Healthcare workers stand at the entrance to the NICU at a hospital in Ethiopia.
Staff members (from left to right): NICU nurse coordinator, Sister Tejie; neonatologist pediatrician and director of the NICU, Dr. Asrat; and neonatology fellow pediatrician, Dr. Firehiwot, all from the NICU at an Ethiopian healthcare facility that is a focus of CDC’s GAIHN initiative.

Two hospitals in Addis Ababa, Ethiopia, are demonstrating that even when access to resources is limited, commitment to infection prevention and control (IPC) practices makes combating antimicrobial resistance (AR) possible.

Antimicrobial-resistant bacteria can cause severe, hard-to-treat infections. They were associated with almost 5 million deaths worldwide in 2019. IPC practices such as proper hand hygiene, correct use of personal protective equipment (PPE), and adequate cleaning and disinfection of the healthcare environment, are crucial to prevent the spread of antimicrobial-resistant threats within healthcare settings. However, healthcare facilities with limited resources may lack the tools or training necessary to carry out these practices.

Ethiopia is the first country in Africa to join CDC’s Global Action in Healthcare Network (GAIHN). Improving and sustaining IPC practices is key to GAIHN’s mission of protecting patients and healthcare workers from antimicrobial resistance threats. Through GAIHN, two hospitals in Addis Ababa are collaborating with CDC, the Ethiopian Public Health Institute, and The Ohio State University to reduce the spread of antimicrobial-resistant bacteria in their facilities.

During an initial evaluation of one facility’s neonatal intensive care units (NICUs), healthcare workers reported struggles with protecting their young patients from infections due to a lack of training and limited IPC resources. They didn’t have sufficient access to hand hygiene, environmental cleaning, and PPE supplies or adequate healthcare infrastructure such as running water. However, these facilities were committed to instituting change as part of GAIHN. And changes occurred rapidly.

Essential IPC supplies such as alcohol-based hand sanitizer, buckets for hand washing, cleaning supplies, and reusable cloth gowns were obtained, which empowered and enabled healthcare workers to perform IPC practices correctly. “Availability of hand sanitizer at the gate of the NICU, [in] corridors, and on each bed helped us to implement hand disinfection frequently after each contact with the patients,” said Dr. Asrat, the head neonatologist. “This simple yet crucial practice has helped reduce the spread of infections within our unit.”

However, supplies alone cannot create lasting change. Staff training is important, too. Locally hired IPC officers conduct IPC trainings for all NICU healthcare workers. The IPC officers also provide supportive supervision, including routine monitoring and feedback on IPC practices. The monthly education on infection prevention to all our staff, residents, and interns strengthened the knowledge and practice on infection prevention. Healthcare workers are now more diligent in practicing proper hand hygiene, using PPE correctly, and following strict cleaning and disinfection protocols,” shared Dr. Asrat.

Dr. Asrat’s observations of improved IPC practices are supported by evidence. The IPC officers monitor how healthcare workers perform hand hygiene and environmental cleaning to provide immediate feedback to them and to track performance rates over time. The NICU healthcare workers have demonstrated impressive improvements in practices with a 20-30% increase in hand hygiene performance and a 200% increase in environmental cleaning performance in just seven months.

The successes of GAIHN in Ethiopia have been clear, but keeping momentum requires ongoing commitment, support, and funding. “While these changes are promising, the challenges of maintaining consistency and addressing [staff] turnover persist,” noted NICU nurse coordinator, Sister Tejie. However, the NICU healthcare workers remain committed to confronting these challenges to protect sick and vulnerable babies. According to Dr. Asrat, “The GAIHN initiative has undoubtedly played a role in improving patient outcomes by promoting a culture of responsible infection prevention in our unit.”

Global partnerships like this help CDC and collaborators coordinate efforts to prevent and control antimicrobial-resistant threats. Learn more about what CDC and partners are doing around the world to detect, prevent, and respond to AR.

Guest Authors:

Sophie Jones, PhD, MSc is an epidemiologist with a background in Infectious Diseases. She is on the Prevention Team in the International Infection Control Branch in the Division of Healthcare Quality Promotion at the U.S. Centers for Disease Control and Prevention in Atlanta.

Elizabeth Soda, MD is a physician of Infectious Diseases. She is on the Prevention Team in the International Infection Control Branch in the Division of Healthcare Quality Promotion at the U.S. Centers for Disease Control and Prevention in Atlanta.


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