Who to refer

• Referrals for consideration of Infectious Diseases admission/transfer
• Patients presenting with fever or other infective symptoms following travel
• Patients in whom a bedside infection consult service review is required​ (this can be requested through any infection specialist).
• Invasive/severe infection with difficult to treat or unusual organisms where treatment regimens are not well-established or infection specialist assessment of source/disseminated infection would be beneficial
• Patients with suspected or confirmed tropical infections
• Clinical advice for people who are living with HIV who are inpatients
• Advice on treatment of inpatients with confirmed COVID-19
  • Inpatient guidance is available here: COVID-19 treatment guidelines. 
  • Outpatient guidance is available here: COVID 19 – RefHelp (nhslothian.scot)

Infection advice also available from these sources:

• Microbiology advice (including antimicrobial advice not covered by the NHS Lothian Antimicrobial Prescribing Guidelines and result interpretation) should be directed to extension 63373 option 4​. Advice on making a good referral is here:
  • How to get advice | Right Decisions (scot.nhs.uk)
  • Microbiology | Edinburgh and Lothians Laboratory Medicine (edinburghlabmed.co.uk)
• Virology advice relating to diagnostics should be directed to extension 63373 option 2 or to loth.virologyadvice@nhs.scot 
  • Virology | Edinburgh and Lothians Laboratory Medicine (edinburghlabmed.co.uk)
• Infection prevention and control advice can be found here:
  • Infection Prevention and Control | Edinburgh and Lothians Laboratory Medicine (edinburghlabmed.co.uk)
• Information about laboratory diagnostics is available here: 
  • NHS Lothian Laboratory Medicine | Edinburgh and Lothians Laboratory Medicine (edinburghlabmed.co.uk)
• For Primary care Infection advice in NHS Lothian, please consult the RefHelp page:
  • https://apps.nhslothian.scot/refhelp/guidelines/infectiousdiseases/ 

1. Review "Who to refer and available guidance" section and check if your question would be better directed to microbiology/virology/IPC or answered by guidance available on this toolkit/antimicrobial prescribing guidelines/guidelines
2. Review the patient's TRAK record and see if infection advice has already been given. Infection Service notes can usually be found in TRAK clinical notes by searching "infs"
3. If you still need to contact
   1. Non-urgent advice in primary care can be accessed by SCI-Gateway referrals
   2. In secondary care see below checklist and ideally phone within usual hours 0900-1900

Situation

• Hello my name is...I’m phoning from...about a patient (name, age, CHI).
• The working diagnosis is... and I would like to ask about....(IV to oral switch/duration etc.)
• Can I tell you more about the patient?

Background

• Important co-morbidities, organ dysfunction (acute and chronic) and immunosuppression (transplant, chemotherapy, HIV etc).
• What has happened to the patient up to now?
• Relevant travel history. The below information is very helpful in giving accurate advice around patients presenting with infection symptoms following travel:
  • Travel destinations: Detailed history of travel including dates of arrival and departure, and
    countries of transit. Detailed information on the locations visited within each country is useful for assessing specific risks
  • Environments: Rural versus urban, humidity/temperature, season, altitude, type of accommodation.
  • Activities: Swimming in fresh or saltwater, safari, caving, hiking, hunting, etc.
  • Diet: Consumption of street food, meat, bottled water.
  • Bites: Recall of bites from animals, insects, or ticks.
  • Sexual history: Protected/unprotected sexual intercourse, nature of contacts (e.g., casual/regular, men who have sex with men, commercial sex workers).
  • Malaria prophylaxis and pre-travel health: Use of chemoprophylaxis, mosquito nets, and
    insect repellent; pre-travel/childhood immunisation history.
  • Health while traveling: Details of any illness episodes while traveling and any healthcare
    accessed, admission to hospital or intensive care, cosmetic/aesthetic procedures undertaken
    outside the UK including dental procedures and tattoos, use of antimicrobials.
  • Unwell contacts: Contact with unwell individuals in the community or in hospital.
  • Funerals attended: Details of any funerals attended
• Does the patient have any known allergies? Have you reviewed the penicillin allergy section in the Antimicrobial prescribing guidelines

Assessment

• What is the patient's current NEWS? Is it getting better or worse? Do they have sepsis?
• What did you find when you examined the patient?
• What investigations have been performed and what are the results?

Recommendation

• Summarise the question and what advice you require

For secondary care:

• The NHS Lothian Infection service comprises of Infectious diseases, Medical microbiology, Medical virology and Infection prevention and control teams. Registrars are dual trained between specialties.​
• General infection advice can obtained by calling 0131 537 3373 (x63373)
• Referrals can be made by contacting the Infectious Diseases Registrar via page 8161 9am-7pm 7 days a week.
• Emergency advice is available via the oncall consultant through NHS Lothian switchboard outwith these hours​.
• For patients already on the RIE infection consult service there is an email address available, which will be written in infection consult service notes​.

For primary care, please see Refhelp guidelines:

• Infectious Diseases – RefHelp (nhslothian.scot)

• The infectious diseases departments has two inpatient wards at the Western General hospital, wards 42 and 43. ​
• OPAT delivers outpatient antimicrobials with sites at the Western General and St. Johns​.
• There is a consult service which runs at the Royal Infirmary of Edinburgh and the Western General Hospital and a front-door in-reach service to Western General Hospital acute medicine (further details below)
• Blood borne virus services include HIV, HBV, HCV clinics and teams.

1. Febrile returned travellers
2. Complicated urinary tract infection (pyelonephritis or lower UTI with multi-resistant organism)
3. Probable/proven meningitis/encephalitis
4. Cellulitis requiring IV antibiotics
5. Acute gastroenteritis (acute onset new diarrhoea with systemic upset)
6. Fever, systemic upset, no clear aetiology
7. Patients with a penicillin allergy label who are on watch/reserve antibiotics

• The Regional infectious Diseases Unit can be found at the Western General Hospital, close to the Telford Road Entrance.​

Clinical Infection Research Group Edinburgh is a collaborative organisation bringing together researchers from across NHS Lothian, University of Edinburgh, and our partners further afield in healthcare, academia, and industry.

For more information on research within CIRG: Clinical Infection Research Group (CIRG) Edinburgh 

The Travel Clinic is based in the Regional Infectious Diseases Unit (RIDU) at the Western General Hospital. The clinic provides pre-travel advice, vaccination and prophylaxis to over 1,000 new patients a year. 

For full details on the NHSL Travel Clinic, opening hours, contact details, and prices please see our public facing site at:

Travel Clinics – NHS Lothian | Our Services