Amid the ongoing war in Ukraine, health care-associated infection and antimicrobial resistance (AMR) are of major concern – improving infection prevention and control (IPC) quality and standards has the potential to dramatically reduce harm and improve the health of people both inside and outside the country.
With support from the U.S. Centers for Disease Control and Prevention (CDC), ICAP at Columbia University supported the implementation of an IPC quality improvement program at nine facilities in Ukraine, focusing especially on hand hygiene and environmental cleaning. Participating facilities included four hospitals and four regional centers for disease control known as rCDCs – in Ternopil, Khmelnytskyi, Vinnytsia, and Dnipro regions – as well a cancer insititute in Kyiv. The pilot period operated between July 2024 and March 2025.
In June 2024, ICAP facilitated a three-day training for implementation teams and facility leadership around basic principles, methods, and tools for quality improvement in IPC. ICAP also conducted two online learning sessions to track the implementation of the program and two individual mentorship meetings for each facility to provide additional support.
Staff shortages, limited IPC knowledge and awareness, and lack of IPC standard operating procedures were just a few challenges health teams had been facing before the launch of the program. During and after the training, teams planned next steps, including analyzing root causes of major IPC challenges, mapping and prioritizing change ideas, and developing methods for tracking success.
“Stressed health systems lead to environments where antimicrobial-resistant bacteria can thrive and quickly spread within the country and across borders, increasing the risk of difficult-to-treat infections,” said Andrea Howard, MD, MS, project lead and director of ICAP’s Clinical and Laboratory Unit. “Improved IPC measures have the power to protect communities from those risks. We are supporting health facilities through the process of understanding their own bottlenecks and helping them to design measures to address those challenges.”
“Every health facility and team are different,” added Oksana Dereviankina, MD, MBA, country representative for ICAP in Ukraine, “so it’s been great to see each team design their own change ideas and implementation plan based on their needs, circumstances, and available resources, as those are the changes that will be maintained in the long term.”
After the pilot period, teams observed major IPC successes.
At a hosptial in Vinnytsia, for example, teams increased hand hygiene compliance from 44 to 80 percent within six months. Appointing a hand hygiene coordinator in the facility and training nurses from each department to work as hand hygiene trainers were key to promoting a culture of quality hand-hygiene compliance.
At a hospital inTernopil, the health team increased hand-hygiene compliance from 64 to 85 percent in six months. The most successful change involved placing hand sanitizers at all points of care, including near patients’ beds, medical equipment, doctors’ offices, and at the entrance to the patient rooms.
At a hospital in Khmelnytsky, ICAP supported implementation of the quality improvement program among two surgical departments and an intensive care unit, which had a hand hygiene compliance rate of 28 percent before the start of the program. While the quality improvement program engaged for a shorter pilot period of just four months due to other challenges, the health team was still able to achieve 54 percent hand-hygiene compliance in that relatively brief time. The most effective change occurred through conducting hand-hygiene training in small groups of 4-5 people.
“Implementation of quality improvement methodology has proven to be an effective approach for developing IPC within Ukraine’s health care system,” said Valerii Harbuziuk, director of a hospital in Khmelnytskyi City.
At a cancer institute, the health team worked to improve cleaning compliance across the entire facility, not just the pilot units. By the end of the pilot period, the institute had increased cleaning compliance from 22 to 77 percent through such approaches as creating cleaning zones and risk-based cleaning schedules, indicating the frequency and scope of cleaning needed.
Beyond this pilot program, ICAP will continue to protect patients and health care workers by promoting safe and quality health care delivery systems in Ukraine. Facilities involved in the initial quality improvement program will be supported in implementing enhanced IPC measures, such as isolation and personal protective equipment for patients infected with multi-drug-resistant organisms.
About ICAP
A major global health organization that has been improving public health in countries around the world for two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 40 countries, working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies. Online at icap.columbia.edu
