Section 3: Establishing Communication Resources

Overview

Depending on the size of the notification, e.g., a thousand patients or more, it may be necessary to establish a call center to respond to questions and concerns from the community. A call center can manage the flow of information to and from a large number of callers, enabling health department staff to focus on conducting the investigation. Even with a small notification, local resources can quickly become overwhelmed. Regardless of the size of the notification, patients often want to speak with a knowledgeable resource after receiving the letter. This section contains resources that will help you determine the need for and establish a means to handle public inquiries.

• Setting up a call center
  • Call center considerations
  • External resources for contact center "communities of practice"
• Example Q/A Resources
• Most frequently asked questions utilized by the Nevada Call Center, 2008, such as:
  • Which clinic are we talking about? (17% of callers)
  • Where can I get tested? (12% of callers)
  • When were the known cases exposed? (5% of callers)
  • Can you tell me if I'm on the list and should I receive a letter? (5% of callers)
  • I am uninsured.
  • When can I get tested? (5% of callers)

Setting up a Call Center

The purpose of a call center is to rapidly handle a surge of inquiries by telephone and/or email. The call center must efficiently handle a large number of calls or emails from the general public as well as healthcare professionals, and should have all necessary information related to the notification. Call centers should also be able to provide special services such as English-to-Spanish translation, TTY for the hearing impaired, and support beyond normal business hours. With large notifications, it may be necessary to contract with a large independent call center such as a regional poison control center.

The following is a list of general considerations for setting up a call center.

Call Center Considerations

• Be ready to respond to questions from the general public as well as healthcare professionals.
• Develop pre-cleared, accurate material specific to your event that is:
  • Question and answer format
  • Specific to your patient notification and investigation
  • Easily read and understood
  • Available in multiple languages
• Choose a call manager whose job will be to quickly integrate new information into call center responses. Call center personnel must have access to updated information as quickly as possible.
• Tailor special accommodations to your population, e.g., for hearing impaired or non-English speaking communities.
• Assign and train personnel to answer calls and direct people as needed. These personnel should know where to send callers who have additional questions that cannot be answered by the phone operators.
• Decide between the use of an existing number or a "new" toll-free number designated for your response.
• Consider the time of day – patients will call after 5p.m. and on weekends. Even for a small notification, it may be necessary to staff phone lines after normal business hours, at least for the first week (e.g., 5p.m. to 8p.m.).
• Make sure your call center is expandable – be prepared to increase the number of call lines and respondents to handle a larger volume of calls on short notice, e.g., immediately after a media release of new information.
• Provide monitoring and statistics in order to measure standards of performance.
• Assess the need for an outside source to handle overflow and surge calls (e.g., health department, CDC)
• Consider accepting email inquiries – Some patients may prefer this form of communication.

Example Q/A Resources

Hepatitis C Outbreak, Southern Nevada, 2008

The Issue – Safe Injection Practices

What are Safe Injection Practices?

• Safe Injection Practices are a component of the basic infection control practices that all healthcare personnel should follow. Safe Injection Practices include appropriate practices related to the use of needles, syringes, and single and multidose medication vials.
• Definition of a safe injection: Safe injections are those that do not harm patients, do not expose healthcare providers to avoidable risks and do not result in waste that is dangerous to the community.
• Healthcare providers (doctors, nurses, and anyone providing injections) should never reuse a needle or syringe from one patient to another or to withdraw medicine from a vial. Both needle and syringe must be discarded once they have been used. It is not safe to change the needle and reuse the syringe – this practice can transmit disease.
• A multi-dose vial is a bottle of liquid medication that contains more than one dose of medication and is often used by diabetic patients or for vaccinations. A new, clean needle and clean syringe should always be used to access the medication in a multi-dose vial. Reuse of needles or syringes to access medication can result in contamination of the medicine with germs that can be spread to others when the medicine is used again.
• Safe Injection Practices recommendations
• General fact sheet about syringe reuse

What happened recently at the clinic in southern Nevada?

• In January 2008, CDC investigators responded to a request from the Southern Nevada Health District (SNHD) to help investigate three persons reported to the local surveillance program with acute hepatitis C virus (HCV) infection; all three persons had undergone procedures at a Las Vegas endoscopy clinic.
• Since beginning the investigation, CDC and SNHD have identified a total of six cases of HCV infection among patients who had undergone procedures at the clinic in the 35–90 days before developing symptoms. These patients did not have other risks for HCV infection (e.g., injecting drug use).

Worried Well

Does everyone who visits a healthcare provider or has some type of medical test have to be concerned about getting a serious infection?

• No, the risk for infection is low if appropriate infection control precautions are used. All healthcare providers and medical facilities should follow safe injection and appropriate infection control practices. Patients can and should ask their healthcare providers about the practices used in their facility.

I am scheduled to have a procedure at an ambulatory surgical center; is there anything I can do to learn about their safe injection practices?

• As a healthcare recipient, you have the right to ask any questions related to the procedure you are undergoing and the practices the surgical center uses to ensure your safety.
• You may want to find out the ambulatory surgery center's procedures related to infection control and safe injections. These procedures include but are not limited to handwashing, needle and syringe use and disposal, use of equipment that is single-use or disposable, medication vial reuse, and prevention of medication contamination.

Colonoscopies

Are colonoscopies safe?

• When proper injection practices and infection control procedures are followed, medical procedures, including colonoscopies, are generally very safe.
• In the southern Nevada situation, the disease transmission was not related to the colonoscopy, but rather to the injection practices used to administer anesthesia to the patients.

Should I still get a colonoscopy?

• If recommended by your healthcare provider, there is no reason for you to avoid undergoing this procedure.
• Colonoscopies are an important way of screening for or detecting colorectal cancer.
• Although this investigation focused on a center that performed colonoscopies, and similar procedures, the source of the exposure was unsafe practices associated with administration of anesthesia and not the colonoscopy procedure.

As a patient, how can I protect myself?

• As a patient, you should feel empowered to discuss with your healthcare provider what steps are being taken to protect you.
• If you have concerns about specific issues, ask your healthcare provider about those issues.

If I think I may have been exposed, should I go to the emergency room?

• No. Although you are concerned about your health, this exposure is not immediately life threatening and does not require a visit to an emergency room.
• Emergency rooms should be used for immediate health emergencies only.
• Instead, please call your healthcare provider and make an appointment to get tested.

CDC's Role

Who performed the investigation at the Endoscopy Center of Southern Nevada?

• The response was led by the Southern Nevada Health District, and the team included members of the Nevada State Bureau of Licensure and Certification and the Centers for Disease Control and Prevention.

Have other locations in Nevada been inspected to ensure that this is not occurring in other healthcare facilities?

• CDC, the Centers for Medicare and Medicaid Services, and the Southern Nevada Health District are assisting clinic inspectors to evaluate practices at about 50 other clinics in the region to ensure their practices are in line with standard infection control and safe injection practices.

What is CDC's role in the inspection process in Nevada?

• CDC will assist the state health department to perform on-site visits at all their ambulatory surgery centers. This will include assessments of injection safety and other infection control procedures.
• CDC assistance includes sending a team of CDC personnel to provide on-site expertise and assistance in facility evaluation.
• CDC is in daily contact with Nevada's state health department and other key officials. Regularly scheduled calls include CDC, state health officials, and the Southern Nevada Health District to share information and coordinate the activities of the investigation.
• CDC does not have regulatory authority to enforce recommended infection control practices.

What is happening in other clinics in the United States?

• There are currently no other investigations or reported concerns about safe injection practices or infection control in clinics across the country.
• CDC has previously investigated transmissions of hepatitis B and/or hepatitis C virus associated with unsafe injection practices or lapses in infection control in other clinics around the country. This is not the first or only time these practices have been discovered.

I am a reporter and would like to interview someone at CDC about this investigation. How do I get in touch with someone to interview?

• Contact CDC Media Relations at: (404) 639-3286.