Clinical and treatment aspects

Details

Title

Clinical and treatment aspects

Type

Stage Two

Module code

HLS279

Requirement

Compulsory

Module objective

By the end of the training period trainees will, in respect of the clinical and treatment aspects of virology and gaining clinical competences to become an independent practitioner in clinical virology, be able to:

• analyse, synthesise, evaluate and apply knowledge
• perform, adapt and master a range of technical and clinical skills and procedures and
• demonstrate the attitudes and behaviours necessary for professional practice as a consultant clinical scientist dealing with the complexities, uncertainties and tensions of professional practice at this level.

Knowledge and understanding

By the end of the training period the trainee will be able to demonstrate the ability to analyse, evaluate and synthesise relevant knowledge and its application to their professional practice in relation to:

• giving appropriate clinical and management advice including:
  • the aetiology and clinical presentation of infectious
  • the pathophysiology of the disease process
  • available diagnostic techniques and their limitations
  • available therapeutic measures and preventative measures
• show a good working knowledge of treatment and prevention of virus infections, including:
• antivirals
  • knowledge of the mechanisms of action of the anti-viral drugs in use and under development, and the development of resistance to those drugs
  • knowledge of the optimum treatment of viral infections in immunocompetent and immunocompromised patients and the differences in drug dosages, routes of administration, duration of treatment, and relevant side effects and drug
  • knowledge of the role of antivirals in prophylaxis of viral infections in immunocompetent and immunocompromised patients including how to access drug dosage, route of administration and duration of
  • mechanisms of development of anti-viral resistance and how to reduce the risks of anti- viral
  • knowledge of how to test for anti-viral
  • knowledge of how to access current guidelines relating to anti-viral drugs and their use in clinical practice.
• vaccines: knowledge of:
  • viral vaccines in current use and an understanding of those under
  • indications and contra-indications and differences between the types of vaccines, i.e. live attenuated, killed, recombinant, sub-unit, DNA vaccines,
  • adverse effects of vaccines
  • properties of available adjuvants
  • use of viral vaccines and their schedules of administration for both prevention and post exposure prophylaxis in the community, occupational health and clinical setting and in the context of travel related
  • efficacy of the viral vaccines in current use and the guidance on post vaccination immunity checks.
• immunoglobulins: knowledge of:
  • the role of monoclonal and polyclonal human immunoglobulins for treatment, prevention and post-exposure prophylaxis of viral
  • their efficacy and indications of use, dosage schedules and route of
• demonstrate understanding of the importance of infection prevention and control in hospital and community setting, including knowledge of:
  • the epidemiological consequences of different diseases and of the systems available for disease control.
  • the reservoirs, sources, routes of transmission and portals of entry of common hospital; acquired and community acquired
  • the interaction between the patient, environment and
  • disinfection and sterilisation in the hospital and primary care
  • knowledge of public health principles as applied to
  • evidence base for effectiveness of local, national and international standards guidelines for
  • relevance of audit to
  • contribution of COI to total quality management, risk and control
  • clinical governance and review body inspections as e.g. Clinical Pathology Accreditation (CPA), Care Quality Commission,
  • importance of non-clinical areas as clinical waste, kitchens and laundry to COI issues and hospital-acquired infection (HAI)
• show awareness of the role of occupational health, including:
  • knowledge of inoculation incident management including follow-up protocols and post-exposure prophylaxis for BBVs.
  • knowledge of local, national and international guidelines and standards in relation to occupational exposure to infection and limitation of practice/exclusion from work.
  • knowledge of pre- and post-exposure prophylaxis regimes.
• maintain up to date knowledge of emerging virus infections
• demonstrate a working knowledge of clinical microbiology, especially:
  • knowledge of the impact of practice of medical microbiology on virology.
  • knowledge of basic medical microbiology to enable consideration of non-viral infections in the differential diagnosis of patients presenting with suspected viral infections.
  • knowledge of the diagnostic tests (and their limitations) available in the routine microbiology laboratory with understanding of further tests available at specialised centres.
  • familiarity with the professional responsibilities of being the first point of reference for clinical advice and sample investigation as an independent practitioner, including out of hours or similar environment.
• demonstrate competencies for advising independently, including knowledge (dependent on stage of training) of:
• during training for Part 1
  • knowledge of the out-of-hours repertoire
  • knowledge of the testing protocols for assays used out of hours, including the sensitivity and specificity of the test relative to standard tests.
  • knowledge of the limitations of the tests offered outside normal working hours.
• during training for Part 2
  • knowledge of correct interpretation of difficult test results, especially unconfirmed positive or equivocal results for BBV in source patients for needle stick injuries and in pre-transplant
  • treatment and prophylaxis: vaccines and immunoglobulins
  • knowledge of the acquisition, storage, availability and prescription of any vaccine or immunoglobulin controlled by the department that may be used at anytime.
  • clinical advice, professional responsibilities out of hours.
  • knowledge of the relevant clinical guideline appropriate to the case or investigation.
  • knowledge of the health and safety legislation, control of infection guidelines and public health issues appropriate to the case or investigation.

Technical and clinical skills

By the end of the training period the trainee will be able to demonstrate a critical understanding of current relevant research, theory and knowledge and its application to the performance, adaptation and mastery of the following technical procedures and laboratory skills:

• demonstrate
  • ability to carry forward understanding of virology at basic/cellular, clinical, laboratory and epidemiological level to clinical scenarios, i.e. patient management
  • ability to select and interpret relevant laboratory investigations to achieve a specific diagnosis or differential and to guide patient management
• demonstrate
  • ability to make accurate risk assessment and to recognise when control of infection action is required
  • ability to recognise the various sterilisation and disinfection processes and their indications and advantages
  • understanding of the principles behind bacterial, parasitic and fungal diagnostic techniques so as to be able to liaise with colleagues for the appropriate investigation and management of patients with microbial infections
• appropriately use laboratory resources when further investigations may be warranted (further tests undertaken, time taken for staff to set-up, and/or complete further tests or repeat results)
• participate in the recommendation, testing and reporting of investigations with a high health protection profile (e.g. pandemic influenza, viral haemorrhagic fevers)
• communicate significant results to health protection/public health personnel
• communicate with national reference laboratories.

By the end of the training period the trainee will be able to apply knowledge of clinical and treatment aspects to perform, adapt and master the clinical skills necessary to manage to:

• ability to:
  • choose most appropriate treatment
  • justify to colleagues the chosen course of action in relation to patient
  • select the most appropriate anti-viral or combination of anti-viral drugs for the treatment of viral infections
• ability to advise on:
  • use of anti-viral drugs for prophylaxis of infection for outbreak control or for prevention/ suppression of infection in individual patients
  • dosage, route of administration and duration of treatment with specific agents or combinations of anti-viral drugs
  • recognition of and monitoring for development of resistance to the anti-viral drugs in current use and advises on the use of alternative drugs
• ability to advise on:
  • administration of viral vaccine for prevention and post-exposure prophylaxis for all patient groups including those travelling to countries where infections non-endemic to the UK are prevalent
  • appropriate pre- and post- vaccination immunity checks
• ability to advise on:
  • use of virus-specific immunoglobulins for prevention, prophylaxis or treatment of infection
  • use of normal immunoglobulin for prevention, prophylaxis or treatment of infection
• ability to describe the role of surveillance in infection prevention and control
• ability to explain how the pressure for beds in a hospital may potentially conflict with effective infection prevention and control measures
• demonstrate understanding of:
  • the ethical implications of BBVs for HCWs and for patients
  • the role of counselling
  • national guidelines
  • antiviral prophylactic protocols
  • understanding of the dynamics of viral infections causing hospital acquired infections
  • ability to describe the development and execution of infection prevention and control policies and processes in hospital and community setting
  • awareness of signs and symptoms and management implications of patients with non-viral infections
• use professional contacts appropriately (eg laboratory staff to arrange and discuss testing, notification of results to healthcare professionals, communication with on-call pharmacist for issue of immunoglobulin/vaccine, arranging courier)
• advise appropriate sample collection according to the relevance of the clinical case and the test to be undertaken
• be able to advise on:
  • need for urgent testing versus delayed testing
  • appropriate tests to be undertaken
  • appropriate test interpretation
  • appropriate follow-up regimen
  • treatment and management options available following the out of hours enquiry (e.g. the appropriate use of an immunoglobulin or antiviral recommended to a pregnant or immunocompromised patient)
  • infection control in a case (not involving ward closure)
• be competent in recommending giving or withholding treatment or prophylaxis in a complex clinical scenario or where laboratory results not easily accessible or where a decision has to be made on unconfirmed positive screens, e.g. equivocal results for BBV in source patients for needle stick injuries and in pre-transplant screens
• be aware when there is a need to discuss a complex case with a clinical colleague requiring the acquisition of further advice from an expert source (outside your institution) to complete the final clinical advice given to local clinicians
• discuss with senior hospital managers the implementation of infection control measures (e.g. ward closures) in a potential outbreak scenario.