Early Detection is Key
A travel history is a key part of assessing sick patients especially during entry to a healthcare facility, due to special pathogens like:
and other travel-associated infections such as:
- Zika virus
- Measles and other vaccine-preventable diseases.
Taking a travel history is an important part of:
- providing rapid triage.
- isolating patients promptly.
- starting infection control measures to minimize the spread of infectious diseases to other patients and healthcare staff.
Infection control measures may include:
- placing a facemask over the patient's nose and mouth (for those with respiratory illness)
- placing an ill patient in a private room
- asking the patient to perform hand hygiene by washing their hands or applying hand gel.
Screening and Triage
When you evaluate patients for acute illness, ask: "Have you traveled internationally within the past 3 weeks (21 days)"?
Acute symptoms that could indicate an infection include:
- new respiratory symptoms
- fever (≥100.4◦F or 38.0◦C)
- a rash.
Place patients who answer "yes" to recent travel and acute illness in a private room until they can be evaluated by a health professional. Follow infection prevention precautions based on their symptoms and per your facility's protocol.
For patients that report recent travel and acute symptoms, assess the following:
- severity of illness
- travel itinerary
- underlying illness
- recent exposure to an infection.
Screening and infection control guidance resources
- Centers for Disease Control and Prevention Case Definition of EVD
- National Ebola Training and Education Center (NETEC)
- Special Pathogen Frontline Hospital Playbook form the Assistant Secretary for Preparedness and Response (ASPR)
- Minnesota Department of Public Health
Clinical Evaluation Resources
It is important to assess the severity of illness, travel itinerary, underlying illness, and individual exposure history in order to triage the patient and to distinguish certain infections from each other.
- CDC Travelers' Health - Search by traveler destination, find travel health notices and updates.
- CDC Yellow Book - Published every two years as a reference for health professionals providing care to international travelers and is a useful resource for anyone interested in staying healthy abroad.
- Travel Clinical Assistant - Provides travel-related disease information for 231 countries (Georgia Department of Public Health)
- Health Map – World outbreak tracker and map (Boston Children's Hospital)
During the 2014-16 Western Africa Ebola Virus Disease outbreak, the Centers for Disease Control and Prevention (CDC) created a tiered healthcare model to identify and manage patients with suspect and confirmed special pathogens.
Working with CDC, Washington State adopted this healthcare readiness model with four response tiers:
In Washington, there are frontline, assessment and treatment facilities. Providence Sacred Heart Medical Center in Spokane was designated by the US Department of Health & Human Services (HHS) in 2015 as one of 10 Regional Treatment centers in the country, serving Region X (Washington, Idaho, Oregon and Alaska).