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Antimicrobial resistance (AMR) is a critical global health challenge, and the ongoing war in Ukraine has only intensified the crisis. A new paper from WHO Ukraine with Radboudumc, published in The Lancet Infectious Diseases, highlights the impact of continuous on-site mentoring in strengthening infection management in war-affected healthcare settings.
Addressing AMR in Challenging Conditions
Even before the Russian invasion in 2022, Ukraine faced significant hurdles in controlling AMR. The destruction of healthcare infrastructure, overcrowded hospitals, and widespread use of broad-spectrum antibiotics in trauma cases have exacerbated the problem. Patients transferred from Ukraine to Western Europe commonly carry carbapenem-resistant Gram-negative bacteria, underscoring the urgent need for effective infection prevention measures.
Recognizing these challenges, the Ukrainian government mandated infection prevention and antimicrobial stewardship programs across healthcare facilities in 2022. While international organizations have supported these efforts through webinars and technical assessments, their long-term impact has remained limited due to insufficient follow-up and lack of context-specific applicability.
A Better Approach: On-Site Mentoring
The paper emphasizes the strength of on-site mentoring, a hands-on approach that enables healthcare professionals to implement improvement measures in real time. By working closely with teams, mentors identify barriers, provide immediate feedback, and instill a culture of accountability and continuous learning.
An example of this approach took place at Dnipro City Hospital #4 between October 2024 and February 2025, where WHO-led on-site mentoring together with medical microbiologist Heiman Wertheim from Radboudumc led to the successful implementation of crucial infection management strategies. These included contact precautions for multidrug-resistant infections, surveillance of surgical site infections, improved hand hygiene compliance, antibiotic pre-authorization processes, enhanced medical microbiology diagnostic reporting, and locally adapted treatment guidelines. Compared to previous short-term technical support initiatives, mentoring proved far more effective in integrating sustainable infection management practices.
Toward Scalable Solutions
Scaling up on-site mentoring programs could significantly strengthen infection prevention in Ukraine and other conflict-affected regions. The study calls for institutionalizing mentorship models within national antimicrobial stewardship strategies, fostering professional networks for local mentorship, and securing long-term funding to ensure sustainable implementation.
As international efforts to combat AMR continue, approaches like on-site mentoring may offer a path toward lasting improvements in healthcare resilience, bridging the gap between policy and practice in crisis settings. Scalability is an issue, but positive examples across the globe are arising, such as the Radboudumc SPICE initiative (About SPICE - Radboudumc) and DRIVE AMS program (Drive-AMS in Low- and Middle Income Countries - Radboudumc).
Read the full publication: The Lancet Infectious Diseases.
