High Risk Groups

Module details

Title

High Risk Groups

Type

Specialist

Module code

SLS222

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with the knowledge and understanding of the aetiology, pathophysiology, clinical presentation and management of patients with sexually transmitted infections. They will understand the increased risks and causes/manifestations of microbial infection in immunocompromised patients, in the intensive care unit, during pregnancy and in children, and the management of these patient groups. In the work-based module they will be expected to apply this knowledge as they use relevant methods and gain experience of the interpretation of patient results from these high-risk groups in a variety of clinical settings. This module will enable the trainee to gain experience of the clinical presentation and laboratory investigation and management of microbial infections, including the reporting of results in the correct clinical context. The trainee will be able to perform point-of-care methods that are used in the investigation and management of high-risk groups. The trainee will be able to Identify and apply risk management actions for the particular health and safety issues associated with the high-risk groups.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Select suitable methods for the investigation of high-risk groups, including: sexual health immunocompromised patients patients in the intensive care unit pregnant women children and neonates.	Action View
# 2	Learning outcome 2	Competency Perform clinical and laboratory investigation of sexually transmitted infections, to include: chlamydia genital herpes genital warts, gonorrhoea HBV HIV syphilis.	Action View
# 3	Learning outcome 2	Competency Perform clinical and laboratory investigation of immunocompromised patients, including patients from the intensive care unit (ICU).	Action View
# 4	Learning outcome 2	Competency Perform clinical and laboratory investigation of infections considered important in pregnancy, including: urinary tract infections sexually transmitted infections fungal infections including candidosis, parasitic diseases, e.g. toxoplasmosis and malaria, septic abortion, chorioamnionitis and endometritis.	Action View
# 5	Learning outcome 2	Competency Perform the clinical and laboratory investigation of infections specific to paediatrics,including: neonatal meningitis, group B streptococcal sepsis respiratory illnesses.	Action View
# 6	Learning outcome 4	Competency Interpret and report the results of the laboratory investigation of patients from the following high-risk groups: sexual health immunocompromised patients, including patients in the ICU pregnant women children and neonates.	Action View
# 7	Learning outcome 6	Competency Perform quality assurance and quality control tasks within the laboratory in the investigation of the specified high-risk groups.	Action View
# 8	Learning outcome 2	Competency Perform point-of-care testing (POCT), including quality assurance, in the management of sexual health.	Action View
# 9	Learning outcome 3,5	Competency Recommend and contribute to clinical risk management strategies to minimise infection in all of the following: sexual health immunocompromised patients, including patients in the ICU pregnant women children and neonates.	Action View
# 10	Learning outcome 4	Competency Comply with laboratory procedures for the identification and processing of samples from high-risk patients	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform the analysis of an appropriate IQA or EQA e.g. NEQAS sample	DOPS
Read five pre prepared high vaginal slides for the diagnosis of bacterial vaginosis using the Hay Ison grading system	DOPS
Interpret the results from a NAAT used in the diagnosis of STI	DOPS
Analyse a CSF sample of an immunocompromised patient, including cell count, white cell differential, Gram stain, India ink, NAAT, latex agglutination and other antigen detection, as appropriate.	DOPS
Interpret the ante natal serology results of five patients	DOPS
Under supervision obtain a patient history from a normal volunteer or typical patient referred to your service and present the findings to a colleague or peer	OCE
Under supervision provide advice for a normal volunteer who has come into contact with a patient with a rash during pregnancy. Present the findings to a colleague or peer	OCE

Learning outcomes

1. Perform clinical and laboratory investigation and management of microbial infections in the specified high-risk groups.
2. Perform laboratory (and point-of-care) investigation in these high-risk groups.
3. Identify and apply risk management actions for the particular issues associated with the high-risk groups.
4. Interpret and report on investigations and management of microbial infections in high-risk groups.
5. Work in partnership with other clinical specialisms in the investigation and management of high-risk groups.
6. Perform quality assurance and control tasks associated with the investigation and management of high-risk groups.

Learning outcomes

1. Describe the pathogenesis, clinical presentation and treatment of microbial infections in the following specific high-risk groups:
   • a. sexual health patients
   • b. immunocompromised patients
   • c. patients in the intensive care unit
   • d. pregnant patients
   • e. children.
2. Describe the design and application of a range of clinical microbiology laboratory investigations in different healthcare settings used in the detection and management of microbial infections in high-risk groups.
3. Explain the specific health and safety issues associated with the high-risk groups and the underpinning evidence base.
4. Discuss and evaluate the role of the clinical microbiology laboratory, as part of the multidisciplinary team, in the provision of information for management, control and treatment of microbial infections in high-risk groups.

Indicative content

• The aetiology, pathophysiology and clinical presentation of the more common sexually transmitted infections (STI)
• Laboratory investigation of STI in different healthcare settings (e.g. hospital, specialised clinic, community)
• Congenital STI and associated risks
• The multidisciplinary team approach to the management of STI
• Biological and iatrogenic causes of immunodeficiency
• Measures to prevent infection in the immunocompromised patient
• Clinical and laboratory investigation of the immunocompromised patient
• Investigation and management of common infection problems in the intensive care unit (ICU)
• Effects of pregnancy on the immune system
• Infections specific to pregnancy (e.g. septic abortion, chorioamnionitis, endometritis)
• Infections that may compromise pregnancy (e.g. STI, fungal infection, parasitic disease)
• Antimicrobial therapy in pregnancy and the risk of teratogenicity
• Pathophysiology of infectious disease in children (e.g. neonatal meningitis, group B sepsis, intraventricular shunt infections)
• Treatment of childhood infections, including the selective use of antimicrobials

Activities

• Identify at least two patients from the following high-risk groups. Participate in multidisciplinary review meetings at which patients from the following high-risk groups are discussed: sexual health; immunocompromised patients; patients in the intensive care unit; pregnant women; children and neonates. Follow the progress of these patients and prepare a report to include the patient experience and care, the application and success of investigations and factors that will influence your future practice.
• Prepare a portfolio of relevant clinical cases; describe the clinical outcome and learning points in terms of patient care, procedures and processes for investigation and your future practice.
• Participate in ward rounds at which high-risk patients are discussed. Prepare a portfolio of relevant clinical cases; describe the clinical outcome and learning points in relation to the management of high-risk patients.
• Visit clinics and other healthcare units and describe the role of doctors, nurses and others in the management of infection risk in sexual health and pregnancy. Discuss with your supervisor in terms of the impact on your future practice.