Download The role of Clinical Pathologist in Infectious Diseases

The Role of Clinical Pathologist
in Infection Management
Ida Parwati
Indonesian Society of Clinical Pathologist
and Laboratory Medicine
20160602 The Role of Clinical Pathologist in
Management infectious disease
VISI
Menjadi organisasi profesi di bidang
Patologi Klinik dan Kedokteran
Laboratorium yang unggul dan profesional
bertaraf internasional
20160602 The Role of Clinical Pathologist in
Management infectious disease
MISI
1. Memelihara dan meningkatkan kompetensi dan
profesionalitas anggota PDSPatKLIn
2. Meningkatkan kualitas dan kuantitas pendidikan
dan penelitian di bidang Patologi Klinik dan
Kedokteran Laboratorium
3. Meningkatkan kerjasama dengan organisasi
profesi lain dan organisasi keseminatan di tingkat
nasional maupun internasional
4. Meningkatkan peran serta profesi PDSPatKLIn
dalam menunjang program pemerintah di bidang
kesehatan masyarakat
20160602 The Role of Clinical Pathologist in
Management infectious disease
Organization
Academy of
Medicine of
Indonesia
(MKKI)
Ministry of
culture and
Education
Indonesian
Medical
Association
(IDI)
Faculty of
Medicine
Collegium
of
CPLM
Ministry
Of
Health
Teaching
Hospital
Department
of CPLM
20160602 The Role of Clinical Pathologist in
Management infectious disease
Profesional
organization:
ISCPLM
Benchmark: Colleague of American Pathologist (CAP)
ACGME
(Accreditation Council for Graduate Medical Education)
“Education in clinical pathology must include
microbiology (including bacteriology, mycology,
parasitology, and virology), immunopathology, blood
banking/transfusion medicine, chemical pathology,
cytogenetics, hematology, coagulation, toxicology,
medical microscopy (including urinalysis), molecular
biologic techniques, aspiration techniques, and other
advanced diagnostic techniques as they become
available.”
Smith BR. Am J Clin Pathol 2006
20160602 The Role of Clinical Pathologist in
Management infectious disease
MICROBIOLOGY
I. General Microbiology
II. Bacteriology
III. Susceptibility Testing
IV. Mycobacteriology
V. Mycology
VI. Parasitology
VII. Virology
VIII. Molecular biology
Skill Level I
Skill level II
Skill level III
20160602 The Role of Clinical Pathologist in
Management infectious disease
MICROBIOLOGY in
CLINICAL PATHOLOGY
I. General Microbiology
Clinical
Immunology
II. Bacteriology
chemistry
III. Susceptibility Testing
IV. Mycobacteriology
V. Mycology
VI. Parasitology Laboratory
Hematology
VII. Virology
management
VIII. Molecular Biology
Urinalysis and body fluid
Microbiology continously implemented throughout curriculla
20160602 The Role of Clinical Pathologist in
Management infectious disease
Multispectrum laboratory role
Start from praanalytical→post analytical
From risk factor → Diagnosis
→ Monitoring Therapy
Service in health care →
research in community →
Epidemiology
Different laboratory role:
Promotion-Prevention-Curative
20160602 The Role of Clinical Pathologist in
Management infectious disease
The multispectrum laboratory aspect for
management of infection
Pathogen
Virulence
resistance
Host:
immune
competent
/deficiency
Laboratory
results
Management
of infection
hostpathogen
interaction
Lab test
spesific non
spesific
Host/Immun
response
20160602 The Role of Clinical Pathologist in
Management infectious disease
Role of diagnostic tests in the management of
Infection
1. Patient management:
to confirm, rule out diagnosis
2. Screening for asymptomatic infections:
prevent clinical disease/complication, reduce transmission
in community
3. Surveillance, including verification of elimination
4. Epidemiological studies;
rapid assessment of disease burden, outbreak investigation
5. Detection of drug resistance
20160602 The Role of Clinical Pathologist in
Management infectious disease
Laboratory diagnosis for infectious diseases
Causative Agent:
1. Culture is gold standard, but some are imperfect! →need
other tests
2. Antigen detection (serology/NAAT/proteomic)
Host response:
1. Serology: IgA, IgM, IgG (not for TB)
2. Hematology: involvement of WBC (MN/PMN), thrombocyte
(M/IP), coagulation system
3. Clinical Chemistry: biomarker/depend on organ involved:
LFT/KFT etc
20160602 The Role of Clinical Pathologist in
Management infectious disease
Example
of Multi
spectrum
laboratory
tests
SEPSIS
20160602 The Role of Clinical Pathologist in
Management infectious disease
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
12 Steps to Prevent Antimicrobial
Resistance: Hospitalized Adults
12 Contain your contagion
Prevent Transmission
11 Isolate the pathogen
10 Stop treatment when cured
9 Know when to say “no” to vanco
8 Treat infection, not colonization
Use Antimicrobials Wisely
7 Treat infection, not contamination
6 Use local data
5 Practice antimicrobial control
4 Access the experts
Diagnose and Treat Effectively
3 Target the pathogen
2 Get the catheters out
Prevent Infection
1 Vaccinate
20160602 The Role of Clinical Pathologist in
Management infectious disease
Six Essential Elements of ASP
Information
Technology
Microbiology
Lab
Monitoring of
Process and
Outcome
Measurement
Suplemental
Strategies
Active
Strategies
Effective
Antimicrobial
Stewardship
Program
20160602 The Role of Clinical Pathologist in
Management infectious disease
Comprehensive
Multidiciplinary
Team Approach
Surveillance of
bacteriological
and antibiotics
susceptibility
pattern
20160602 The Role of Clinical Pathologist in
Management infectious disease
INFECTIOUS DISEASE INTEGRATED SERVICE TEAM
KLINISI
PERAWAT/BIDAN
DALIN/PPIRS
SKFT
FARMASI
LAB
20160602 The Role of Clinical
Pathologist in
MIKROBIOLOGI
Management infectious disease
16
LABORATORIUM
MIKROBIOLOGI
RSHS
DOTS
PPRA
Jejaring Lab
PPIRS
TB
Jejaring lab
PPRA
Jejaring lab
EID
HIV
Pelayanan
pasien
Integrated
Infectious
Diseases team
Metadon
IO
Penelitian
Internasional
20160602 The Role of Clinical Pathologist in
Management infectious disease
Rujukan
↔
Narasumber
DinKes
Penelitian di
komunitas
8
0
3
2
2
1
5
2
2
4
6
1
2
1
1
1
2
4
2
1
20160602 The Role of Clinical Pathologist in
Management infectious disease
Clinical Pathologist and
Centers of Clinical Pathology Education
v
v
11 Centers
23 branches
Center
Branch
1134 Clin. pathologists
20160602 The Role of Clinical Pathologist in
Management infectious disease
Tantangan vs Peluang
• AFTA (ASEAN Free Trade Area) 2015
• Kompetensi minimal setara dengan profesi
sejenis di ASEAN
• Akreditasi laboratorium nasional/internasional
• Penyakit Infeksi emerging-re emerging: MERS
CoV, Ebola dll
• Sistem Jaminan Kesehatan Nasional (SJKN)
• Tuntutan Pelayanan Laboratorium untuk
‘preventive medicine’
20160602 The Role of Clinical Pathologist in
Management infectious disease
Thank you for
your attention
20160602 The Role of Clinical Pathologist in
Management infectious disease