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Epidemiologic Risk Screening Questionnaire

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If a patient is flagged by the Communicable Infectious Diseases Identify, Isolate, Inform Algorithm as being at risk for infection with a special pathogen based on presenting symptoms and epidemiologic risk (Country List with Outbreaks of Interest) your clinicians may need support in further assessing the patient. This template supports a targeted clinical history and captures many of the common pieces of information that local subject matter experts (facility infectious disease clinicians or infection control) or your public health authority will want to know when you discuss the case with them (Inform).

Download the Epidemiologic Risk Screening Questionnaire here.

Video tutorial on Epidemiologic Risk Screening Questionnaire

Explore the Identify, Isolate, Inform Approach for High Consequence Infectious Diseases

5 tools
1
Woman with mask doing labwork.
Identify, Isolate, Inform Approach for High Consequence Infectious Diseases
Updated: Jan 25, 2023

Communicable Infectious Diseases Identify, Isolate, & Inform Algorithm

This nine step algorithm walks healthcare providers through the steps to 1) quickly Identify patients with symptoms consistent with communicable infectious diseases, and 2) rapidly Isolate them to limit exposures. It then couples presenting symptoms with an epidemiologic travel assessment to stratify those who might have a high consequence infectious disease (Identify) and require further Isolation and escalation within and external to the facility (Inform). The algorithm can be adapted with a built-in plug and play feature that allows healthcare facilities to include local or site-specific outbreaks of interest in the screening.
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2
Identify, Isolate, Inform Approach for High Consequence Infectious Diseases
Updated: Jan 25, 2023

Epidemiologic Risk Screening Questionnaire

If a patient is flagged by the Communicable Infectious Diseases Identify, Isolate, Inform Algorithm as being at risk for infection with a special pathogen based on presenting symptoms and epidemiologic risk (Country List with Outbreaks of Interest) your clinicians may need support in further assessing the patient. This template supports a targeted clinical history and captures many of the common pieces of information that local subject matter experts (facility infectious disease clinicians or infection control) or your public health authority will want to know when you discuss the case with them (Inform).
Learn More
3
Identify, Isolate, Inform Approach for High Consequence Infectious Diseases
Updated: Jan 25, 2023

Country List with Outbreaks of Interest

Give your frontline team members information that is easy to access and utilize in real time. This template supports identification of outbreaks of concern and is to be used in conjunction with the Communicable Infectious Diseases Identify, Isolate, Inform Algorithm. Once developed this resource requires input and upkeep by a knowledgeable member of your facility team, it also allows you to adapt to existing situations and your patient population and facility risk tolerance.
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4
Doctor on phone with thumbs up.
Identify, Isolate, Inform Approach for High Consequence Infectious Diseases
Updated: Jan 25, 2023

Special Pathogens Notification List

Communication is a critical component of managing a special pathogens patient. If a patient is flagged as potentially having a high consequence infectious disease, ensure your staff know who to alert (Inform) and how.
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5
Man with mask laughing.
Identify, Isolate, Inform Approach for High Consequence Infectious Diseases
Updated: Jan 25, 2023

Disease-Specific Fact Sheet

Most healthcare workers have limited experiences with special pathogens. Creating short, pathogen-specific guides that address pathogen transmission, isolation measures, symptoms and patient assessment can provide much needed support during what can be a stressful time. We have provided a template on recommended components and two exemplars from different facilities demonstrating the concept. If you choose to create disease specific fact sheets, they should be reviewed and updated on a routine basis to remain current.
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Country List with Outbreaks of Interest