CDC Call Script

Form Approved

OMB No. 0920-1011

Exp. Date 03/31/2017

Appendix 1. CDC PATIENT INTERVIEW SCRIPT

CDC PATIENT INTERVIEW SCRIPT

Patient Name:

Patient Phone Number:

Date of last Oncology clinic visit:

First Call	Date:	Interviewer name:	Time (military):	Left message: Y N
Second Call	Date:	Interviewer name:	Time (military):	Left message: Y N
Third Call	Date:	Interviewer name:	Time (military):	Left message: Y N

If there is no answer, please leave this message:

Hello, I am [NAME], and I am calling from the Centers for Disease Control and Prevention on behalf of the New York City Department of Health. I am trying to contact [Patient Name] because according to our records, you have received a potentially contaminated medication that has been linked to an outbreak of severe infections at [CLINIC NAME].

We are requesting that all patients who have received at injection at the ________ clinic since March 2016 come in to get blood work drawn. This blood work will help us determine if you have this infection. We want to know if you are having any problems suggestive of infection following your injection. And that you are awawre of the symptoms that would suggest the need to go see a healthcare provider. Please call us back at: XXXXXX as soon as possible and request to speak with the NYC Outbreak Call Center.

If there is an answer:

Hello, I am [NAME], and I am calling from the Centers for Disease Control and Prevention on behalf of the New York City Department of Health. I am contacting you because you had an injection or procedure at [CLINIC NAME] on [DATE] of a potentially contaminated medication that has been linked to an outbreak of infections. The infection is called Exophiala dermatitidis, a type of fungal bloodstream infection.

We are recommending that all patients who received an injection at this clinic between March and May 2016 come in to get blood work drawn. The blood work will help us determine if you have this infection. I know that this information may be alarming, but not all of the patients who received injections have become ill. Of those who did, some developed symptoms within several days to weeks after their injection.

We also want to know if you are having any problems suggestive of infection following your injection. I am going to ask you a series of questions regarding your health. Before I do, do you have any questions for me?

Please stop me if you have any concerns or questions as we are going through these.

Since your last visit to the oncology clinic:

Have you had fever?

Have you had chills?

Have you had malaise?

Do you have any new neurologic symptoms, such as headache, weakness or numbness in any part of your body?

Have you had any increased pain, redness, warmth or swelling at your injection/port site?

If patient said YES to any of the above questions:

Given the feedback you have provided me today, I think it would be best if you are evaluated by a healthcare provider as soon as possible. You may have been exposed to potentially contaminated medicine and could have a fungal infection of the bloodstream. We recommend you go to ___ Hospital as the doctors there are aware of this outbreak and will be knowledgeable about what to do. Wherever you chose to go, you should let your healthcare provider know that you may have been exposed to a contaminated medication and that there is an outbreak of Exophiala fungal bloodstream infections associated with the contaminated medications. The doctor can contact the health department at XXXXXX for more information. We know that this information may be alarming, but we also know that getting evaluated early is critical, so you can start treatment right away.

If patient said NO to all of the above questions:

Arrange for a time and provide instructions on how to get blood work done.

We also want you to know that having a blood test now that does not show evidence of infection does not mean that you may not develop it in the future, although the chances are lower the longer it has been since your last injection. You should seek health care immediately if you feel unwell in any way. The signs and symptoms of this bloodstream infection can be subtle and non-specific. When you seek healthcare, you should notify the provider about possible exposure to contaminated medications and the possiblity of Exophiala blood stream infection.

Do you have any questions about any of the information I have provided you?

Notes: ______________________________________________________________________________

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74 Atlanta, Georgia 30333; ATTN: PRA (0920-1011)