Minnesota Refugee
Screening Protocol
Refugee and International Health Unit
Cross-Cutting Epidemiology, Programs and Partnerships Section
Infectious Disease, Epidemiology and Prevention Division
Minnesota Department of Health
Outline of Recommended
Exam Components
• Health History
• Immunization review and update
• Screen for:
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–
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–
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Tuberculosis
Hepatitis B
Intestinal Parasites
Lead poisoning (6 months - 16 years)
HIV and Syphilis
• Evaluate for other STI
• Assess for malaria risk
– Screen per provider discretion
• Physical Exam
• Assessment for Dental, Vision, Mental Health
• Treat, Refer or Initiate primary care
Recommended Exam Components
• Use national guidance provided by CDC
– www.cdc.gov/ncidod/dq/refugee/rh_guide/index.htm
• Questions about national guidelines:
– 24 Hours/Every Day
– 800-CDC-INFO (800-232-4636)
– cdcinfo@cdc.gov
• Minnesota Refugee Provider Guide
– www.health.state.mn.us/divs/idepc/refugee/guide/index.html
Exam Process / Scheduling
To increase compliance with screening….
• Schedule refugees as a family unit
• Schedule a trained medical interpreter for all
visits or use Language Line
• Arrange transportation to clinic if needed
• Make reminder calls for each clinic visit
Exam Process/Scheduling cont.
To increase compliance and return visit:
• If unable to locate/contact family, work with
Resettlement agency (VOLAG) case
manager to find refugee
• Use 2 or 3-visit model
– Many clinics have moved toward 2 visits
– See example workflows for the 2 or 3-visit models
in the following slides:
Example of workflow for
Three (3) clinic visits
refugee health screening
1st Pre-Screening
Nurse Visit
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•
•
•
•
•
Medical histories
• Read TST
Check for documentation • Obtain PA and Left
of pre-departure treatment
Lateral CXR for all
of malaria and parasitic
with positive
infection
TSTs/QFR
Screen for acute medical
• Obtain Labs (see
or social issues
assessment form for
Plot children on growth
complete list, including
charts
CBC with differential for
Collect urinalysis
absolute eosinophil count;
Urine pregnancy test
may be done on first visit if
(females 13 -45)
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•
•
2nd Pre-Screening
Nurse Visit
Serologic testing for
strongyloides and/or
schistosoma or give stool
containers with direction
for collection
Administer Tuberculin
Skin Test (TST) or draw
IGRA
Schedule return
appointment in 2 to 3
days
preferred)
• Collect stool
containers for O&P (if
applicable)
• Hearing and vision
check
• Schedule refugee 3rd
visit / provider exam
in 1-2 weeks when all
lab results are
available
3rd Visit:
Provider Exam
• Review test and lab results
and treat based on
findings
• Administer presumptive
therapy for malaria for
refugees from subSaharan Africa, if indicated
• Immunize
• Growth and Development
Screening
• Mental Health Screening
• Perform physical exam,
include vision, hearing,
cursory dental assessment
• Make referrals if needed
(hearing, vision, dental, family
planning, WIC, pediatrics, other
specialties)
Example of workflow for
Two (2) clinic visits
refugee health screening
(NOTE:
If patient has TST placed or stool sample due, a third visit
may be required depending on scheduling)
1st Pre-Screening
Nurse Visit
•
•
•
•
•
•
•
•
•
Medical histories
Check for documentation of pre-departure
treatment of malaria and parasitic infection
Screen for acute medical or social issues
Plot children on growth charts
Collect urinalysis
Urine pregnancy test (females 13 -45)
Serologic testing for strongyloides and/or
schistosoma or give stool containers with
direction for collection. If stool sample is
required, refugee will need to drop off at
clinic for testing before provider exam.
Administer Tuberculin Skin Test (TST) or
draw IGRA
Obtain Labs (see assessment form for
complete list, including CBC with differential for
absolute eosinophil count)
•
•
Hearing and vision check
Schedule return appointment in 1-2 weeks.
If TST is placed, refugee will need to come
in for a read-only visit in 2-3 days.
2nd Visit:
Provider Exam
• Review test and lab results and
treat based on findings
• Administer presumptive therapy for
malaria for refugees from subSaharan Africa, if indicated
• Immunize
• Growth and Development
Screening
• Mental Health Screening
• Perform physical exam, include
vision, hearing, cursory dental
assessment
• Make referrals if needed (hearing,
vision, dental, family planning,
WIC, pediatrics, other specialties)
• Obtain PA and Left Lateral CXR for
all with positive TSTs/QFR
Minnesota Refugee Health Program
Phone: 651-201-5414 or 1-877-676-5414
Website: www.health.state.mn.us/refugee
Address: Minnesota Department of Health
Refugee Health Program
Freeman Building
625 N. Robert Street
P.O. Box 64975
St. Paul, MN 55164-0975