Section 1: Developing Documents for a Patient Notification

A patient notification almost always involves a letter being mailed to each patient who was potentially exposed to bloodborne or other pathogens. Patient notifications can be conducted via phone call if the number of patients being notified is small.  Personnel who are responsible for making the calls must be comfortable with the script they will use to deliver the message and have the ability to answer any immediate questions the patients may have. Most often letters are used to quickly deliver a consistent message to all patients, using certified mail or other traceable shipping service to verify delivery. Other materials (e.g., testing recommendations letter, test results letter) may or may not be needed depending on whether testing is being recommended by the public health authorities who are conducting the investigation. CDC is available to assist with the process of developing documents for a patient notification.

This section offers sample notification letters, a summary of formative research on patient notification conducted by CDC, and resources on risk communications. Additionally, links to fact sheets on bloodborne pathogens (e.g., hepatitis B, hepatitis C, and HIV) and injection safety are included.

 Sample Materials

Sample Patient Notification Letters

Patient notification letters can vary based on who is issuing them (a health department or a healthcare facility in coordination with a health department), whether just an infection control lapse or actual disease transmission has been identified, and whether or not testing is being recommended. Here we are including two sample letters with the following parameters:

• Sample Patient Letter A: No Disease Transmission Identified
  Download Customizable letter [Doc – 23 KB]
  This sample letter was issued by a healthcare facility when an infection control breach was recognized but no disease transmission had yet been identified. Testing was recommended in this case.
• Sample Patient Letter B: Disease Transmission Identified
  Download Customizable letter [Doc – 25 KB]
  This sample letter was issued by a health department when disease transmission resulting from an infection control breach was identified. Testing was recommended in this case.

Sample Primary Healthcare Provider Notification of Testing Recommendations Letter

Download Customizable letter [Doc – 26 KB]
This sample courtesy letter is intended for the patients’ primary healthcare provider to inform him/her that the patient is receiving a notification letter, as well as which tests are recommended for the patient. When testing is being recommended, options for testing typically include the facility where the incident occurred, the patients’ individual healthcare providers, an independent laboratory, or the health department. Sending a letter such as this (to the patients’ primary healthcare providers and to all area healthcare providers and laboratories) can help assure that the correct testing is provided to all patients. Alternatively, a letter such as this can be sent to patients in a packet with the notification letter for them to take with them to their primary healthcare provider.

Sample Patient Test Results Letter

Download Customizable letter [Doc – 27 KB]
This sample letter tells patients their test results were negative. If results are positive, a healthcare provider typically conveys the information in person or via telephone so that all questions may be answered and a treatment or follow up plan can be discussed.

 Additional Resources

What Patients Expect to See in a Notification Letter
Summary Results from Patient Notification Focus Groups (Schneider et al, J Patient Saf 2013:9;8-12). This summary summarizes information patients expect to see in a letter, their key concerns, the appropriate tone for the letter, and the amount of information to include.

General Principles of Risk Communication
This is a summary of risk communication principles adapted from CDC guidelines. Reynolds, B. 2012. Crisis and Emergency Risk Communication 2012 Edition. CDC, Atlanta, GA: http://emergency.cdc.gov/cerc/resources/pdf/cerc_2012edition.pdf

General Fact Sheets and Resources

The following links provide general information on bloodborne pathogens including hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV.

• Hepatitis B virus information: http://www.cdc.gov/hepatitis/HBV/index.htm
• Fact Sheet: http://www.cdc.gov/hepatitis/HBV/PDFs/HepBGeneralFactSheet.pdf [PDF – 1.1MB]
• Hepatitis C virus information: http://www.cdc.gov/hepatitis/HCV/index.htm
• Fact Sheet: http://www.cdc.gov/hepatitis/HCV/PDFs/HepCGeneralFactSheet.pdf [PDF – 1.1MB]
• HIV information: http://www.cdc.gov/hiv/
• Fact Sheet: http://www.cdc.gov/hiv/topics/basic/index.htm (click on “Printer-Friendly Version” to generate a fact sheet)

Injection Safety Fact Sheets and Resources for Patients and Healthcare Providers

For Patients

• http://www.cdc.gov/injectionsafety/patients/patient_faqs.html
• http://www.cdc.gov/injectionsafety/patients/syringeReuse_faqs.html

For Healthcare Providers

• http://www.cdc.gov/injectionsafety/providers/provider_faqs.html
• http://www.cdc.gov/injectionsafety/providers.html

One & Only Campaign

• http://www.oneandonlycampaign.org/

Patient Resource: Compassionate Response Toolkit

• http://www.southernnevadahealthdistrict.org/download/outbreaks/hepatitis-toolkit.pdf [PDF – 16.23 MB]

 Top of Page

 What Patients Expect to See in a Notification Letter

In the fall of 2009, CDC conducted six focus groups with general public participants to obtain feedback on patient notification letters as well as to assess knowledge and awareness of safe injection practices. Focus group participants provided valuable feedback on what to include in a letter, as well as key concerns, the appropriate tone for the letter, and the amount of information to include. Below is an outline of the focus group results.

Summary Results from Patient Notification Focus Groups

• Participants had somewhat limited understanding of safe injection practices and the diseases that can be transmitted by unsafe practices.
• Focus group participants thought unsafe injection practices were more common in hospital settings than in a healthcare provider’s office. However, a review of U.S. outbreaks resulting from unsafe injection practices in the past 10 years indicated that the majority of them took place in outpatient settings.
• Participants had a neutral perception of the risk of getting an infection from an unsafe injection practice.
  • — News of an infection may come as a surprise to the patients, because they don’t see themselves as being at risk.
• Cost of exams, treatments, etc. were key concerns to focus group participants if they received a letter.
• All but one participant said they were “very likely” to get tested if they received a letter.
• Focus group participants would continue to seek medical care if they received a letter; some would even go back to the healthcare provider where the incident occurred.