Antimicrobial resistance (AMR) is spreading extensively in Central Asia as shown by new data from the Central Asian and European Surveillance of Antimicrobial Resistance (CAESAR) network. Such findings highlight the need for concerted action and increased investment into laboratory strengthening including quality assurance, laboratory networks, properly outfitted reference laboratories and standardization of methodologies.
The good news is that a programme to address these challenges has been established by the World Health Organization’s Regional Office for Europe . Better Labs for Better Health (Better Labs)— launched in 2012— is an intersectoral approach that seeks to provide sustainable improvements to the quality of all laboratories that deal with health.
The AMR Centre, Uzbekistan‘s national reference laboratory, joined the Better Labs programme in 2018. The Centre diagnoses, identifies and monitors the emergence of drug-resistant bacteria. It plays a key role in training laboratories and maintaining the surveillance network in Uzbekistan.
“Well-functioning, sustainable laboratory services operating according to international principles of quality and safety are crucial for strong health systems and improving public health, therefore impacting individuals”
– Dr Joanna Zwetyenga, Laboratory Technical Officer, Better Labs for Better Health, WHO Regional Office for Europe
Photo credit: WHO Country Office for Uzbekistan
A key element of the Better Labs approach is mentoring. Better Labs has trained international mentors to support laboratory staff in using WHO‘s Laboratory Quality Stepwise Implementation tool. This web-based tool provides a stepwise plan that guides medical laboratories on how to implement a quality management system in compliance with international standards. The tool also provides detailed explanations on how to implement quality requirements in alignment with customer satisfaction. This ensures reliable diagnostics that, in turn, generate accurate data and guide clinicians to provide timely and appropriate treatment.
Boltaeva Manzura Nishanovana, Head of the Department of Pathology of Young Children, Republican Specialized Scientific and Practical Medical Centre of Pediatrics of Uzbekistan says: “What I like the most about this programme [Better Labs AMR Mentoring] is that it has been helping us to maintain standards of diagnostics and treatment of severe cases referred/coming from our provinces. There has been a considerable improvement in our seamless interaction/collaboration with the laboratory. We were able to achieve even better treatment outcomes for our patients. Previously, hospital stays were as long as 15-20 days and now, because quality of [laboratory test] results has improved, we have succeeded in ensuring that patients receive treatment for 7-8 days and are then discharged in better health condition. In other words, a decrease in the number bed-days has considerably facilitated our work.”
The laboratory supports efforts to contain AMR by identifying the pathogen responsible for a patient’s infection. Once the organism is identified and isolated, antimicrobial susceptibility testing is a crucial step to determine the optimal antimicrobial therapy for the patient.
microbiological analysis and capable national reference laboratories supporting
national laboratory networks are important for surveillance of AMR in countries,
analyzing trends of resistance and measuring the effect of interventions”
– Dr Danilo Lo Fo Wong,
Regional Advisor, Control of AMR unit, WHO Regional Office for Europe.
Photo credit: WHO Country Office for Uzbekistan
On 2 March 2020, the National Accreditation Centre of Uzbekistan accredited the Research Institute of Epidemiology, Microbiology and Infectious Diseases of the Ministry of Health of the Republic of Uzbekistan and the Clinic of the Centre for Antimicrobial Resistance (AMR Centre) in Tashkent against the international standards for medical laboratories (Oʻz DSt ISO 15189:2019). The overall process of accreditation took six months during which the first two national mentors for Uzbekistan were trained
Dr Gulnora Abdukhalilova, head of the AMR Centre said: “the mentoring program for AMR Centre was timely. Thanks to the competent assistance of WHO experts during mentoring visits, the quality of microbiology diagnostics has improved at the AMR Centre. The introduction of a quality management system in medical laboratories means the delivery of high quality services to the public. This is the motto of the AMR Centre’s team.” The first successful laboratory accreditation in Uzbekistan marks a milestone for the successful collaborative support from the AMR and Better Labs for Better Health teams from the WHO Regional Office for Europe, the WHO Country Office for Uzbekistan, and mentors.
As noted by Zulfiya Atadjanova, National Program Officer in WHO Country Office for Uzbekistan, “this project is a great example of integration between WHO programs (AMR and Better Labs) at country level. It also shows how we contribute to each other’s area to achieve better results.”