Author: Nertila Ivanovski

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.

A complex hybrid procedure – implantation of biological valve on mitral position (valve in valve) was performed in a 74 years old patient with a severe status with disrupted kidney function, placed on a dialysis machine.

This minimally invasive method, a mitral valve prosthesis replacement, is a rarity in the world, and in the Zan Mitrev Clinic, it was performed in a 74-year-old patient. The team of cardio surgeons and interventional cardiologists has performed a successful Transcatheter mitral valve implantation procedure, without classical surgery.

“Today, we have a special case, an extremely complex procedure on an extremely difficult patient. These, seemingly impossible missions which prolong the life of the patients for years and decades are possible and more frequent in Zan Mitrev Clinic, moving the frontiers of the cardiac surgery in the world. The team of Zan Mitrev Clinic has been setting new standards in the entire field of healthcare and finding ways to help more and more patients in the last 25 years. With state-of-the-art equipment, using advanced technology, we create better quality of life opportunities for our patients and justify the true function of medicine”, emphasized Dr. Mitrev.

The mitral valve prosthesis was placed through the top of the heart in the mitral position without performing classical surgery on the patient. The difference between the classical surgery and this intervention is that there is only a small opening of the chest – 5cm on the left side to access the top of the heart and using a special catheter, the new valve is placed in the existing one without using extracorporeal circulation.

“These cardiac surgery achievements indicate the great potential of the Macedonia’s healthcare. The innovative method, minimally invasive, is primarily safe for the patient, and it also accelerates the recovery of the patient and reduces the hospital stay. This procedure is enabled by the Health Insurance Fund and its package for the most elderly patients that includes this type of intervention and an increase of the number of these procedures in 2025, support for new procedures/interventions as well as complementarity of the public and private sector”, emphasized Sasho Klekovski, Director of the Health Insurance Fund of Macedonia.

The tram of cardiac surgeons and interventional cardiologists led by Dr. Mitrev, together with Doc. Dr. Oliver Bushljetikj, internal medicine specialist, subspecialist in cardiology and Dr. Vilma Ampova Sokolov, internal medicine specialist, subspecialist in cardiology.

“The patient has had two previous surgeries and needed to be operated for a third time since the prosthesis of the mitral valve has completely failed. We managed to place a mitral valve prosthesis through the top of the heart, in the mitral position without performing a classical surgery on the patent and without any additional risk of surgery she would not otherwise have survived. This type of surgery is relatively new in aortic valve replacement, and in the case of mitral prosthesis it is extremely rare. Usually, this procedure is used for the aortic valve, very rarely for the mitral valve. For this patient, whose chest has been opened in two previous occasions, that was the only option to save her life. This was the only chance for positive outcome for the patient.”, emphasized Dr. Bushljetikj.

The patient had her first operation in 1994 at VMA in Belgrade, and the second one in 2011 at Zan Mitrev Clinic when a surgery was performed to replace the mitral valve with a biological prosthesis. With the two previous surgeries, first when she was 43 in Belgrade, the second one after 17 years (2011) and now after 14 years, the patient’s life was prolonged by 30 years which is a proof of the doctors’ struggle and relevant application of the modern medicine in order to save and prolong the life.

Due to the big demand of our patients, we offer the specialist ophthalmology examination at promotional prices.
The ophthalmology center in the Zan Mitrev Clinic, in cooperation with Promedika ophthalmology, offers -50% on specialist ophthalmology examinations including refraction measurement, visual acuity tests, intraocular pressure measurement, and examinations of the anterior and posterior sections of the eye.
Comprehensive preventive eye examinations is always very welcome, especially in winter.
Schedule your exam at 📞02/3091-484

Versius – the innovative surgical robotic system designed to perform minimal access robot surgery was presented in the Zan Mitrev Clinical Hospital today. The presentation of the performance introduced the smallest surgical robot to the Macedonian professional, medical community. It can perform laparoscopic and minimally invasive procedures which benefits the patients, the surgeons and all medical professionals.
Versius technology is a digital interface between the surgeon and the patient. It consists of a work console operated by a surgeon and 4 arms, one holding the camera, and the other three holding the instruments. All arms are modular and completely imitate the movements of a human arm (shoulder, elbow, wrist). Each of the arms can work independently of the others, but they also work in unison (triangulation). The robotic procedure reduces blood loss, pain after surgery, as well as the recovery time.
Versius assists surgeons in various medical areas, mostly in urology, laparoscopic hysterectomy, gastroenterology and gynecology, wherever laparoscopic or minimally invasive approach is used, where the surgery involves a series of small incisions, something which is not available to millions of people around the world.
Versius is an invention of the British company, Cambridge Medical Robotics Surgical and it has been used to perform more than 20 thousand procedures in more than 20 countries.
Zan Mitrev Clinical Hospital always strives to develop and perfect the work techniques by introducing and using the most innovative methods, applying the latest developments in the new digital era in the sphere of medicine, with a view of providing the greatest possible benefits to the patients.

In the early morning hours, the first baby was born in the the Zan Mitrev Clinic Mother and Baby Center. The team on call, led by Dr. Kizheski spontaneously delivered the first male baby into this world, weighing 3,460g and 50cm. The newborn’s name will be Ognen. The maternity ward and the gynecology department in the Zan Mitrev Clinical Hospital were opened yesterday and they provide a multidisciplinary approach in the monitoring of future mothers before, throughout, as well as after the pregnancy. The center has state-of-the-art equipment from top global manufacturers and experienced medical staff. It has two delivery rooms, recovery rooms, an operation room, six incubators and for rooms – suites, a neonatology office, a gynecology office and an examination room.
On the occasion of the opening of the Center, we created special packages with many amenities and discounts which are transparent and without additional or hidden costs. The price for spontaneous delivery is 95,000 denars, and the price for cesarian birth is 130,000 denars. Zan Mitrev Clinic cooperates with all private health insurance companies, and it has a transparent offer with promotional prices without hidden additional costs
Some of the amenities include free obstetrician examinations after the 36th week as well as free pediatric examinations of the newborn during the first month. Fast and painless delivery. Complete care for the newborn by a neonatology team, 24-hour availability for consultation with the neonatology team and special benefits and discounts for the newborn and its family.

The Mother and Baby Center in the Zan Mitrev Clinic started to work in more than 800 square meters, equipped with state-of-the-art medical equipment. The new department in the Clinic has two delivery rooms, recovery rooms, an operation room, six incubators and four rooms – suites, neonatology, gynecology offices and an examination office. The Mother and Baby Center provides a multidisciplinary approach with all the necessary capacities, equipment and staff to manage the prepartum, delivery and postpartum phases, and to meet all of the mother’s and baby’s needs.
Primarius Dr. Ljupcho Petrovski – gynecology and obstetrics specialist, perinatology subspecialist is the leader of the team of doctors that also includes Dr. Irena Andonova, gynecology and obstetrics specialist; Dr. Nenad Lazarov, gynecology and obstetrics specialist; Dr. Vladimir Kizheski, gynecology and obstetrics specialist; Dr. Violeta Nikolov, gynecology and obstetrics specialist; Dr. Vesna Delovska, pediatrician, neonatology specialist; Dr. Liljana Nikolikj, pediatrician, neonatology specialist etc.
“Opening of the Mother and Baby Center completes our aim to create a complete healthcare center and an integrated clinic, offering all the services in one place. We created a maternity center with a unique concept, which is an investment in the Macedonian healthcare, and its services will contribute to the improvement of the child delivery practice in our healthcare system. This completes the investment of 5 million euros which started with new equipment, promotion and expansion of the existing departments, opening several completely new departments and engaging top specialist physicians,” emphasized Dr. Zhan Mitrev. The Mother and Baby Center is equipped with the state-of-the-art equipment from various global manufacturers and an experienced medical team which always will be available in the Center to take care of the mothers and the babies during and after the pregnancy. The Center provides services throughout the three trimesters of the pregnancy, as well as diagnostic examinations, HSG laboratory, genetic investigations such as amniocentesis, chorionic villus sampling, ultrasound and non-invasive prenatal tests.
“Our approach involves a comprehensive education of the future mother before and after childbirth, as well as involvement of the whole family in the care for the new mother and the newborn. This Center provides complete 24-hour care for mothers and babies. The physician that has gained the trust of the new mother before delivery, i.e. the one who guided the patient throughout the pregnancy, will also be available and present during the delivery itself,” emphasized Dr. Lazarov, a gynecology and obstetrics specialist.
The equipment, including gynecology tables and delivery tables, ultrasound machines, CPG machines, temperature control incubators, resuscitators, two function blenders with CPAP and high flow humidified air, was procured from renowned and top global manufacturers which completes this investment cycle that exceeds 5 million euros.
The Center monitors pregnant women as early as during the first trimester, manages pathological conditions during pregnancy, provides safe and painless delivery and adequate monitoring after delivery. The neonatology department is equipped with state-of-the-art equipment and experienced medical staff, employing an interdisciplinary approach, providing complete pediatric care for the newborns.
The Mother and Baby Center is ready to receive and accommodate its first patients and take care of the mothers and babies throughout, as well as after the pregnancy.
In order to make it more accessible, on the occasion of the opening of the Center, we created special packages without hidden costs.