The patient population
Infection is an extremely common cause of admission to hospital, and can affect all age groups. There is evidence that specialist infection management leads to improved outcomes for patients (eg for Staphylococcus aureus bloodstream infection). Increasing access to infectious diseases physicians for patients in secondary care can improve outcomes for a wide variety of patients, while also enhancing areas such as antibiotic stewardship and infection control/outbreak management. The World Health Organization and Public Health England are useful sources of data on the patient populations most affected by infections.
The patient population requiring infection expertise varies greatly between different conditions, eg hepatitis C is more common amongst people who use intravenous drugs. Local prevalence and incidence of common infections is available via reporting data to Public Health England.
Patients accessing infection services are often from marginalised and vulnerable areas of society, such as asylum seekers, prisoners, homeless people and drug users. The age of patients tends to be younger than for many other specialties, and they may have less medical comorbidity but often higher levels of social and psychological issues. High numbers of patients may be born overseas and do not speak English as a first language. Access to interpreting services is therefore essential.
Prevention of disease
For patients with longer-term conditions managed by infectious diseases physicians, prevention of onward transmission of blood-borne viruses (BBVs) and tuberculosis are key areas for intervention. Vaccination against hepatitis B should be offered to all non-immune HIV and hepatitis C patients as a recognised risk-reduction strategy. Promotion of condom use and risk reduction via needle exchanges for people who inject drugs are also successful ways of reducing spread of BBVs, and liaison with local sexual health and drug services is crucial in achieving this. TB clinics have championed contact tracing and treatment of latent infection to reduce active disease and onward transmission, and infectious diseases clinicians contribute significantly to this.
Infectious diseases physicians can also play a part in reducing the morbidity from recurrent infections such as cellulitis (prophylactic penicillin treatment) and respiratory infection (vaccination and prophylactic antibiotics in certain subgroups). In this capacity, there is also scope for antibiotic stewardship activity directed towards primary care, often in collaboration with medical microbiology and primary care colleagues in developing regional guidance dependent on local antibiotic resistance patterns.
Planning effective services
With increasing levels of blood-borne viral infections, commissioners should be aware of the need for infectious diseases services to contribute to their management. Operational Delivery Networks are being developed and those for HIV, viral hepatitis and tuberculosis will have significant input from infectious diseases physicians.
Nationally, specialist units for the treatment of patients with highly infectious diseases such as Ebola virus are required, and on a regional level there is a need for units able to treat patients with infections such as drug-resistant tuberculosis. Commissioners also need to be aware of the requirement for regional units to treat people with complex imported infection, dependent on local patterns of migration and travel.
Specialist laboratory services to complement clinical services are within the remit of Public Health England with infectious diseases units regularly requiring close liaison with the specialist diagnostic services available.