Infectious diseases / Combined infection training - Mersey



Mersey Programme Director Infectious Diseases

Dr Sylviane Defres

Liverpool School of Tropical Medicine
Pembroke Place
L3 5QA

Tel: 0151 705 3722



Mersey Programme Director Microbiology

Dr Jonathan Folb

Department of Microbiology
Royal Liverpool University Hospital
Royal Liverpool and Broadgreen University Hospitals NHS Trust
Prescot Street
L7 8XP

Tel: 0151 706 2000



Liverpool Training

The infectious disease training takes place at the Royal Liverpool University Hospital (RLUH) including the clinics of the Liverpool School of Tropical Medicine. It is one of three programmes in the UK which is also recognised for tropical medicine training.



Inpatient training is centred on two infectious disease wards with a total of 32 adult beds. The first has 19 beds, 13 of which are in isolation cubicles. Six of these have controlled ventilation (negative pressure) suitable for containing high-risk pathogens such as multi-drug resistant TB, chickenpox etc. Approximately 700 adult admissions a year, include around 100 HIV admissions, 100-150 travel related admissions (including all those for the LSTM), 100 TB admissions, the usual range of community based infections directly from general practice or from the emergency room, and tertiary referrals from within and outside our region. The second ward provides 13 single isolation rooms (8 with negative pressure), primarily to deal with nosocomial infection risks such as small round structured viruses, Clostridium difficile, influenza etc. The ward currently admits 900 patients per year and includes patients with general infection problems as well. The ward has made major contributions to the control of Cl difficile and norovirus infection in the Trust, winning a variety of local and Trust awards, and the team was commended by the Health Protection Agency and the European Centre for Disease Control for its role in limiting the spread of influenza in the Trust during concurrent epidemics. Together with the Infection Prevention and Control Team they were finalists in the National Patient Safety Awards 2010 and 2011. The ward has been further adapted and extra multidisciplinary team training supports its additional role as one of the two nationally designated “surge units” to receive Ebola cases, commissioned by NHS England in late 2014.



We see about 3500 outpatients annually in a variety of clinics. There are separate pre-travel advice clinics at the Liverpool School of Tropical Medicine (LSTM) (over 8,000 visits per year) as well as tropical medicine and post travel clinics. The LSTM is a core partner in the National Travel Health Network and Centre (NaTHNaC) and supports the National Imported Fever Service with PHE Porton, both links providing further specialist training opportunities. The Tropical and Infectious Disease Unit shares HIV activity with the Liverpool Centre for Sexual Health, acting as the hub for the Cheshire and Mersey HIV Network; there are similar multidisciplinary and cross community networks for viral hepatitis, tuberculosis (including co-ordinating NWTB cohort audit), neurological infections, bone and joint infections and chronic fatigue and these provide excellent opportunities for clinical research links as well as optimal care. An outpatient antibiotic therapy service (OPAT) is in place and there is an active shared consult service with the microbiologists.


Academic Opportunities

The unit is active in clinical research, supported by a cadre of research nurses, and trainees are encouraged to participate in this area and develop their own interests. The majority of our trainees have been successful in competing for Wellcome Trust or other training fellowships, completing their PhDs as part of this. We encourage periods out of programme for research, many of these through our partnership links with the Wellcome Trust Liverpool Glasgow Centre for Global Health Research in Blantyre, Malawi. Former trainees have taken up opportunities for clinical and research training through our networks in Sri Lanka, Vietnam, India, Uganda, Kenya and South Africa. Similar opportunities continue to be available. There is flexible and frequent involvement of consultant colleagues from the local academic institutes including the Liverpool School of Tropical Medicine and two Institutes within the University of Liverpool; the Institute of Translational Medicine and the Institute of Infection and Global Health.


General Internal Medicine

General Internal Medicine (GIM) training is provided in the RLUH, both while contributing to the busy general medicine on call rota and while based on the wards including the Clinical Pharmacology ward, which is part of the same directorate as the Tropical and Infectious Disease Unit. Trainees also rotate out for GIM training with different subspecialty interests in several other hospitals in the Mersey Region, depending on their own training requirements and interests. This provides flexibility and variety within the whole training programme.


Core Infection Training

Core Infection Training is fully integrated with the regional training programme in Clinical Microbiology and Virology, which rotates through several hospitals in Mersey Region including the Liverpool Clinical Laboratories, which provides a comprehensive diagnostic microbiology and virology service for the Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLUH) and Aintree University Hospital Foundation NHS Trust. This includes excellent training in the well-established joint infection consult service at the RLUH as well as a wide variety of training experience on external rotations.


Tropical Medicine

Liverpool provides one of three nationally accredited programmes for higher specialist training in Tropical Medicine. Trainees rotate to the Liverpool School of Tropical Medicine (LSTM), working alongside its large staff with extensive experience of working overseas. Trainees are based in the LSTM clinics seeing specialist referrals and returned travellers. Patients requiring admission from LSTM clinics are admitted to the Royal Liverpool University Hospital. Trainees learn from external enquiries for pre and post travel advice and have weekly exposure to the specialist teleconferences of the National Imported Fever Service, to which LSTM contributes. Trainees also work with the accredited diagnostic clinical parasitology laboratory on site, help with the LSTM input to the GeoSentinel and EuroTravNet initiatives and have teaching and learning opportunities on the many postgraduate courses in the LSTM. The LSTM attachment also provides opportunities for specialist clinical audits and discussions with staff about developing clinical research proposals. A full range of travel medicine training and experience is provided in association with the Well Travelled Clinic, which has approximately 10,000 pre-travel attendances per year, and the national telephone advice service provided on site by specialist nurses handling calls for advice from the National Travel Health Network and Centre, of which the LSTM is one of the founding partners.


Placements for the year of clinical training overseas are personalised for each trainee and facilitated through the many international links of the LSTM: recent trainees have been placed in Malawi, Sri Lanka and Vietnam, but many other opportunities are available.


Regional Teaching Programme and Rotation Opportunities

Based on the 2014 curriculum for combined infection training, Mersey offers a joint teaching programme targeted at both infectious diseases and medical microbiology trainees, with some sessions also incorporating public health trainees. This two year rolling programme addresses the core areas of the curriculum through facilitator-led sessions that actively engage participants through approaches to adult learning. In addition to clinical and laboratory topics, management, leadership and research are incorporated in designated sessions. Two sessions a year are run jointly with North Manchester.