According to data from the Spanish Register of Tumours in Infants (RETI), ours it the Department that treats the most children in Spain, and is the leading centre for the transplant of haematopoietic progenitors or stem cells (better known as "bone marrow transplants"), having performed more than 1200 such operations. The Paediatric Oncology and Haematology Day Hospital handles up to 3,600 treatment visits a year and up to 7,600 visits for consultations.

Our experience, staff and advanced technological prowess mean our Department can offer multidisciplinary, comprehensive care to patients and their families, covering all diagnostic procedures and offering the most advanced treatments. We are a self-sufficient department when it comes to applying the latest care techniques in this field, and we also have resources to carry out research in such diseases.

Childhood cancer is the leading cause of child mortality due to illness in children more than one year old. Survival is currently around 80%, but it is essential we advance research into the disease to achieve more effective treatments.

 

Portfolio of services

The Department has a multiprofessional team of staff made up of doctors, nurses and others. Their functions include:

• Comprehensive, multidisciplinary care for the treatment of retinoblastoma
• Comprehensive, multidisciplinary care for the treatment of soft tissue sarcoma
• Comprehensive, multidisciplinary care for the treatment of brain tumours
• Comprehensive, multidisciplinary care for the treatment of bone tumours
• Comprehensive care for the treatment of leukaemia
• Comprehensive care for the treatment of lymphomas
• Comprehensive care for the treatment of Wilms tumours
• Specialised psychosocial care
• High-complexity cancer surgery
• Tumour committee
• Genetic counselling and cancer risk assessment in at-risk population
• High resolution clinic
• Second opinion consultations and consultations for other national and international hospitals
• Haploidentical transplant
• Day hospital: treatments
• Home-based hospitalisation with psychosocial support in terminal oncohaematological patients
• Online doctor 24 hours a day, 7 days a week
• New therapies for patients who have not benefitted from conventional treatments. Clinical trials, Phase I, II, III. Member of ITCC
• Malignant and benign haematological pathologies: diagnosis, treatment and follow-up
• Malignant and benign neoplasia pathologies: diagnosis, treatment and follow-up
• Radiotherapy. Linear accelerator. Stereotaxy. Modulated intensity. Brachytherapy
• Sedation for painful procedures
• Specialised psychosocial department
• Transplant of haematopoietic progenitors (autologous, allogeneic relatives and unrelated donors). Bone marrow, peripheral blood
• Umbilical cord blood transplant
• Haematological and oncological emergencies

  

Research

The Group for Translational Research into Childhood and Adolescent Cancer is focused on research for new treatment targets or molecule targets (the place in the organism a drug acts on), based on the most advanced knowledge available on the biology of paediatric cancers. The Group has identified and will continue to work on new molecular targets for sarcomas (cancer that originates in connective tissue cells) and tumours of the nervous system.

Collaborations with the biotechnology industry are currently being established and consolidated in order to develop new drugs capable of inhibiting pro-oncogenic processes, such as invasion and proliferation, in order to provide patients with alternative therapy options.

As an international centre of reference, our Department belongs to the International Network of Excellence in the Treatment of Cancer in Children and Adolescents. We carry out clinical work, research and teaching activity in coordination with international scientific societies: International Society of Paediatric Oncology (SIOP), European Society for Blood and Marrow Transplantation (EBMT), Center for International Blood and Marrow Transplant Research (CIBMTR), and national societies: Spanish Society of Paediatric Haematology and Oncology (SEHOP), Programme for the Study and Treatment of Malignant Haemopathy (Pethema).

Based on data from the National Registry of Child Tumours, our hospital diagnoses and treats the most children. Their survival rates are comparable to the most prestigious international centres of excellence. Our centre was the first in Spain to obtain JACIE accreditation (Joint Accreditation Committee ISCT and EBMT), the most prestigious in our field.

The Haematopoietic Progenitors Transplant Unit is the most active of its kind in Spain, with an average of 40 transplants per year. We perform all kinds of transplants, and are pioneers in complex cases, such as unrelated donors and umbilical cord blood transplants. We also perform transplants in cases of malignant oncohaematological diseases, acquired medullary aplasias and congenital pathologies such as immunodeficiencies, haemoglobinopathies, metabolopathies and medullary insufficiencies.

We should highlight our translational research group, which applies the knowledge acquired from basic research to the prevention and treatment of clinical cases in childhood cancer and haematological diseases, which contributes to better diagnosis, prognosis, treatment and control of such diseases. The Department has a Clinical Trials Unit for Innovative Treatments and belongs to the Innovative Therapy in Cancer Children (ITCC) group.

At the Infectious Diseases Department, our care is structured into the following areas: hospitalisation, outpatient care, nosocomial infection control (infections contracted during a hospital stay), prevention and treatment of infection in HIV- immunodepressed patients (with solid or haematological neoplasia, bone marrow transplant or solid organ); international health and imported infections, and the HIV+ patients ward.

Our Department handles approximately 10,000 outpatient visits a year. There is also a day hospital where all types of prolonged antimicrobial treatments can be carried out, as well as a large number of diagnostic tests, in order to reduce hospital admissions.

In the hospitalisation division, between 550 and 600 patients are admitted a year, with an average hospital stay of about nine days. We admit immunodepressed patients with serious infections or requiring clinical isolation, as well as patients with serious infections that can be helped by our specialised care.

The priorities of the nosocomial infection control division are to identify and reduce the risk of transmission of especially complex infections and to ensure effective treatment. This latter aspect is key across all of the Department’s areas of care. Antimicrobial treatments are complex and one of the main responsibilities of the group is to ensure that they are administered as accurately as possible. To this end we are careful to constantly carry out a cost-benefit assessment.

Monitoring of infection in immunodepressed patients, both for HIV and others, is handled by two wards that treat patients with especially complex, serious infections, bearing in mind the type of infection and number of patients being treated at the Hospital. We aim to provide comprehensive care, handling prevention, diagnosis and treatment of infectious pathologies, especially opportunistic infections, that this type of patients suffer. One example is the Anal Dysplasia Unit in the HIV+ population, inaugurated in 2009 for the prevention, diagnosis and early treatment of anal cancer secondary to chronic infection by the human papilloma virus.

The international health and imported infections division, which works in coordination with the Tropical and Imported Diseases Unit of the Drassanes primary care centre and various local NGOs, is dedicated to providing overall care for patients affected by these infections. Thanks to telemedicine, we make regular contact with the regional Nossa Senhora da Paz Hospital in Cubal (Angola) to carry out joint sessions.

The Infectious Diseases Department was created in 1996 and consists of 14 doctors on staff, with resident doctors, predoctoral and postdoctoral doctors carrying out research and other key healthcare professionals all a part of its structure. The main characteristic of the Department, therefore, is our transversality. We firmly believe in the importance of having members of the Department collaborate with the different medical and surgical teams of the Hospital, both in terms of healthcare and research.

 

Portfolio of services

The portfolio of services offered by the Infectious Diseases Department responds to the health needs of the population and the demand for services generated at Vall d'Hebron University Hospital, guaranteeing accessibility, equity and quality of care, in a way that satisfies the expectations of the clients following the strategic lines of the Catalan Health Institute.

 

Open hospitalisation ward in infectious diseases

These wards are used to treat patients with systemic infections acquired in the community, including:

• Sepsis and primary bacteraemia

• Zoonoses with organic complications

• Parasitosis requiring hospital admission

• Febrile syndromes of unknown origin with severe systemic repercussions

• Organospecific infections requiring hospital admission due to systemic or organic repercussions

• Human immunodeficiency virus infection and infections secondary to other primary or secondary immunodeficiencies, for the diagnosis and treatment of opportunistic infections.

 

Day hospital

This area cares for patients with infections acquired in the community, offering treatment with acute clinical symptoms.

• Systemic infections
• Organospecific infections requiring hospital admission due to systemic or organic repercussions
• Organospecific infections with pre-admission and early discharge due to having completed treatment and under supervision of the acute incident away from the hospital, such as with infectious endocarditis or abscesses once removed.
• Human immunodeficiency virus infection and infections secondary to other primary or secondary immunodeficiencies, for the diagnosis, treatment and prophylaxis of opportunistic infections.
• Specific nursing consultation for patients infected with HIV. Follow-up programme for adherence to antiretroviral treatment, counselling, sexual counselling for serodiscordant couples and follow-up programme for seropositive pregnant women.

  

Outpatient Clinic for Infectious Diseases

This area covers:

• Patients with systemic or organospecific infections, previously treated in the hospitalisation ward for infectious diseases or in other Hospital departments, the day hospital or in a primary care centre, referrals to outpatient clinic for diagnosis, control and monitoring until discharge.
• Patients sent for initial study due to fever of unknown origin, without general effect.
• Patients with human immunodeficiency virus infection, for initial evaluation, diagnosis, treatment of HIV infection, prophylaxis of opportunistic infections and follow-up.
• HCV co-infection in patients with HIV infection.
• Patients with recurrent infections suspected to be secondary to other primary or secondary immunodeficiencies.

 

Prevention, diagnosis and early treatment of dysplasia and rectal and anal cancer in the HIV-positive population

This is a specific clinic included in the Pere Virgili Health Park, integrated into the policy for treatment of the HIV positive population.

 

Hospital combined clinics for infectious diseases

This area handles patients with any type of systemic or organospecific infection, nosocomial or acquired in the community, whichever part of the body is affected and in immunocompetent or immunodepressed hosts, whatever the cause. It includes the differential diagnosis of community and nosocomial febrile syndrome.

 

Nosocomial infection

Includes the following activities:

• Treatment of nosocomial infections, with special emphasis on those caused by multiresistant and especially aggressive microorganisms (for example, fungal infections), or in those that affect groups of patients in serious condition (for example, ICU, burns, transplants or oncohaematological).
• Clinical participation in surveillance and control programmes for nosocomial infections.
• Participation in activities carried out by the Infections Committee and the Antibiotics Subcommittee.
• Surveillance and control are carried out as part of the objectives defined by the Infections and Antibiotherapy Committee. They are carried out in coordination with the departments involved, and with those departments the Infection Committee and the Antibiotics Subcommittee decide on in their specific programmes.

 

Care programmes in the Primary Care area

Includes the following activities:

• Creation and following of protocols for diagnostic and therapeutic criteria with local primary care physicians for infectious community diseases, specifically in the process of intermediate-duration fevers, infectious respiratory disease, infectious urinary disease, infectious diseases carried by immigrants, as well as assisting in the treatment of tuberculosis.
• Guarantee of continued care.
• Coordination with non-hospital care in the integrated care process for patients infected with HIV.

 

Research

The Infectious Diseases Research Group (coordinated by Dr Benito Almirante) of the Vall d'Hebron Research Institute carries out clinical research that is closely linked to the care we provide, and which groups together the various Research Areas. We should also highlight our animal experimentation laboratory, within the Vall d'Hebron University Research Institute, which allows us to experiment and obtain results using various animal models, with the ultimate goal of trying to improve the prognosis of various serious infectious pathologies in humans. The current lines of research are:

• Nosocomial infection
• Serious community infection
• HIV/AIDS infection
• Infection in transplants
• Infection in oncohaematology
• Experimental models of infections

These lines of research are externally funded through research projects funded by the pharmaceutical industry or by public entities, as well as receiving funding as a member of thematic cooperative research networks organised by the Carlos III Health Institute (REIPI and RIS).

 

Teaching

Teaching represents a major part of the Department's activity. We collaborate and foster basic and continued training for students, professionals undergoing training (resident doctors) and predoctoral students in the area of knowledge of infectious diseases. This work is carried out both as part of hospital work and in academic and research activity.

It includes the following activities:

• Undergraduate training in infectious diseases, with three medical teacher positions and two associate medical teacher positions.
• Training for internal medicine residents and medical specialties that include training in infectious diseases as part of their curricula. The rotation is designed according to their needs, and includes residents from our Hospital and residents on temporary transfers from other hospitals. Every year, a maximum of two internal medicine residents who have completed their third year can be hosted, as the last two years of their period of training can be carried out in our Department, following a specific training programme in infectious diseases.
• Training for Primary Care doctors as part of continued education programmes. They are offered in the outpatient clinics and day hospital sections, where pathologies for non-hospital treatment are handled.
• Training for specialists from the Internal Medicine Divisions of other hospitals, as temporary transfers. Rotations are designed based on their training needs.
• Possibility of continuing postgraduate training for nursing professionals.

The General and Digestive Surgery Unit is divided up into four independent sub-units, each of which is a benchmark in its sub-speciality: The Colon and Rectal Surgery Unit, the Endocrine, Metabolic and Bariatric Surgery Unit, the Oesophagogastric Surgery Unit and the Abdominal Wall Surgery Unit.

This Department carries out activity across several areas: hospitalisation, emergencies, outpatient clinics and in local primary care centres: Chafarinas and Sant Andreu. Outpatient and walk in surgery is carried out at the Pere Virgili Health Park.

Our team of professionals are also members of various multidisciplinary teams, such as the Breast Pathology and Gynaecological Oncology Surgery units, both part of the Gynaecology Department. This multidisciplinary working method, together with our high level of specialisation, allow us to offer our patients the highest quality care.

The Surgical Block, which opened in 2016, means we can work in integrated operating theatres equipped with all the latest technology, which guarantees the highest quality and safety in surgery, ultimately leading to the best quality of care for our patients.

 

Research 

The General Surgery Service is part of the Research Institute’s General and Digestive Surgery Research Group (VHIR), as recognised by the Catalan government's University and Research Grant Management Agency (AGAUR) (2017 SGR 1476)

 

Teaching 

At Vall d'Hebron University Hospital, we have a teaching unit that trains postgraduate students in general and digestive surgery. We regularly organise continued education courses accredited by the Catalan Council for Continuing Education in the Health Professions, and we actively participate in teaching as part of the medical degree course at the Vall d'Hebron University Hospital Teaching Unit, part of the Faculty of Medicine of the Autonomous University of Barcelona (UAB) and the PhD Programme of the Surgery Department of the UAB.