Columbus County Health Department Policy and Procedures
Policy Title:
Communicable Disease Investigation and Follow Up
Program Area:
Communicable Disease
Policy Identifier:
(optional)
Approval Date:
Effective Date:
June 12th 2009
Revision
Date(s):
Approved by:
Kim Smith RN, BSN, MSHCA, Health Director
Approved by:
Hilda Memory RN, BS, MSHA, Director of Nursing
6/12/2009
8/3/10
Purpose:
Columbus County Health Department disease investigation process will:

Identify Communicable Disease cases associated with a reported incident and determine a common
source.

Prevent further cases of illness or contamination

Provide adequate education

Set standards for Communicable Disease control activities at Columbus County Health Department
Definitions:
Columbus County Health Department will set forth interventions to prevent the spread of Communicable
Disease by providing appropriate reporting, education of staff and community, surveillance, treatment and
follow up. Staff will adhere to the state laws (10A NCAC 41A) and all current recommendations of North
Carolina Department of Health and Human Services (NCDHHS), CDC guidelines pertinent to the control of
communicable Disease will be followed.
Definitions:

Communicable Disease- An illness due to a specific contagious agent or its toxic products that
arises through transmission of that agent or its products from an infected person, animal, or
inanimate reservoir to a susceptible host; either directly or indirectly through and intermediate plant
or animal host, vector, or the inanimate environment.

Outbreak- A public health emergency that requires rapid but careful and systematic approach to
identify the sources(s) of the outbreak and prevent further human illness.

Contact- A person or animal that has been in such association with an infected person or animal or
a contaminated environment as to have has an opportunity to acquire the infection
Responsibilities
The Communicable Disease Nurse and assisting clinical staff.
Procedures:
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Columbus County Health Department Policy and Procedures
The Communicable Disease Nurse will:

Contact primary care provider to confirm diagnosis, if reported by other than diagnosing physician or
Communicable Disease Report Card.

Classify the disease, i.e., vaccine preventable, food borne, STD, etc., and review the definition of a
confirmed case and what lab results are needed to confirm.

Log each communicable disease along with the patient’s information into the North Carolina
Electronic Surveillance System (NC EDS)

Interview the source of the report.

Request lab results, if available, from diagnosing physician or laboratory doing the testing.

Specimens will be submitted as appropriate for testing on all rash illnesses that meet case
definition for rubella or measles.

Interview suspect (or parent or caregiver) for symptoms, demographic information, travel history,
vaccination status (For young children check the NC Immunization Registry), risk factors for the
disease, and any treatment received, laboratory finding, and contacts.

Verify vaccine status if indicated.

Coordinate collection, preparation, and testing of needed lab specimens. Consult with care provider
or Medical Director, when needed.

Determine if contact follow-up can wait until disease id confirmed and respond accordingly.

If the case is confirmed according to definition, educate the case and contacts about
communicability, symptoms, treatment, and necessary follow-up. Refer to their private care provider,
urgent care center, or primary care clinic or Columbus County Health Department as indicated.

If telephone contact with suspect (patient) cannot be made, make a home visit, and if unable to
locate, will send a “Please contact me” letter.

Complete needed surveillance and reporting information (See Communicable Disease Guideline
Book) in patient’s record and/or in NC EDS.

Surveillance form is initiated by the nurse, when required. Depending on the disease and
information needed for completing, the nurse will complete the surveillance form and/or document
the positive laboratory report to the Communicable Disease Branch using the North Carolina
Electronic Disease Surveillance System. Whenever records cannot be obtained, the surveillance
form (s) and letter will be mailed to the primary physician with a self-addressed envelope for prompt
completion and return to the CD Nurse.

Surveillance form may be completed by the nurse via telephone call with the physician for those
diseases with 24 hour reporting time frames, requiring immediate attention.

Continue with follow-up until all elements of the disease control process are completed, e.g., contact
tracing, preventive treatment, repeat labor tests.

Document all nursing actions throughout the investigation.

Communicable disease cards and surveillance forms are checked for accuracy prior to data entry
and mailing.

File documentation in the client’s existing medical record, which is maintained in Medical Record
Room.

If there is no existing medical record on file, place communicable disease documentation in a
Communicable Disease Folder in Medical Records alphabetically by client’s name.
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Columbus County Health Department Policy and Procedures

Notify the Clinical Supervisor, Medical Director, Nursing Director, Health Director, Environmental
Health Director or Supervisor, State Regional Consultant, State TB Consultant, Disease Intervention
Specialist, Department of Health and Human Services, Division of Public Health, (Immunization,
HIV/STD Prevention and Care, General Communicable Disease) as the case warrants.

If the case involves, or is likely to impact a daycare, notify the Day Care Operator.

If the case involves, or is likely to impact a school, notify the School Nurse at that school. However,
the Health Department is the Lead agency for dealing with serious communicable diseases.
(The Health Department is responsible for notifying parents, conducting follow-up medical
evaluations or ordering any medical procedures. The Health Department will determine what steps
will be taken and will ask the school for assistance. This may take the form of providing student
information, passing out letters or providing space for clinics. In each case, the principal and staff
are in a support role to the Health Department. The Health Department will prepare any letters to
parent and the school (with the Health Department) will prepare a statement for the media and
parents if needed.)

Conduct Communicable Disease investigation in conjunction with the Epi (Epidemiology) Team for
all disease outbreaks and for those diseases that are of major public health concern.

For diseases that are determined to be a major public health concern, mass vaccination clinic(s)
may be initiated to prevent further outbreaks and the Public Health Regional Surveillance Team
(PHRST) may be consulted for guidance.

Accomplish disease investigation within appropriate time frames to adequately control the disease
and protect the public as disease investigation is a priority focus of the Health Department.

Mail Communicable Disease card/forms and surveillance forms for HIV, AIDS, and Syphilis to:
Communicable Disease Control Branch
1902 Mail Service Center
Raleigh, NC 27699-1902

Review Communicable Disease line listings from the State as soon as they are received. Verify, and
amend, if necessary, and returned as requested.
Laws and Rules:
State laws NCAC 10A and 41A
Title X
Reference(s):
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