“We haven’t had any sepsis cases in months,” reports a maternity hospital in Tajikistan

“Some of my colleagues are a bit confused,” confesses Dr Rosa Nodirshoeva, who is known here simply as Dr Rosa. “We have not had any cases of sepsis for a few months now. They find this unusual,” she adds, smiling at her collaborator, Dr Joyrine Biromumaiso, before declaring, “but you and I, we know the reason.”

Dr Rosa shifts comfortably in her chair. She has an air of authority about her. This suits her position as a senior doctor at the large Maternity Hospital Number 1 in Dushanbe, Tajikistan. Dr Rosa has worked at the health facility for over 30 years and knows it like the back of her hand.

She works closely with Dr Joyrine, an expert on infection prevention and control based at the WHO Country Office in Tajikistan. Today they are discussing how much has changed since the start of their close collaboration, just over 3 years ago.

Preventing health care-associated infections

“Infection prevention and control training have changed the way we work,” Dr Rosa declares. “Before, nurses with years of experience could accidentally infect a patient while performing even the simplest procedures, such as inserting a catheter, because they simply weren’t aware of the right measures and techniques to prevent health care-associated infections. They had not been taught well.”

Dr Rosa explains that the facility had been working on improving infection prevention and control for decades. However, since working with Dr Joyrine, they have been able to strengthen their capacity dramatically and accelerate progress.

She gives examples of improvements made at the facility, adding that staff now pay close attention to infection prevention and control measures, and understand how important this is to provide safe, quality care.

“Our staff apply the 5 moments of hand hygiene and have become much more diligent in how we clean the facility. My colleagues know how to properly dispose of used syringes, masks and other medical waste. Our facility has clearly articulated the need for disinfectants and other health products used for protection. We now have devices with disinfectant solutions throughout the facility. Patients want to receive quality care and all these changes help us to keep them, and our health workers, safe from health care-associated infections.”

Dr Rosa notes that a simple reminder is sometimes enough to prevent a tragedy, and that patients themselves have become more aware of their own health. “They may come in for a treatment, but if they see that the doctor has not cleaned his hands, they speak up.”

Fewer infection cases

At the end of the corridor, the discomfort of a mother-to-be can be heard. Almost 1000 babies per month are born in this facility. One in every 5 babies is delivered through a caesarean section, as the facility receives women with complications from all regions of the country.

Before, at least 2 or 3 cases of septic complications were registered in the maternity hospital every month, but this situation has changed in recent years. The facility has also seen a dramatic reduction in other infections, including hepatitis B among health workers. The improvements made in infection prevent and control have been key to this success.

Dr Joyrine is proud of the achievements of Dr Rosa and her staff. She herself knows how proper infection prevention and control practices save lives. She was in western Africa at the height of the Ebola crisis, which killed over 11 000 people. As a frontline worker, she trained health workers to provide safe treatment and to protect themselves from the virus, but it killed many of her colleagues.

After this terrible experience, Dr Joyrine is one of the biggest advocates for implementation of infection prevention and control programmes in health-care facilities. “In Tajikistan, I often talk about my experiences in western Africa and East Africa and about what I have seen in the field.”

She explains that the topic of cultural norms often comes up. “By having an open conversation about cultural practices and traditions – for example, those related to burial rites – the Tajik health-care workers start to understand how infections can spread. They are keen to learn about WHO’s guidance and to implement the practices and techniques which we recommend. This is why we see such improvements.”

Since Dr Joyrine started working in Tajikistan, much has changed. With technical support from WHO, the country developed new national guidelines on infection prevention and control in 2022. Financial support from the United States Agency for International Development (USAID) has been crucial in developing further guidance for health workers on how to put these measures into practice.

“Infection prevention and control are everything”

Over the past few years, based on the WHO guidelines on infection prevention and control and in collaboration with other organizations, such as the United Nations Children’s Fund (UNICEF), over 8000 health workers across the country have been trained in infection prevention and control. Quality training and communication materials have been developed in national languages.

Many partners are supporting Tajikistan to ensure access to adequate water, sanitation and hygiene infrastructure and services, as well as essential materials and equipment for infection prevention and control, to deliver safe care.

The hard work continues. Many facilities in the country are still not following proper infection prevention and control practices, and many more health workers require training. Furthermore, the lack of access to safe, running water in health facilities, and the lack of availability of personal protective equipment such as gloves, masks and alcohol-based hand rub, pose major barriers to implementing infection prevention and control measures.

With support from USAID, Dr Joyrine will train a monitoring and evaluation team that will be instrumental in keeping track of the progress made in health facilities in all districts of Tajikistan. Key next steps for the country also include ensuring that courses on infection prevention and control are incorporated into all medical curricula and offered to health workers in facilities systematically.

The establishment of a new cadre of health workers, fully dedicated to guiding and monitoring the proper implementation of infection prevention and control practices in health facilities, is a key WHO recommendation.

A cleaner passes the room that Dr Rosa and Dr Joyrine are sitting in. Dr Rosa adjusts her glasses and declares, “Infection prevention and control are everything. If you don't know how to prevent infections, you cannot work in a health-care institution.”