In the last 10 years, over 15,000 physicians have left Romania, exasperated by the deficiencies in the Romanian healthcare system and the significantly higher salaries in Western Europe. They also had the feeling that things would not improve anytime soon.
Seven years ago Dr. Andreea Moldovan returned to Romania after working for three years in Switzerland. She was not naïve, but she was very determined to bring the same infection control standards she found in Western Europe to Romania.
In 2011, Andreea Moldovan became the Coordinator of the Department of Prevention and Control of Nosocomial Infections at Saint Constantine hospital in Brasov. In 2013, after just two years of Andreea’s leadership, the World Health Organization (WHO) recognized Saint Constantine hospital with the “Cleanest Hospital in Europe” award.
Validated with this international recognition, Dr. Moldovan has been systemically working to share the knowledge she gained abroad to save hundreds of lives in hospitals across Romania.
Nosocomial infections are infections that patients acquire while in the hospital. In the United States, the Center for Disease Control estimates that 5 to 10% of hospital patients acquire an infection while in the hospital, leading to 90,000 deaths per year. Many of these hospital born infections are resistant to antibiotics.
In Romania, the problem is still taboo. Numerous analyses in specialized publications and the media reveal the prevalence of infection in Romanian hospitals. But the numbers are underreported because both physicians and the hospitals fear the risk of sanctions.
Solutions to reducing hospital infections in Romania never get off the ground because the State does not want to recognize the problem.
Family of Physicians
Born in 1973 into a family of doctors from Tîrgu-Mureş, Andreea Moldovan dreamed of following in her parents’ footsteps from a very young age.
In 1998, she graduated from medical school in her hometown with a GPA of 9.61 out of 10. After completing her residency, she specialized in infectious diseases and continued to work in Tîrgu-Mureş.
The turning point in her career came in 2009 when she received an honorary scholarship from the “Hôpital Cantonal de Genève” through a program sponsored by the International Society for Infectious Diseases.
For two and a half years, she worked alongside of Didier Pittet, Professor of Medicine and the creator of a protocol that significantly reduces the rate of nosocomial infections in medical clinics. At that time, the World Health Organization had just named him the External Lead of the Global Patient Safety Challenge. Dr Pittet still holds that position today.
His protocol became known as the Geneva Model and is considered the gold standard in measures taken to prevent nosocomial infections.
Andreea Moldovan arrived in Switzerland around the same time when these procedures were becoming standard practice for Swiss doctors. She specialized in caring for patients who had weakened immune systems due to transplant surgery. As a result, they were more vulnerable to potential infections.
During this period of time, Andreea’s husband, Bogdan Moldovan, was studying multi-organ transplants at the same hospital in Geneva while their daughter was registered in a local school.
After completing his internship, Dr. Bogdan Moldovan received a job offer in Belgium, but the couple decided to return home.
“There was the dilemma of going back to Romania or going to Belgium, where my husband had received a job offer. My husband and daughter wanted to return home, and I submitted to the majority vote.
I wouldn’t leave Romania now, because I get the feeling that things are starting to move, slowly but surely. I don’t know what the future has in store, but I believe that alongside of our colleagues who are more and more supportive, we’re going to manage to do something,” says Dr. Andreea Moldovan.
Didier Pittet saves lives without any scalpels or pharmaceuticals
“From the beginning of the 1990s, it was clear that the overwhelming majority of nosocomial infections were transmitted by our hands. So we were confronted with the issue of identifying the critical moments of when medical staff needed to wash their hands,” explains Dr. Didier Pittet, who was in Bucharest March 13-15, 2018.
When Pittet began studying this issue, the World Health Organization did not have a standard of good practice for hospital hygiene.
Having observed that the typical hand washing process was too time-consuming, the Swiss doctor developed an alcohol-based solution that would be permanently available to medical staff. His concept is as simple as it is efficient. It has reduced the rate of nosocomial infections by 50% in the hospital where he worked in Geneva.
His method, formally called the Geneva Method, entails that medical personnel clean their hands in five particular instances with the use of a hydro-alcoholic solution – not the traditional soap and water.
These five instances of practicing hand hygiene are:
- Before touching the patient;
- Before giving the patient an infusion;
- After coming in contact with biological liquids;
- After touching objects that have come into contact with patients;
- After ending an interaction with a patient.
A Sisyphean Task
When she is asked how her team in Brasov was able to to reach such a high standard of hygiene in just two years, Andreea Moldovan states that it was a “Sisyphean task” which necessitated lots and lots of patience.
“I have a small team of three people and we use the water torture method – one drop at a time. It’s been an extremely laborious task, hindered by resistance, refusals and arrogance from people who like do things their own way.
We made it through this period, slowly, like how small snowballs get rolled in the snow and are suddenly sizeable in mass and consistency. But it’s a routine that must be consistently sustained,” she explains.
After her hospital won the award, Andreea Moldovan did not rest on her laurels. She continued to work while studying to become an epidemiologist.
Andreea has given over 60 lectures in public and private hospitals all over the country. The purpose is to convince the hospital administration and medical personnel to adopt clinical protocols for ensuring good infection control, which have been bearing good fruit for years in the West.
“I took up this cause as a debt of honor. Not to be egotistical and keep the knowledge to myself, but rather to pay it forward, to pass it on to others. I did this alongside of a team of colleagues with whom I’ve been collaborating more and more closely.”
She would like the Geneva Model to become the standard of care in Romania so that illnesses provoked by nosocomial infections become exceptions and not the norm. But Dr. Moldovan says she has met many skeptical physicians during her presentations throughout the country.
“They tell me that because I work in a private clinic, it’s easy for me to talk about disposable materials and high quality solutions, because my hospital can afford them.
I responded that I’m familiar with the price of solutions and materials because that is one of my responsibilities in the hospital where I work. These solutions cost just 2000 to 3000 Euros per month, while a week in the hospital for a patient with MRSA or other complicated infections can cost 25,000 Euros.
If you balance the material costs and health benefits, this is a no brainer.
And when patients die of preventable illnesses, there is a moral cost that we doctors must carry on our shoulders,” she says.
So in that case, why is the snowball effect so difficult to initiate?
“There is resistance to anything new, over anyone who comes in with new information other than what we previously deemed to be good. This reluctance to accept the new exists in absolutely every single domain.
In addition, if this information comes from someone in a private hospital with more resources, it becomes even harder to accept. Fortunately, I’m seeing this less and less in the lectures that I give and in the hospital meetings I attend.
The fact that we have so few epidemiologists is also a problem because they are the primary specialists who are expected to intervene in cases of infections or epidemics.
A medical epidemiologist proves to be very timely when making the observation that something is going wrong. But it is often a battle of one physician against many who are more powerful.
There are many hospitals where professors of medicine consider themselves to have a larger breadth of knowledge and do not give the epidemiologist due importance,” says Andreea Moldovan.
In addition, medical training has not kept up with the times, she believes.
“I passed the epidemiology exam last year. I was given a case study from 1945 and other case studies from the the 1980’s and 1990’s! But medical references and clincal protocols have changed radically since those eras as well. “
“I get the feeling that things are starting to move, slowly but surely.”
Andreea Moldovan describes herself as an optimist. She says that compared to the situation five years ago, when multiple roadblocks were put in her way, she is starting to see more specialists taking interest in her lectures.
At the Bucharest conference organized with Professor Didier Pittet, the doctors welcomed the participation of the new Health Minister, Sorina Pintea. According to them, she had been on the list of participatants even before being appointed, when she was still the manager of the County Hospital in Baia Mare.
Now, Andreea Moldovan hopes that the force of her arguments — based on studies and models that work — will cause a systemic change.