Notification & Communication

Chapter Summary

When patients are placed at risk as a result of an infection or disease outbreak in a healthcare setting, a serious infection control breach, or another situation that jeopardizes their health, they have a right to know what happened, the extent of their risk, and what they need to do. 

In Chapter 8, Notification & Communication, we describe “who, what, how, why, and when” for the notification of patients and other stakeholders, along with a detailed review of applicable risk communication principles and strategies. 

This chapter contains information on:

• Patient stories and ethical considerations for notification
• Notification of affected and exposed patients, stakeholders such as providers and healthcare facilities, and the general public both during and after an outbreak
• Advice on managing effective communications as part of patient notification, including managing differences of opinion between public health agencies and healthcare facilities
• Pointers for engaging the media, either proactively or reactively
• Examples detailing notification procedures in outbreak situations involving (a) Legionella in a hospital setting and (b) antibiotic-resistant infections in a long-term care facility 

As advances occur in outbreak protocols, this guidance document will be updated. Previous changes can be tracked below:

• 2nd Edition – Published June 2024
• 1st Edition – Published June 2023
• URLs in this document are valid as of May 31, 2024.

1. Author not reported. “The surprising way to stay safe in the hospital.” Consumer Reports. 2014
   Dec. Available at: https://www.consumerreports.org/cro/magazine/2015/02/the-surprisingway-to-stay-safe-in-the-hospital/index.html.
2. Day, K. “Sticky: John McCleary’s MRSA Nightmare.” McCleary MRSA Prevention webpage. 2009
   Feb 9. Available at: http://mcclearymrsaprevention.com/?p=12.
3. Petersen M. “UCI doctor’s plan to stop superbugs is widely used. At her own hospital, it didn’t
   work.” Los Angeles Times. 2017 May. Available at: https://www.latimes.com/business/la-fi-uciinfant-outbreak-20170515-story.html.
4. Dudzinski DM, Hébert PC, Foglia MB, Gallagher TH. The disclosure dilemma ─ large-scale
   adverse events. N Engl J Med. 2010 Sep 2;363(10):978-86.
5. Sandman PM. “Introduction to Risk Communication and Orientation to this Website.” The Peter
   Sandman Risk Communication Website. Available at: https://www.psandman.com/indexintro.htm.
6. Schaefer MK, Perkins KM, Link-Gelles R, Kallen AJ, Patel PR, Perz JF. Outbreaks and infection
   control breaches in health care settings: Considerations for patient notification. Am J Infect
   Control. 2020 Jun;48(6):718-724.
7. Centers for Disease Control and Prevention (CDC). Crisis and Emergency Risk Communication
   (CERC) Manual. Available at: https://emergency.cdc.gov/cerc/manual/index.asp.
8. Centers for Disease Control and Prevention (CDC). Injection Safety: Patient Notification Toolkit.
   Available at: https://www.cdc.gov/injectionsafety/pntoolkit/index.html.
9. Prouty CD, Foglia MB, Gallagher TH. Patients’ experiences with disclosure of a large-scale
   adverse event. J Clin Ethics. 2013 Winter; No. 4:353-363.
10. Sakamoto S, Terashita D, Balter S. Liaison Public Health Nurse Project: Innovative Public Health
    Approach to Combat Infectious Disease in Hospitals. J Public Health Manag Pract. 2020
    Nov/Dec;26(6):557-561.
11. Urbina I, Fink S. A deadly fungus and questions at a hospital. New York Times. 2014 Apr.
    Available at: https://www.nytimes.com/2014/04/29/us/a-deadly-fungus-and-questions-at-ahospital.html.
12. Duffy J, Harris J, Gade L, Sehulster L, Newhouse E, O'Connell H, Noble-Wang J, Rao C, Balajee SA,
    Chiller T. Mucormycosis outbreak associated with hospital linens. Pediatric Infect Dis J. 2014
    May;33(5):472-6. Available at: https://pubmed.ncbi.nlm.nih.gov/24667485/.