What It Takes to Stop Carbapenem-Resistant Organisms: Lessons From the Front Lines in Ethiopia

Shu-Hua Wang, MD, MPH, infectious disease physician-scientist and tenured professor of medicine at The Ohio State University, College of Medicine, Internal Medicine Department, and Infectious Disease Division. She is the director of OSU Global One Health Initiative (GOHI) Implementation Science and Research. and Sarah Fisseha, MPH, CIC, infection control epidemiologist for Johns Hopkins Hospital, Maryland.

Carbapenem-resistant organisms (CROs) remain one of the most urgent antimicrobial resistance threats worldwide, particularly in low- and middle-income countries where laboratory and infection prevention infrastructure may be limited. At the national Association for Professionals in Infection Control and Epidemiology (APIC) Annual Conference and Expo 2025, held in Phoenix, Arizona, from June 16 to 18, a multidisciplinary team shared how a long-running surveillance and capacity-building project in Ethiopia is helping address that gap by strengthening both laboratory diagnostics and infection prevention and control (IPC) practices.

The work is part of the Global Action in Healthcare Network Antimicrobial Resistance (GAIN-AR) project, led by collaborators from The Ohio State University, Johns Hopkins Hospital, and Ethiopian public health partners. The project currently operates in 2 hospitals, Tikur Anbessa Specialized Hospital (TASH) and St. Paul’s Hospital Millennium Medical College, as well as the Ethiopian Public Health Institute (EPHI).

“This project is really about building the foundation,” said Shu-Hua Wang, MD, an infectious disease physician at The Ohio State University and director of the OSU Global One Health Initiative, to Carole W Kamangu, MPH, RN, CIC, a contributing editor for Infection Control Today^®. “Before you can even talk about colonization screening, you have to build laboratory capacity and infection prevention systems that actually work together.”

Sarah Fisseha, MPH, CIC, an infection preventionist (IP) and supervisor in the Hospital Epidemiology and Infection Control department at Johns Hopkins Hospital, joined the project as part of the IPC arm. “My role focused on reducing transmission,” she said. “That means hand hygiene, environmental cleaning, isolation practices, and making sure the data coming from the lab actually informs what IPC teams are doing on the ground.”

Rather than introducing surveillance in isolation, the team prioritized core IPC practices. “We didn’t just write protocols,” Wang explained. “We provided supplies, trained staff, and then went back to audit and monitor hand hygiene, environmental cleaning, and contact isolation. Without evaluation, protocols don’t change behavior.”

Cultural context was also central to the project’s success. “You can’t assume what works in the US will translate directly,” Fisseha said. “In some settings, for example, there’s a strong cultural emphasis on floor cleanliness. We had to help teams shift focus toward high-touch surfaces that drive transmission, while still respecting local norms.”

Introducing colonization screening presented additional challenges. “Rectal swabbing wasn’t a routine practice,” Wang noted. “So, we had to explain why identifying colonization matters, even when patients aren’t infected, and make sure staff and patients understood the purpose.”

Progress has been incremental but meaningful. “Hand hygiene [adherence] improved by about 20%,” Fisseha said. “That might not sound dramatic, but in resource-limited settings, that’s a big win.”

The team emphasized sustainability from the outset, engaging hospital leadership and the Ministry of Health early. “Success is when you can hand the program over,” Wang said. “We’ve focused on building local expertise, so these practices continue beyond the grant.”

For facilities hoping to start similar work without major funding, both experts stressed starting small. “Focus on the basics,” Fisseha advised. “Hand hygiene, environmental cleaning, monitoring, and feedback. Build momentum over time.”

Wang agreed. “Be systematic, document your processes, and use existing tools from [World Health Organization] and CDC. It takes time, but the impact is worth it.”

As antimicrobial resistance continues to rise globally, the project offers a practical reminder that sustained adherence to IPC fundamentals, paired with strong lab capacity and local partnerships, remains an essential tool for containment.