Month: March 2025

Dr. Ignevska, Zan Mitrev Clinic: Through education and practice to zero tolerance for hospital infections
Dr. Katerina Ignevska is a microbiologist at the Zan Mitrev Clinic, and at the same time she also performs an exceptionally important activity as a Quality and Intrahospital Infections Control Director. With her, we talk about the standards and the regulations for protection against intrahospital infections in the clinic, about the training of the staff and the necessary mechanisms required in any healthcare institution in order to preserve the health of the population.

Can you shortly describe the method and standards applied by the clinic for protection against intrahospital infections?

Dr. Ignevska: The responsibility quality control and prevention of hospital infections function essentially means safe and efficient healthcare for every patient. When talking about patient safety, I have to emphasize that it is an enormously complex process including many measurable elements and starts as soon as the patient enters the hospital. The first step is proper identification followed by all consequent medical procedures for a precise diagnosis and an efficient treatment of the patient.
The hospital has clearly defined internal manuals and measures for prevention of the occurrence and prevention of the transmission of hospital infections, created according to the highest requirements of the prestigious JCI accreditation and they are adjusted to the requirements of the national regulations in R. N. Macedonia.

Since the very beginning, the hospital supported the concept of zero tolerance for hospital infections which, indeed, requires maximum efforts to create policies and programs, their implementation, continuous education and practical training for the entire staff. Certainly, at the end, the monitoring/control of all processes is what confirms the efficiency of the prescribed and implemented measures.

Is there a regular education of the staff, how often are sanitary examinations performed and what are the protocols for implementing measures for protection against infections?

Dr. Ignevska: The prevention of hospital infections proportionately depends on the education and preparedness of the entire staff. It concerns not only the medical staff, but also the non-medical staff and their knowledge of the transmission of infections, the importance of hygiene in the premises, appropriate use of disinfectants, proper use of personal protection equipment, hand hygiene and use of gloves, handling sharp objects, waste selection, etc. Each employee receives the initial guidelines at the employment and then is integrated in the education concept, created and provided by the Commission for Prevention of Hospital Infections.

Permanent monitoring and evaluation of the staff is key for the further proper strategic planning and optimization of the processes which will ensure good quality healthcare.
Regarding the sanitary examinations – they are performed according to the legal regulations, but internally, the hospital infections control team performs additional unannounced routine checks of the staff, of the inanimate environment and air in the hospital in order to maintain safe environment for the patients and the staff.

What is the method of isolation of patients where infections have been isolated, what are the clinic’s procedures?

Dr. Ignevska: The basic principle of work with each patient is to comply with the standard protection measures which are well known and universal. One of the stronger tools in the hospital infections prevention process is the isolation of the patients and/or their proper cohorting. In Zan Mitrev Clinic, each patient entering the inpatient part of the hospital is subjected to microbiologic procedures with epidemiological and diagnostic significance.

Until the results are received, the patients are treated as “isolated” (contact, droplet or aerogenous) which means that they are physically separated from the other patients and appropriate personal protective equipment is used when working with them. Additionally, patient safety is emphasized by the option to have negative pressure in the rooms where patients which should be aerogenously separated are situated. That creates a safe environment for all patients in the hospital, for the visitors, and the staff.

What is the role of the microbiology laboratory in the control of the intrahospital infections?

Dr. Ignevska: The team of the microbiology laboratory is available to patients at any time in order to process samples promptly and it is critical to report the results to the clinical doctors with recommendations regarding the necessary measures for prevention of infections. The multidisciplinary approach makes us unique and exceptionally efficient in establishing a microbiological diagnosis in line with the clinical diagnosis.

What are the usual reasons for the spread of intrahospital infections in healthcare institutions and is it necessary to solve the problem at national level?

Dr. Ignevska: Hospital infections are an enormous challenge that cannot be solved only on an institutional level. We cannot simply sequester the patients; they are circulating through the institutions in line with their needs and possibilities.
Our struggle as an institution would be much easier if all hospitals had a unified approach for maintaining hygiene in the hospitals, implementation of standard protection measures, microbiology laboratory services availability and timely isolation of patients, programs for rational use of antibiotics and all the other measures that comprise the quality and safety of healthcare.

Dr. Elena Ambarkova Vilarova is a transfusion medicine specialist, Process Management and Accreditation Director and part of the digitalization team of the “Zan Mitrev” Clinical Hospital. In this interview, she talks about all her engagements in the clinic, starting with why it is necessary to accredit and reaccredit medical institutions in order to maintain the quality of operations, all the way to the importance of digitalizing all of the work processes.

Previously you were a Medical Director, and last year you were appointed a Process Management and Accreditation Director and part of the digitalization team of the “Zan Mitrev” Clinical Hospital. What does this function mean?

Dr. Ambarkova Vilarova: Everything starts and ends with our main principle “the patient is in the center of our attention” and all the processes are setup, developed and optimized, firstly to improve the quality of the healthcare and secondly, to facilitate and accelerate the work of medical professionals, reduce their idle time and optimize the human and material resources in the given processes. This is a continuous engagement, and, basically, the establishment of a process is the easier part, and the control whether it is implemented according to the prescribed protocol is the harder and more important part because it directly impacts the permanent quality of the medical services, which in turn influences the satisfaction of the patients.

What does accreditation mean for a hospital?

Dr. Ambarkova Vilarova: Our hospital is accredited and reaccredited with the prestigious JCI accreditation, but also with the Macedonian healthcare institutions accreditation. The accreditation, in fact, means the establishment of internationally accepted rules and processes in the healthcare industry and their continuous implementation by the entire staff in order to improve the quality of the medical services and patient safety, as well as the safety of the staff and the hospital. It is one thing to think that we are the best, but this can be confirmed only by an evaluation by relevant institutions. I think that all the healthcare institutions in Macedonia should be accredited, the Macedonian accreditation is solid, and they should be continuously reaccredited. I think that this process is an important part of the improvement of the quality of healthcare services in Macedonia, but, more importantly because reaccreditations occur every three year in order to maintain the level of quality.

Zan Mitrev Clinic is the first completely digitalized hospital in the region. What was your role in the digitalization team of the “Zan Mitev” Clinic?

Dr. Ambarkova Vilarova: Yes, we are the first completely digitalized hospital in the region, and I provide medical support to the digitalization team. We have our own hospital information system (HIS), which we created ourselves according to our work processes. In addition to the medical software, we have material and accounting operations software, legal operations and human resources software, hospitality operation software and they are all integrated within HIS. My role is to “further explain” the processes to the IT engineers so that they can transform them from analogue to digital, test them and offer specific solutions for optimizing them. All medical profiles were involved in the creation of HIS in order to facilitate the transition and acceptance of digitalization by the staff, which, indeed is the most difficult part of the process.

As a physician, clinical transfusion medicine specialist, what are your day-to-day engagements in the hospital?

Dr. Ambarkova Vilarova: The primary activity of a transfusion medicine specialist is the timely provision of blood and blood components for each patient. Blood is a limited resource of human origin which can save lives, but blood transfusion can also cause many side effects which may seriously affect the patient’s health. Therefore, the rational use of blood has always been a main principle of the hospital. In addition, I work every day in the clinic on diagnosing and treatment of thrombotic and hemorrhagic diseases, as well as diagnosing of vein insufficiency (varicose veins) which are then treated by the surgeons. Thromboembolic diseases are potentially life-threatening conditions and may cause severe complications in patients who have had surgeries and severely ill patients. Therefore, timely diagnosis and treatment, but also the prevention of vein thromboembolism is very important, especially considering that today’s medicine, with its modern diagnostic procedures and medicines, makes this possible.

On the occasion of the 25th anniversary of the establishment of the Zan Mitrev Clinic, a Memorandum of Cooperation between the founder of the Clinic, Dr. Zhan Mitrev and the Acting Director of the PE Macedonian Forests, Prof. Dr. Zdravko Trajanov was signed today.
As a symbol of the quarter century of existence, 25,000 plants will be planted in the upcoming period, in several phases, which once again confirms the Zan Mitrev Clinic’s ambition and mission that this health institution’s story is not limited to medicine only, but also includes social responsibility, healthy environment, dedication to the future, and preservation of people’s health.
Planting will start in the parts of the Shtip region affected by wildfires. The founder of the Clinic, Dr. Zhan Mitrev, at the signing of the Memorandum of Cooperation, said that the planting of 25,000 plants is not just a symbolic act, but also represents a concrete step towards improving air quality, creating a healthier environment and legacy for future generations.

“In the past 25 years, the Zan Mitrev Clinic has set high standards in cardiovascular medicine, but our mission has always been broader – to create better conditions for healthy life. Healthy environment is on of the key factors for cardiovascular health, because polluted air, shrinking green areas, and climate change directly influence cardiovascular diseases,” said Dr. Zhan Mitrev.
The Director of the PE National Forests, Prof. Dr. Zdravko Trajanov said that planting 25,000 plants in cooperation with the Zan Mitrev Clinic was not only a step towards renewal of the forests but also a direct investment in cleaner air, better environment and healthier future for all citizens.
“The best way to invest in the future of our Republic of Macedonia, among other things, is afforestation. Thus, we leave legacy for the future generations – forestation means more clean air, and, in a way, it is an investment in healthcare. It is my great pleasure to be here, and I hope for many cooperations in the future,” said Trajanov.

In the last 25 years, Zan Mitrev Clinic had 1.1 million visits from more than 400,000 patients from Macedonia and from many other countries throughout the world. To date, more than 45,000 surgeries have been performed in this prestigious healthcare institution, thanks to a team of top professionals who apply state-of-the-art methods in medicine as a result to access state-of-the-art technology.
The first of March 2000 is the day when the new history of the Macedonian healthcare began, as well as a new era in cardiovascular surgery – it was the day when the first bypass surgery in the Zan Mitrev Clinic was performed. Two years later, the first open-hearth surgery was performed on an awake patient. The development of the children’s cardio surgery continues in 2019. In 2020, Dr. Zhan Mitrev, Dr. Tanja Angjusheva, and Dr. Nikola Hristov together with several doctors from the public healthcare sector, performed the first hearth transplant in the country and for that they received the prestigious “13th of November” Award. In 2023, Zan Mitrev Clinic received the third Golden Seal by the Joint Commission International (JCI) and this recertification confirms that this healthcare institution has the highest healthcare services quality and patient safety standards.

Today, Zan Mitrev Clinic is a leading private healthcare institution in the region, known for its top expertise, application of modern medical techniques and individual approach to the patients.