tertiary hospital in Fiji: A prospective cohort study

“…HA-SAB is one of the commonest causes of nosocomial bacteraemia 37 and is associated with high mortality, however there are proven interventions – such as hand hygiene, or improved management of intravascular catheters – that can lower the HA-SAB rate. 38 Although a meta-analysis suggested that healthcare-associated infections (HAIs) are 2–3 times more common in LMICs compared to high-income countries, 10 a recent point-prevalence survey of HAIs in Fiji found a relatively low overall prevalence of HAIs at CMWH of 8.7%, 21 slightly below estimates from similar studies in both Australia 39 and Singapore. 40 Despite this apparent low overall rate of HAIs, CWMH's HA-SAB rate of 2.3 per 10,000 patients days is higher than that seen in equivalent large hospitals in Australia (0.96 per 10,000 patient days) 41 or in England (1.04 per 10,000 patient days).…”

“…A recent point-prevalence survey of HAIs at CWMH reported that 8.7% of inpatients had an HAI, 69.4% had a peripheral vascular catheter and 5.5% had a central vascular catheter. 21 …”

Prevalence of Hospital Acquired Infection and Associated Factors Among Patients Admitted, at Hawassa University Comprehensive Specialized Hospital Getachew Melakie 1, Embialle Mengistie2, Tesfaye Ashenafi3, Busera Seman4 1′ 2’3 Hawassa University Dep

“…The prevalence of HAI revealed high a teaching hospitals in Africa such as the prevalence in Uganda 28%, Ghana14% [7], and Ethiopia 7.4% to19.4% [8][9][10] were higher than the prevalence reported from USA (8.7%) [11] and china (4.26%) [12]. On top of that, extended-spectrum betalactamase producing Gram-negative bacilli (1.9% to 53.0%) were the most reported antimicrobial resistant pathogens for causing HAIs [13].…”