Clinical
ID’s Hospital Epidemiology team conducts an Ebola preparedness drill at UVA Hospital.
Division of Infectious Diseases:
CLINICAL
The division’s 18 clinical faculty members provide care and clinical expertise in infectious diseases at UVA Medical Center’s inpatient medical wards, through a busy consult service, and at six outpatient clinics [see sidebar]. They manage virtually all infectious disease cases in the hospital, with specific areas of expertise in:
- antibiotic resistance (Mathers)
- diarrheal diseases (Petri)
- fungal infections (Donowitz, Scheld)
- HIV medicine (Dillingham, Moore, Scheld, Townsend, Wispelwey)
- infections in cancer patients (Donowitz, Sifri, Wispelwey)
- meningitis and brain abscess (Scheld, Wispelwey)
- nosocomial (healthcare-associated) infections and hospital epidemiology (Sifri)
- pneumonia (Donowitz, Houpt)
- sexually transmitted diseases (Eby, Warren)
- C. diff (Warren)
- hepatitis C (Dillingham, Townsend)
- tick-borne diseases (Petri, Scheld)
- transplant-related infectious diseases (Donowitz, Sifri, Wispelwey)
- tropical medicine (Hewlett, Houpt, Hughes, Pearson, Petri)
- tuberculosis (Heysell, Houpt, Thomas)
Division faculty members provide substantial inpatient care on the general medicine wards; in FY 2014, about one-third of attending staffing was supplied by ID physicians, who exceeded the 90th percentile in UHC measures of productivity. They also provide consultations in infectious diseases and transplant infectious diseases at UVA Hospital and Culpepper Hospital – more than 7,000 in FY 2014 – and lead or co-lead the Infection Control, Formulary and Antibiotic Utilization committees.
One of the division’s essential roles is providing oversight of UVA Medical Center’s infection control program and efforts related to quality improvement in the prevention and control of healthcare-associated infections. Targeted projects by hospital epidemiologist Costi Sifri and fellow ID faculty members Amy Mathers and Heather Cox have led to reduced rates of pseuodomonal antibacterial resistance in intensive care units, and of Clostridium difficile infection in general medicine wards.
Mathers and Cox lead the Medical Center-wide Antibiotic Stewardship Program, initiated in 2009 to address the dual problems of increased antimicrobial resistance and declining new antimicrobials. The program’s efforts to reduce antibiotic use have resulted in savings of approximately $1 million a year in the last four years. The division’s quality officer, Joshua Eby, has focused on improved management of pneumonia in the last two years – one of the Medical Center’s key Quality Improvement (QI) goals – and on updating its pneumonia management guidelines. Additional quality initiatives in Staph bacteremia and nephrotoxicity of HIV protease inhibitors are underway. ID is working on refining metrics for patient care provided by its physicians in the outpatient and inpatient settings, and has proposed using Epic to measure consult responsiveness and efficacy.
The division’s outpatient clinics include the Infectious Diseases Clinic (HIV and general infectious diseases), the Sexually Transmitted Diseases Clinic, HCV Clinic, Musculoskeletal Clinic, C Diff Clinic, and Travelers’ Clinic. The Transplant Infectious Diseases program provides both inpatient and outpatient consultation in infectious disease management and prevention for transplant recipients and donors, who take immunosuppressing drugs that make them vulnerable to opportunistic infections. ID physicians maintain patient satisfaction survey scores above 92 percent for outpatient settings.
The hepatitis C clinic, with a particular focus on patients co-infected with HCV and HIV and led by Rebecca Dillingham, has grown substantially in the past year. Our transplant consult service provides critically important infection prevention and antibiotic management for recent transplant patients.
The Ryan White HIV/AIDS Clinic, established in 1991, had over 3,100 visits this year, providing medical care to individuals with HIV, including visits for medical, dental and mental health care. Patients come from all across Virginia and 18 other states. Research conducted at the clinic includes studies of antiretroviral protocols, new approaches to improving adherence to therapy, and evaluation of therapies for opportunistic infections. The clinic is also at the forefront of compiling quality metrics for HIV care. In the future the division hopes to find larger physical space for the clinic, in order to support the expanded staff and services made possible by a significant increase in funding.