Introduction: In Cambodia, we implemented a pilot surveillance of superficial surgical site infections (SSSI) following caesarean deliveries (CD) in a provincial hospital, to estimate their incidence, describe their clinical management, and determine their causative pathogens. Methodology: Between October 2010 and February 2011, all women admitted for CD were included in the surveillance. Their clinical condition was monitored for a post-operative period of 30 days, including two assessments performed by surgeons. Cases were clinically diagnosed by surgeons, with bacterial cultures performed. Results: Of the 222 patients admitted for CD, 176 (79.3%) were monitored for 30 days. Of these, 11 were diagnosed with a SSSI, giving an incidence rate of 6.25% (95% CI 3.2-10.9). Four of the cases (36.4%) were detected after hospital discharge. Length of hospitalization was significantly longer for the SSSI cases. All 222 patients were prescribed antibiotics. Ampicillin was administered intravenously to 98.6% of them, with subsequent oral amoxicillin given to 82.9%. Three of six pus samples collected were positive on culture: two with Staphylococcus aureus and one with Staphylococcus lugdunensis. One S.aureus was methicillin resistant (MRSA). The other was clindamycin and erythromycin resistant. Conclusion: Surveillance of health-care associated infections in a setting with limited resources is challenging but feasible. Effective postdischarge surveillance was essential for the estimation of the incidence rate of SSSI following caesarean deliveries. This surveillance led to a peer-review of medical practices.
Background Early diagnosis of HIV infection reduces morbidity and mortality associated with late presentation. Despite UK guidelines, the HIV testing rate has not increased. We have introduced universal HIV screening in an open‐access returning traveller clinic. Methods Data were prospectively recorded for all patients attending the open‐access returning traveller clinic between August 2008 and December 2010. HIV testing was offered to all patients from May 2009; initially testing with laboratory samples (phase 1) and subsequently a point‐of‐care test (POCT) (phase 2). Results A total of 4965 patients attended the clinic; 1342 in phase 0, 792 in phase 1 and 2831 in phase 2. Testing rates for HIV increased significantly from 2% (38 of 1342) in phase 0 to 23.1% (183 of 792) in phase 1 and further increased to 44.5% (1261 of 2831) during phase 2 (P < 0.0001). Two new diagnoses of HIV‐1 were identified in phase 1 (1.1% of tested); seven patients had a reactive POCT test in phase 2, of whom five (0.4% of those tested) were confirmed in a 4th generation assay. The patients with false reactive tests had a concurrent Plasmodium falciparum infection. Patients travelling to the Middle East and Europe were less likely to accept an HIV test with POCT. Conclusions A nurse‐delivered universal point‐of‐care HIV testing service has been successfully introduced and sustained in an acute medical clinic in a low‐prevalence country. Caution is required in communicating reactive results in low‐prevalence settings where there may be alternative diagnoses or a low population prevalence of HIV infection.
The incidence rate and risk factors for both infectious diseases were identified. The results of this study might guide clinicians to make more accurate and timely diagnoses in returned tropical travellers.
The health threats of modern day travel change as population, wealth and tourism increase across the world. A series of three articles have been written to describe the spectrum of health issues associated with travel. Pre-travel health advice has become more focused on risk assessment and educating the traveller about infectious disease and the more frequent non-infectious hazards associated with travel, while ensuring they are not unnecessarily exposed to injury from vaccines and drugs. In part one, the role of the health advisor and the needs of the traveller are examined. The importance of risk assessment during a consultation is described and factors that influence recommendations and prescribing are explored. As most travel-associated morbidity and mortality is non-vaccine preventable, the focus of the pre-travel consultation should be on educating the traveller and influencing behaviour change. The second article in this series deals with the highest risk group of travellers--residents who visit friends and relatives. It highlights their specific problems and special needs and how to influence their risk of disease by addressing their health beliefs and their cultural dimension of risk. The third article explores the common, and not so common, clinical problems found in returned travellers. Nurses have to deal with a large range of clinical problems and diagnostic dilemmas when attending to the returned traveller. The review provides a perspective on the frequency and severity of problems and how nurses should manage travel associated disease.
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