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The Role of an Infectious disease Specialist in a Healthcare System: Preparing for Global Threats.

Learn about the training requirements and roles of an infectious disease specialist in the healthcare system, as well as the importance of the Global Health Security Agenda in addressing global threats. Understand the impact of infectious disease specialists on patient outcomes, mortality rates, and healthcare costs. Explore the need for specialists in different continents and discover key figures in the field of infectious diseases.

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The Role of an Infectious disease Specialist in a Healthcare System: Preparing for Global Threats.

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  1. The Role of an Infectious disease Specialist in a Healthcare System: Preparing for Global Threats. Dr. Bertha Serwa Ayi, MB. ChB, FACP, FIDSA, MBA Medical Knowledge Fiesta 2016 September 15, 2016 A Competent Physician: Key to a Healthy Nation

  2. Objectives • Understand: • The training requirements of an infectious disease specialist. • The roles played by an infectious disease specialist in a healthcare system. • The Global Health Security Agenda (GHSA)

  3. Who is an Infectious Disease (ID) specialist? • Internal Medicine Residency. • Two years of infectious disease fellowship (clinical and microbiology) • Optional year of research training. • Patient/ Doctor collaboration (perplexing diagnosis in the shortest possible time with the smallest amount of resources) • Hospital • Community Education- teacher • National

  4. Path to ID Subspecialty • The quest for malaria eradication • Louis Pasteur (1822- 95) • John Snow-(1813-1958) • Robert Koch-(1843-1910) • 1884 • Hideyo Noguchi -1876-1928 • Alexander Fleming- drug discovery • Hepatitis C virus identification and cure in 24 years. 1989 to 2013 • Driving the agenda. Leading edge.

  5. Direct Patient Care, The detective • Collaboration with other Doctors • The competent physician • Keynote lecture from Prof. Awuku • DD • Brucellosis • Headache and leukocytosis • Fever

  6. Hospital • Diagnosis and treatment • Transplant • Immunocompromised host • Hospital Epidemiology • Antibiotic stewardship • Infection control • Handwashing • Patient isolation • Ebola Virus infection • Biocontainment Unit • Employee Health • Bioterrorism • Emerging infections • HIV

  7. National • Treatment Guidelines • Policy • Global Health Threats • Global Health Security Agenda (GHSA) • Prevent: ABX resistance, biosafety, zoonotic disease, and immunization. • Detect: National Laboratory System, Real time Surveillance, Reporting, and Workforce Development. • Respond: Emergency Operation Centers, Link Law Enforcement and other sectors with Public Health, Medical countermeasures and Personnel deployment.

  8. Patient outcomes with ID input • ID intervention cohort • lower mortality (odds ratio [OR], 0.87; 95% confidence interval [CI], .83 to .91) • readmissions (OR, 0.96; 95% CI, .93 to .99) • the ID intervention cohort ICU LOS was 3.7% shorter (95% CI, −5.5% to −1.9%). • Scmitt, S, Mcquillen D et al. Infectious Diseases Specialty Intervention Is Associated With Decreased Mortality and Lower Healthcare Costs Clin Infect Dis. (2014) 58 (1): 22-28.doi: 10.1093/cid/cit610 • Value: Health outcomes achieved per dollar spent • Infectious disease consultation resulted in decreased mortality and shorter lengths of stay especially if the consultation was obtained within 2 days of admission.

  9. Studies Staphylococcus aureus sepsis less likely to recur with ID consultation. Sepsis Relative risk reduction of death by 30%. 50% of antibiotic choices were inappropriate.

  10. Africa’s infectious disease burden

  11. Which Continent needs ID specialists the most?

  12. References • Scmitt, S, Mcquillen D et al. Infectious Diseases Specialty Intervention Is Associated With Decreased Mortality and Lower Healthcare Costs Clin Infect Dis. (2014) 58 (1): 22-28.doi: 10.1093/cid/cit610 • Petrak RM, Sexton DJ, Butera ML, et al. The value of an infectious diseases specialist.Clin Infect Dis 2003; 36:1013–17.

  13. References • McQuillen DP, Petrak RM, Wasserman RB, Nahass RG, Scull JA, Martinelli LP. The value of infectious diseases specialists: non-patient care activities. Clin Infect Dis 2008; 47:1051–63. • Borer A, Gilad J, Meydan N, Schlaeffer P, Riesenberg K, Schlaeffer F. Impact of regular attendance by infectious disease specialists on the management of hospitalized adults with community-acquired febrile syndromes. ClinMicrobiol Infect 2004; 10:911–6.

  14. References • Eron LJ, Passos S. Early discharge of infected patients through appropriate antibiotic use. Arch Intern Med 2001; 161:61–5. • Gomez J, Conde Covero SJ, Hernandez Cardona JL, et al. The influence of the opinion of an infectious disease consultant on the appropriateness of antibiotic treatment in a general hospital. J AntimicrobChemother 1996; 38:309–14. • Fluckiger U, Zimmerli W, Sax H, Frei R, Widmer AF. Clinical impact of an infectious disease service on the management of bloodstream infection. Eur J ClinMicrobiol Infect Dis 2000; 19:493–500.

  15. References • Fox BC, Imrey PB, Voights MB, Norwood S. Infectious disease consultation and microbiologic surveillance for intensive care unit trauma patients: a pilot study. Clin Infect Dis 2001; 33:1981–9. • Lahey T, Shah R, Gittzus J, Schwartzman J, Kirkland K. Infectious diseases consultation lowers mortality from Staphylococcus aureus bacteremia. Medicine 2009; 88:263.

  16. References • Kaech C, Elzi L, Sendi P, et al. Course and outcome of Staphylococcus aureus bacteraemia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre. ClinMicrobiol Infect 2006; 12:345–52. • Classen DC, Burke JP, Wenzel RP. Infectious diseases consultation: Impact on outcomes for hospitalized patients and results of a preliminary study. Clin Infect Dis 1997; 24:468–70. • Smetana GW, Landon BE, Bindman AB, et al. A comparison of outcomes resulting from generalist vs. specialist care for a single discrete medical condition. Arch Intern Med 2007; 167:10–20.

  17. References • Smith MA, Liou JI, Frytak JR, Finch MD. 30-day survival and rehospitalization for stroke patients according to physician specialty.Cerebrovasc Dis 2006; 22:21–6. • Lundberg J, Nettleman MD, Costigan M, Bentler S, Dawson J, Wenzel RP. Staphylococcus aureus bacteremia: the cost-effectiveness of longterm therapy associated with infectious diseases consultation. Clin Perform Qual Health Care 1998; 6:9–11. • Honda H, Krauss MJ, Jones JC, Olsen MA, Warren DK. The value of infectious diseases consultation in Staphylococcus aureus bacteremia. Am J Med 2010; 123:631–7.

  18. References • Rieg S, Peyerl-Hoffman G, de With K, et al. Mortality of S. aureus bacteremia and infectious diseases specialist consultation—a study of 521 patients in Germany. J Infection 2009; 59:232–9. • Robinson JO, Pozzi-Langhi S, Phillips M, et al. Formal infectious diseases consultation is associated with decreased mortality in Staphyloccus aureus bacteraemia. Eur J ClinMicrobiol Infect Dis 2012; 31:2421–8. • Porter ME. What is value in health care? N Engl J Med 2010; 363:2477–81

  19. Thank you

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