SBAR: Travel and Infectious Disease Screening
Situation: Travel and Infectious disease screenings are need to help identify
patients with increased risk of serious and/or novel infections. Proper isolation and
assessments are needed minimizes risks of spread of the infection and prevent
complications because of missed diagnoses.
Background:
Multiple types and severity of infectious diseases exists.
 Common, low communicable risk: simple cellulitis, strep throat
 Common, medium communicable risk: upper respiratory infections,
pneumonia, gastroenteritis
 Common, high communicable risk: seasonal influenza
 Common, low general but medium to high healthcare communicable risk:
multi-drug resistant organisms (MRSA, VRE, etc)
 Not common, low communicable risk: Dengue fever, Malaria
 Not Common, high communicable risk: Ebola, Measles
Screening is needed to help providers identify those uncommon infectious diseases
and to quickly isolate those persons with highly communicable diseases. Common
illnesses usually have easily recognizable symptoms patterns and/or seasonal
nature that helps to prompt early isolation and identification. Uncommon illness
may not have easily recognizable symptom patterns and/or symptom patterns that
mimic more common illness which can delay recognition of the need for isolation
and/or diagnosis. Diseases not endemic to an area are by definition are uncommon,
therefore additional information is needed to prompt proper isolation and
expanded differential diagnosis. Travel is a common mechanism for exposure and
spread of novel infectious diseases (Ebola, MERS-CoV). Over the past year the
number of novel infectious disease present in the US appears to be increasing. The
specific regions of concern and infectious agents of concern change but the need for
screening does not change.
Typically, screening should be completed by nurse, medical assistant, paramedic or
ED tech as part of an intake process. For some infections of very high communicable
concern, an additional screening may also be needed by frontline staff such as PSR,
appointment and nurse lines, etc; screening by such staff is intended for prompt
isolation as does not need to be part of a medical record.
Ebola: The WI Division of Public Health is highly confident all persons with travel
history concerning for Ebola are being appropriately monitored but recommends
continuation of current screening process to ensure no gaps exist.
Measles: Currently a large scale multi-state outbreak is evolving with cases in
Minnesota, Michigan and Illinois. Measles vaccination is highly effective but the
number of parents opting not to vaccinate their children has increased in recent
years and the first schedule MMR vaccination is at 1 years old. The infection is
contagious 4 days prior to rash development, spread by droplets and aerosol which
can linger for 2 hours, the average infected person infects 12-16 additional persons.
Assessment: In order to be proactive and all-hazards in nature, emergency
departments and inpatients setting should implement universal screening for recent
international travel and exposure to communicable diseases. A general screening
tool will allow for wide range of detection and prevent the need for frequent
changes as regions or diseases of concern changes. From an infection prevention
standpoint, there may be a case for universal screening for multi-drug resistant
organisms, this is a related but separate issue.
Given special concerns around Ebola and Measles, specific screening needs to occur
at initial points of entry of facilities.
Recommendation:
General Travel and Infectious Disease Screening
Emergency Departments/Urgent Care Settings
 ED/Outpatient Screening Tool for nearly all patients presenting for care as
part of triage/intake process
Inpatients
 Inpatient Screening Tool for all patients presenting for care as part of
intake/admission process
Outpatient Departments
 Development of process for use of ED/Outpatient Screening Tool for either
select routine use (acute care visits or visits with specific chief complaints)
and/or used when increased concerns exist
Ebola
Emergency Departments/Urgent Care Settings
 Continue screening by registration staff
 Discontinue required Ebola specific screening for all patients during
triage/intake process as ED/Outpatient Screening Tool will detect patients of
concern. Ebola specific screening tool should be available for further
evaluation if a patient reports a relevant travel history
Inpatients
 Discontinue required Ebola specific screening for all patients as Inpatient
Screening Tool will detect patients of concern, Ebola specific screening tool
should be available for further evaluation if a patient reports a relevant
travel history
Outpatient Departments
 Continue Ebola specific screening until DHS recommends discontinuation
Measles
Emergency Departments/Urgent Care Settings

Implement assessment of MMR vaccination status in patients presenting
with fever, cough and rash by front line and nursing staff
 ED/Outpatient Screening Tool provides additional checkpoint to identify
asymptomatic patients of concern
Inpatients
 Implement assessment of MMR vaccination status in patients presenting
with fever, cough and rash
Outpatient Departments/Appointment Lines/Nurse Lines
 Implement assessment of MMR vaccination status in patients presenting
with fever, cough and rash by front line and nursing staff
Prepared by: Michael Clark, MD
715-393-3723
Michael.clark@ministryhealth.org
Emergency Department/Outpatient Services
Travel Associated Infectious Disease Screen
1. Have you or any of your close contacts returned from out of the country in the
past 3 weeks?
□ Yes □ No
If Yes: What country?
General Infectious Disease Screen
1. Have you been exposed to someone with a suspected infectious disease within the
past 3 weeks; such as Tuberculosis (TB), Ebola, Influenza, Pertussis, Measles,
Mumps, Chicken Pox etc.?
□ Yes □ No
If Yes: What disease have you recently been exposed to?
If the patient yes to either of the above questions place patient in appropriate
isolation precautions based on current public health concerns.
Inpatient
Travel Associated Infectious Disease Screen
1. Have you or any of your close contacts returned from out of the country in the
past 3 weeks?
□ Yes □ No
If Yes: What country?
 Did you stay overnight in a hospital while in that country?
□ Yes □ No
General Infectious Disease Screen
1. Have you been exposed to someone with a suspected infectious disease within the
past 3 weeks; such as Tuberculosis (TB), Ebola, Influenza, Pertussis, Measles,
Mumps, Chicken Pox etc.)?
□ Yes □ No
If Yes: What disease have you recently been exposed to?
If the patient yes to either of the above questions place patient in appropriate
isolation precautions based on current public health concerns AND notify infection
preventionist