Infectious Diseases

At the Infectious Diseases Department, our care is structured into the following areas: hospitalisation, outpatient care, nosocomial infection control (infections contracted during a hospital stay), prevention and treatment of infection in HIV- immunodepressed patients (with solid or haematological neoplasia, bone marrow transplant or solid organ); international health and imported infections, and the HIV+ patients ward.

Our Department handles approximately 10,000 outpatient visits a year. There is also a day hospital where all types of prolonged antimicrobial treatments can be carried out, as well as a large number of diagnostic tests, in order to reduce hospital admissions.

In the hospitalisation division, between 550 and 600 patients are admitted a year, with an average hospital stay of about nine days. We admit immunodepressed patients with serious infections or requiring clinical isolation, as well as patients with serious infections that can be helped by our specialised care.

The priorities of the nosocomial infection control division are to identify and reduce the risk of transmission of especially complex infections and to ensure effective treatment. This latter aspect is key across all of the Department’s areas of care. Antimicrobial treatments are complex and one of the main responsibilities of the group is to ensure that they are administered as accurately as possible. To this end we are careful to constantly carry out a cost-benefit assessment.

Monitoring of infection in immunodepressed patients, both for HIV and others, is handled by two wards that treat patients with especially complex, serious infections, bearing in mind the type of infection and number of patients being treated at the Hospital. We aim to provide comprehensive care, handling prevention, diagnosis and treatment of infectious pathologies, especially opportunistic infections, that this type of patients suffer. One example is the Anal Dysplasia Unit in the HIV+ population, inaugurated in 2009 for the prevention, diagnosis and early treatment of anal cancer secondary to chronic infection by the human papilloma virus.

The international health and imported infections division, which works in coordination with the Tropical and Imported Diseases Unit of the Drassanes primary care centre and various local NGOs, is dedicated to providing overall care for patients affected by these infections. Thanks to telemedicine, we make regular contact with the regional Nossa Senhora da Paz Hospital in Cubal (Angola) to carry out joint sessions.

The Infectious Diseases Department was created in 1996 and consists of 14 doctors on staff, with resident doctors, predoctoral and postdoctoral doctors carrying out research and other key healthcare professionals all a part of its structure. The main characteristic of the Department, therefore, is our transversality. We firmly believe in the importance of having members of the Department collaborate with the different medical and surgical teams of the Hospital, both in terms of healthcare and research.

Portfolio of services

The portfolio of services offered by the Infectious Diseases Department responds to the health needs of the population and the demand for services generated at Vall d'Hebron University Hospital, guaranteeing accessibility, equity and quality of care, in a way that satisfies the expectations of the clients following the strategic lines of the Catalan Health Institute.

Open hospitalisation ward in infectious diseases

These wards are used to treat patients with systemic infections acquired in the community, including:

• Sepsis and primary bacteraemia

• Zoonoses with organic complications

• Parasitosis requiring hospital admission

• Febrile syndromes of unknown origin with severe systemic repercussions

• Organospecific infections requiring hospital admission due to systemic or organic repercussions

• Human immunodeficiency virus infection and infections secondary to other primary or secondary immunodeficiencies, for the diagnosis and treatment of opportunistic infections.

Day hospital

This area cares for patients with infections acquired in the community, offering treatment with acute clinical symptoms.

• Systemic infections
• Organospecific infections requiring hospital admission due to systemic or organic repercussions
• Organospecific infections with pre-admission and early discharge due to having completed treatment and under supervision of the acute incident away from the hospital, such as with infectious endocarditis or abscesses once removed.
• Human immunodeficiency virus infection and infections secondary to other primary or secondary immunodeficiencies, for the diagnosis, treatment and prophylaxis of opportunistic infections.
• Specific nursing consultation for patients infected with HIV. Follow-up programme for adherence to antiretroviral treatment, counselling, sexual counselling for serodiscordant couples and follow-up programme for seropositive pregnant women.

Outpatient Clinic for Infectious Diseases

This area covers:

• Patients with systemic or organospecific infections, previously treated in the hospitalisation ward for infectious diseases or in other Hospital departments, the day hospital or in a primary care centre, referrals to outpatient clinic for diagnosis, control and monitoring until discharge.
• Patients sent for initial study due to fever of unknown origin, without general effect.
• Patients with human immunodeficiency virus infection, for initial evaluation, diagnosis, treatment of HIV infection, prophylaxis of opportunistic infections and follow-up.
• HCV co-infection in patients with HIV infection.
• Patients with recurrent infections suspected to be secondary to other primary or secondary immunodeficiencies.

Prevention, diagnosis and early treatment of dysplasia and rectal and anal cancer in the HIV-positive population

This is a specific clinic included in the Pere Virgili Health Park, integrated into the policy for treatment of the HIV positive population.

Hospital combined clinics for infectious diseases

This area handles patients with any type of systemic or organospecific infection, nosocomial or acquired in the community, whichever part of the body is affected and in immunocompetent or immunodepressed hosts, whatever the cause. It includes the differential diagnosis of community and nosocomial febrile syndrome.

Nosocomial infection

Includes the following activities:

• Treatment of nosocomial infections, with special emphasis on those caused by multiresistant and especially aggressive microorganisms (for example, fungal infections), or in those that affect groups of patients in serious condition (for example, ICU, burns, transplants or oncohaematological).
• Clinical participation in surveillance and control programmes for nosocomial infections.
• Participation in activities carried out by the Infections Committee and the Antibiotics Subcommittee.
• Surveillance and control are carried out as part of the objectives defined by the Infections and Antibiotherapy Committee. They are carried out in coordination with the departments involved, and with those departments the Infection Committee and the Antibiotics Subcommittee decide on in their specific programmes.

Care programmes in the Primary Care area

Includes the following activities:

• Creation and following of protocols for diagnostic and therapeutic criteria with local primary care physicians for infectious community diseases, specifically in the process of intermediate-duration fevers, infectious respiratory disease, infectious urinary disease, infectious diseases carried by immigrants, as well as assisting in the treatment of tuberculosis.
• Guarantee of continued care.
• Coordination with non-hospital care in the integrated care process for patients infected with HIV.

Research

The Infectious Diseases Research Group (coordinated by Dr Benito Almirante) of the Vall d'Hebron Research Institute carries out clinical research that is closely linked to the care we provide, and which groups together the various Research Areas. We should also highlight our animal experimentation laboratory, within the Vall d'Hebron University Research Institute, which allows us to experiment and obtain results using various animal models, with the ultimate goal of trying to improve the prognosis of various serious infectious pathologies in humans. The current lines of research are:

• Nosocomial infection
• Serious community infection
• HIV/AIDS infection
• Infection in transplants
• Infection in oncohaematology
• Experimental models of infections

These lines of research are externally funded through research projects funded by the pharmaceutical industry or by public entities, as well as receiving funding as a member of thematic cooperative research networks organised by the Carlos III Health Institute (REIPI and RIS).

Teaching

Teaching represents a major part of the Department's activity. We collaborate and foster basic and continued training for students, professionals undergoing training (resident doctors) and predoctoral students in the area of knowledge of infectious diseases. This work is carried out both as part of hospital work and in academic and research activity.

It includes the following activities:

• Undergraduate training in infectious diseases, with three medical teacher positions and two associate medical teacher positions.
• Training for internal medicine residents and medical specialties that include training in infectious diseases as part of their curricula. The rotation is designed according to their needs, and includes residents from our Hospital and residents on temporary transfers from other hospitals. Every year, a maximum of two internal medicine residents who have completed their third year can be hosted, as the last two years of their period of training can be carried out in our Department, following a specific training programme in infectious diseases.
• Training for Primary Care doctors as part of continued education programmes. They are offered in the outpatient clinics and day hospital sections, where pathologies for non-hospital treatment are handled.
• Training for specialists from the Internal Medicine Divisions of other hospitals, as temporary transfers. Rotations are designed based on their training needs.
• Possibility of continuing postgraduate training for nursing professionals.