Department of Infectious Disease

Carilion offers comprehensive infectious disease care. We treat bacterial, fungal, viral and other infections, as well as general internal medicine issues. We're part of a diverse, multidisciplinary team that includes specialized treatment for inpatient and outpatient clinical care and in the hospitals. 

Hospitalization and Consultation

Our inpatient Infectious Disease consultation service consists of three separate teams: A, B and C.

Teams A and B offer consultation service to Roanoke Memorial Hospital. Team B consultation service also provides telehealth advice to our Carilion Clinic Health System which includes Carilion outpatient clinics, Velocity cares and other hospitals throughout the Carilion system. Team B plays an integral part in our antimicrobial stewardship program by limiting unnecessary antibiotic use and providing the right antibiotic to be used for a particular infection. Team C was started in early 2020 specifically to provide assistance and management of our COVID-19 infected patients. We have a team to evaluate the effectiveness of current available therapy for COVID-19 infection and take part in treatment and drug trials to offer our patients more options in COVID-19 treatment. 

Our typical Infectious Disease consults include treatment of bacterial, fungal, viral and parasitic infections. We provide consultation service to immunocompromised patients such as patients with AIDs, patients on chemotherapy and transplant patients. Some of our Infectious Disease faculty members also provide consultation for the newborn and pediatric population. 

Infectious Disease Clinic

In addition to seeing patients in the inpatient setting at Carilion Clinic Roanoke Memorial Hospital, the infectious disease division also runs an outpatient infectious disease clinic. Located at 2001 Crystal Springs Avenue in Roanoke on the third floor, the clinic is staffed by three nurses, an administrative assistant at the front desk and two caseworkers. All the infectious disease faculty and fellows have scheduled hours each week at the clinic. In addition, internal medicine residents, medical students and infectious disease pharmacy residents also rotate through the clinic.  
 
The patients seen in the infectious disease clinic can be broadly divided into three categories:  
- Travel clinic  
- HIV/Hepatitis C disease  
- General infectious disease  
 
The travel clinic is a focused clinic that runs half a day per week. It is attended by the infectious disease faculty and fellows. The main emphasis of the clinic is to provide immunizations to patients that are traveling outside the country.  
 
HIV disease forms a significant portion of the patient population seen in the clinic. Most patients are from Roanoke County, but patients from several adjacent counties are seen here as well. HIV patients are seen every day in the clinic by infectious disease faculty and fellows. These patients have a designated nurse and a caseworker. The clinic does receive Ryan White funding. The clinic also sees patients with hepatitis C mono-infection as well as HIV and hepatitis C coinfection.  
 
General infectious diseases make up the other major bulk of patients seen in the clinic. This includes patients in the outpatient parenteral antimicrobial therapy (OPAT) program. These patients are seen every day in the clinic by infectious disease faculty, fellows and residents and each patient has a designated nurse. Most of these patients have been seen by the inpatient consult service during their stay at the hospital and are seen for follow-up in the clinic for continued outpatient care of their infections. To ensure a smooth transition from the inpatient to the outpatient setting, the patients are signed out to the OPAT nurse by the inpatient consult teams. Some of the common infectious disease conditions that patients are seen for include bacteremia, surgical infections, intra-abdominal infections, bone and joint infections and endocarditis. Most of these patients have labs checked once a week, which are tracked by the OPAT nurse and are reviewed by the physicians or practitioners in the clinic. These patients usually get seen at least twice during their prolonged course of antimicrobial therapy for four to six weeks, including an end-of-therapy appointment. 

Infectious Disease Pharmacy

The specialized infectious diseases pharmacists at Carilion Clinic work closely with the Division of Infectious Diseases, Pharmacy and Infection Control to optimize treatment of infections for patients across the health system. Carilion Clinic has four infectious diseases pharmacists: two at Roanoke Memorial Hospital, one at New River Valley and one located in the infectious diseases ambulatory clinic. The pharmacists partner with the Infectious Diseases Division in four major ways: 

Advanced Education 

Like the infectious diseases physicians, the specialty pharmacists also offer postgraduate training in infectious diseases. The ID residency program graduates two PGY2 pharmacy residents every year. The pharmacy residents and medical fellows work closely all year learning best practices in multidisciplinary care for infections. 

Infectious Diseases Consult 

The inpatient consultation service for complicated infections not only consists of expert infectious diseases physicians—pharmacists also round with the team. Services they provide include optimizing the choice, duration and dosing of antimicrobials to cure complex and difficult to treat infections. Pharmacists may also educate patients on their new antimicrobial medications and perform penicillin skin testing to hopefully remove false or faded penicillin allergies. 

Antimicrobial Stewardship 

ID pharmacists, along with the pharmacists covering each unit in the hospital, review all antimicrobial management in the Carilion Clinic hospitals. Most patients who receive antimicrobials are not seen by an ID physician and the pharmacy specialists offer similar services to all physicians in the hospital as the ID consult service; these include recommendations to start, stop, change, and dose antimicrobials. They may even recommend a consultation by an infectious diseases physician in complicated situations. The Antimicrobial Stewardship Team is available every day as a resource for all inpatient and outpatient healthcare professionals for questions about treating infections. 

Ambulatory Infectious Diseases Clinic 

Our pharmacists also work closely with the physicians in the ambulatory infectious diseases clinic. They educate patients on their new and existing treatment regimens for a multitude of diseases including HIV treatment/prevention, (PrEP) and antibiotic infusions. The ID pharmacists also partner with the Hepatitis C nursing coordinator and follow all patients being treated for Hepatitis C during their active therapy. They monitor labs and assist with management of any issues that arise from medication use.