Meeting the challenges in clinical microbiology and infectious diseases
Clinical Microbiology and Infection
Infectious disease continues to challenge mankind. New diseases, drug resistance, changing population demographics, socio-economic factors, travel and climate change are all contributing to an ever increasing burden, which is increasingly a¡ecting healthcare systems, research institutions and professionals responsible for the diagnosis, treatment and prevention of infection. Parallel to the endemic, epidemic and emerging burden of infectious disease has been major changes to the way healthcare
... ystems are organized, funded and made accountable. Public and political con¢dence in the ability of professionals to deal e¡ectively with infectious diseases has been questioned in relation to epidemic problems such as MRSA and VRE within hospitals and in the community from food-borne diseases, such as E. coli 0157 and salmonellosis, while prion-associated disease in cattle and man has had a major international and economic impact. Within laboratory medicine, signi¢cant changes have taken place with regard to rationalization and centralization of laboratory management and, in turn, the repertoire of investigations o¡ered. This has coincided with exciting developments in new diagnostic approaches that are bene¢ting disease management and prevention. Clinical services, likewise, have witnessed an increase in workload from new diseases, such as hepatitis C, as well as dealing with the evolving complexity of HIV management. Furthermore, the particular needs of patients in high dependency units demand good collaboration between infection specialists and intensivists who increasingly manage some of the most challenging problems within our hospitals. Within the professional arena, the requirement for harmonization of specialist training within the European Union has had a signi¢cant impact on training programmes and trainee assessments, and, in turn, those responsible for training, as well as for maintaining and developing high quality clinical services. In addition, audits have been promoted as a tool for monitoring and improving the quality of services and are now mandatory in some countries. Maintaining quality requires a workforce that is well trained and is committed to a process of lifelong learning. Continuing Medical Education has given way to Continuing Professional Development which must be demonstrable, veri¢able and reinforced by peer review. Against this background, a Workshop was organized by ESCMID in April 1999 in Birmingham, UK entitled'Meeting the Challenges in Clinical Microbiology and Infectious Diseases'. The objectives of this workshop were to share and debate the many aspects of the current and evolving models for the delivery of high quality diagnostic, clinical and public health-care as well as reviewing the training needs for future specialists. It was hoped that by reviewing the diversity of approaches, new insights might be provided into the relative merits of the component services through which a vision for the future might emerge. The structure of the Workshop was based on short position papers which were followed by both prepared and open discussion. The programme commenced with a description of the current arrangements in microbiology, public health and infectious disease for the management of infection. Future needs were then reviewed. Because of the importance of ensuring an appropriate future cadre of healthcare professionals, training in the infection disciplines was considered in some detail. Finally, future models were discussed in relation to laboratory and clinical services. The selection of manuscripts which follows provides a useful record of the workshop, which did not claim to be comprehensive, or deliver a de¢nitive answer to all the issues in a rapidly evolving area. However, it is hoped that they will form the basis for further debate and decision-making that will encourage a shared approach among the infection disciplines.