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TbilisiMinneapolis

Tbilisi, Georgia / Minneapolis, Minnesota

1999-2003


Focus: Disease Prevention, Infection Control, Infectious Diseases, Tobacco Addiction and Control



The Partners

US Partner: The Minnesota Department of Health is one of the nation's leading agencies for disease reporting and outbreak investigation. The University of Minnesota School of Public Health is a multidisciplinary institution active in continuing education, outreach and service activities, offering leading expertise in research and education programs that examine the external nature of human health risks. The Minnesota Chapter of the Association of Professionals in Infection Control and Epidemiology also participates in the partnership.

NIS Partner: The National Center for Disease Control (NCDC) was established in February, 1996 by Order of the Minister of Health of Georgia, and in collaboration with the Centers for Disease Control and Prevention and Prevention (CDC) in Atlanta, Georgia. Initially, the center was responsible for infectious disease control and epidemiology. Since 1998 the responsibility of the center has broadened to include non-communicable disease epidemiology, disease prevention, and health promotion. The NCDC has established regional branch laboratories around the country of Georgia that collect specimens and report on a weekly basis to contain outbreaks.


Partnership Objectives

The partnership's overall goal was to improve the quality and efficiency of healthcare services by assisting the NCDC in Tbilisi to develop national infection control programs and to design and initiate a national health promotion and disease prevention strategy. Specific objectives were to:

  • Ensure advanced training skills in basics of infection control for faculty of the National Center for Disease Control Infection Control Training Center.
  • To develop a targeted, effective surveillance program that can support research, starting with surveillance of surgical site infections.
  • Strengthen the expertise and the consultative role of the NCDC through a standardized protocol for infection control surveys, based on the program developed by the International Hospital Infection Prevention and Quality Assessment Program.
  • Assist the NCDC in integrating the WHONET program into the NCDC infection control program, in order to develop a basis for collecting and analyzing national antimicrobial susceptibility data, and ultimately using that data to promote judicious use of antibiotics.
  • Ensure that three regional reference microbiology labs are capable of supporting the NCDC and hospital infection control programs throughout Georgia by providing the necessary equipment and training for culturing activities, susceptibility testing and quality control. Develop and adopt appropriate guidelines for culturing activities, susceptibility testing and quality control to benefit both clinical and infection control uses of microbiology data.
  • Collaborate with other AIHA partnerships in Georgia to
    1) develop a strategic plan to establish a national non-infectious disease community assessment and surveillance program;
    2) develop resources and train Georgian partners to carry out community assessments, intervention/education-related prevention of cardiovascular disease and continued surveillance of non-infectious diseases in Georgia; and
    3) develop the skills of the Georgian partners in the above areas through targeted school-based projects in the areas of smoking and STD (HIV) prevention for adolescents.


Key Events

   1999
  • In June, partners from Tbilisi participated in a one-week seminar on “International Infection Control” at the University of Minnesota in St. Paul, Minneapolis. A team of infection control experts taught programs on communicable diseases, the role of the microbiology laboratory, hospital surveillance programs, and how to establish infection control committees where they currently do not exist. Hospital and lab visits were made to introduce US standards of disinfection, sterilization, and operating procedures designed to reduce nosocomial infections. The program was repeated on an annual basis.
  • In September the partners conducted an initial site assessment and signed a memorandum of understanding.
  • A Learning Resource Center was established and an information coordinator was appointed to facilitate partnership communications and provide health information for the faculty at the NCDC. The facility provided a computer to allow epidemiologists and other hospital personnel to access databases used such as EpiInfo and WHONET.
  • In October, two Georgian partners visited the Infection Control Training Center in St. Petersburg, Russia, to learn about training methods, local resources, and to share lessons learned for the upcoming Infection Control Training Center in Tbilisi.

   2000

  • In February, the partners jointly conducted a train-the-trainers workshop in Tbilisi as the first step in the establishment of the infection control training center (ICTC) at the National Center for Disease Control (NCDC) in Tbilisi. Five US experts traveled to Tbilisi to conduct the course for the 13 future faculty of the Tbilisi ICTC.
  • The Georgian and US partners presented at the CDC’s Decennial Conference on Hospital Infection Control held in March in Atlanta, Georgia.
  • With the support of AIHA, WHO, CDC and other donors, the NCDC administered a Reproductive Health Survey in different regions of Georgia. The survey was completed in Tbilisi and amongst the refugee populations in Eastern and Western Georgia.
  • A one-week Training-of-Trainers course for infection control practitioners, hospital epidemiologists and chief nurses was organized by AIHA and hosted by the National Center for Disease Control in Tbilisi, Georgia from May 2-5. Included in the training were instructors from the infection control training centers (ICTCs) in Kiev and Almaty, as well as local Georgians, with combined instruction by NIS and US partners. The training was part two of a five-part series of workshops for ICTCs being established by AIHA, based on the model Center in St. Petersburg, Russia. The course included sessions on the role of the microbiology laboratory, patient care practices, nosocomial infection definitions, surveillance, and outbreak investigation.
  • In October the partners conducted the third train-the-trainers seminar for infection control trainers in Georgia during the quarter. The one-week workshop focused on the prevention, identification and treatment of various hospital infections, the role of the environment and the microbiology laboratory, disinfection and sterilization techniques, basic epidemiology, and steps for outbreak investigation.
  • In November, five microbiologists from reference laboratories in Tbilisi, Kutaisi and Batumi traveled to Minneapolis for two weeks of intensive laboratory training at the Department of Health, Children’s Hospital, and the Mayo Clinic. The microbiologists applied new techniques for culturing activities, susceptibility testing and quality control. A major focus of the exchange was to develop and adopt appropriate use guidelines to benefit both clinical and infection control uses of microbiology data. As a follow-up to this training, the NCDC held microbiology training for local hospital laboratories, as well as for collaborating WHONET center participants from Kutaisi and Batumi.

2001

  • The partners presented a poster session at the Society for Healthcare Epidemiology of American Annual Meeting in Toronto, Canada in April. The poster displayed outcomes of a six-month point prevalence study on surgical site infections in three Tbilisi hospitals.
  • The NCDC Infection Control Training Center officially opened on September 10. The Center Director and US Partner Representative cut the ribbon and welcomed guests, who included the Deputy Minister of Health and representatives of USAID/Tbilisi. Several Georgian newspapers covered the event.
  • A physician-epidemiologist from the Tbilisi NCDC Infection Control Training Center completed a ten-day course in Clinical Epidemiology/Evidence-Based Medicine in St. Petersburg, Russia. The course was presented by the Infection Control Training Center at Mechnikov Medical Academy in cooperation with Harvard Medical International. The course covered the theoretical and practical aspects of clinical epidemiology.

2002

  • A pilot Antibiotic Usage Point Prevalence Survey was conducted in Georgia as part of an on-going collaborative effort of Infection Control Training Centers in Russia, Georgia and Ukraine. The Georgian surveys were conducted by teams, which included representatives from the National Center for Disease Control and NCDC-trained representatives from the study hospitals and the Department of Public Health of the Ministry of Health of Georgia. They collected data on antibiotic use in the hospitals to determine both the rate of antibiotic usage in general and the rate of preoperative antibiotic prophylaxis (PAP) in patients undergoing operations. Data was entered and analyzed through Epinfo and guides policy and guideline development on antibiotic use throughout the NIS.
  • Partners conducted a workshop entitled Epidemiology & Surveillance Strategies for Health Promotion in March 2002 at the NCDC Training Center. The workshop focused on modern surveillance and epidemiology of chronic disease and behavioral risk factors leading to chronic disease states. Topics included discussions on modern surveillance techniques, analysis and dissemination of surveillance data, public health informatics, and communicating results of surveillance to responsible public health officials and the community. The workshop also emphasized public health intervention and community participation in intervention efforts, including tobacco use and cessation of smoking by adolescents.
  • Two epidemiologists from Tbilisi and two US partners attended the Annual Society of Healthcare Epidemiology of America meeting from April 6-9. Georgian partners presented on the incidence of surgical site infection in Tbilisi. They also made poster presentations on the evaluation of hospital-wide anti-microbial use with serial point prevalence studies. The information was based on partnership surveys.
  • As a collaborative effort of the Mtskheta/Milwaukee and Tbilisi/Minneapolis partnerships, the National Center of Disease Control initiated health promotion and health education activities to assist the Mtskheta/Milwaukee partnership in promoting high blood pressure (HBP) and cardiovascular disease risk factor education/awareness in the Dusheti region, where the partnership runs an HBP control program. The first training for Dusheti district physicians and nurses took place in Dusheti in October.

2003

  • A Georgian partner participated in the Society for Healthcare Epidemiology of America (SHEA) conference in Arlington, Virginia in April. During the conference, participants discussed the epidemiological status of NIS countries and the goals of infection control programs in the region.



Achievements

   Infection Control

  • An Infection Control Training Center (ICTC) was established at the Georgian National Center for Disease Control for training epidemiologists, physicians, nurses and microbiologists. The workshops conducted there include modern infection control practices for hospital surveillance, nosocomial infections, role of the microbiology laboratory, education of health workers, and patient care practices.
  • An infection control practice guideline was adapted and approved by the Georgian Ministry of Health. The partners also developed and implemented an antimicrobial susceptibility guideline.
  • A new position—infection control nurse—was introduced in several Tbilisi hospitals. Nurses in these new positions received training at the NCDC. Nurses now provide active assistance to epidemiologists in implementing infection control programs.
  • The partners implemented surgical site infection (SSI) surveillance procedures at three hospitals in Tbilisi. For the first time in Georgia, reliable SSI data have been obtained on the basis of standardized case definitions. The active SSI surveillance system was included into the National Surveillance Program from 2001-2002.
  • Three sites in Tbilisi, Kutaisi, and Batumi were established as regional reference laboratories. These laboratories were updated with modern supplies and training in Minneapolis and at the Mayo Clinic and regularly report all outbreaks and incidences of antimicrobial resistance to the NCDC. WHONET Centers were also established in Kutaisi and Tbilisi at the same identified labs to ensure monitoring and reporting to WHO of resistant strains occurring in local hospitals.
  • A three-round pilot Antibiotic Usage Point Prevalence Survey was conducted in Georgia as part of an ongoing collaborative effort of Infection Control Training Centers in Russia, Georgia and Ukraine. The Georgian surveys were conducted by teams, which included representatives from the NCDC. They collected data on antibiotic use in the hospitals to determine both the rate of antibiotic usage in general and the rate of perioperative antibiotic prophylaxis (PAP) in patients undergoing operations. Data was entered and analyzed through Epiinfo and guides policy and guideline development on antibiotic use throughout the NIS.
  • US partners evaluated infection control practices at the National Center of Surgery Hospital, Tbilisi. The survey consisted of interviews of key hospital personnel; observations of facilities, supplies, equipment, and practices; and a point prevalence survey of active nosocomial infections in patients hospitalized at the time of the survey.

Health Promotion

  • Educational work was conducted in different communities to increase pubic awareness on healthy lifestyles. For example, in response to high rates of smoking among students and adults in Georgia, partners carried out regular preventive anti-smoking activities, including discussions for students in 14 schools in Tbilisi and dissemination of over 150 copies of health promotion publications.
  • Reporting forms were designed for surveillance of cardiovascular diseases. The myocardial infarction form was adopted in a pilot hospital in Tbilisi.
  • About 100 health workers received training on public health, basic epidemiology and community mobilization for disease prevention through the partnership.
  • In coordination with the Mtskheta/Milwaukee partnership, partners implemented a cardiovascular disease prevention program in Dusheti. Twenty physicians, nurses and healthcare officials from Dusheti received training on Primary Prevention of Cardiovascular Diseases and over 800 students in six schools also participated in discussions and lectures on health promotion.



Participating Institutions



 


Updated on September 27, 2004