Monkeypox Contact Investigations
The Bureau of Communicable Diseases has released contact investigation steps for health care facilities.
The Centers for Disease Control and Prevention (CDC) is currently requesting that public health entities document monkeypox exposure assessments as well as subsequent monitoring and outcomes for health care workers determined to be at low, intermediate or high exposure risk. This information is also needed as part of the request for post-exposure prophylaxis (PEP) for individuals determined to be at a high exposure risk.
If it has been determined that a probable or confirmed monkeypox case patient has received care during their infectious period, health care facilities should be notified by their local or Tribal health department (LTHD) or facility infection preventionist of the potential exposure. Health care facilities are encouraged to work with their LTHD to complete a contact investigation. This includes completing employee risk assessments, identifying an individuals’ classification per CDC's health care worker exposure assessment tool, and conducting contact tracing efforts. Employee health staff or the facility infection preventionist should partner with the LTHD to complete the following steps.
1. Conduct employee risk assessments for all health care workers, environmental services staff, or volunteers that had contact with the case patient or the health care environment in which they received care in order to determine each person’s risk level.
Individuals determined to have low-, intermediate-, or high-risk exposures should monitor for symptoms for 21 days. Symptom monitoring should be documented by the facility using the facility’s typical symptoms monitoring strategy. Individuals can also use the Monkeypox Symptom Monitoring handout to self-monitor.
Individuals determined to have a high-risk exposure should be offered PEP.
Additional instructions on how to complete employee risk assessments and how to monitor individuals will be provided by the LTHD.
2. Once all employee risk assessments have been completed, fill out the monkeypox exposure contact list for all low, intermediate, or high-risk exposures.
Follow instructions provided within the spreadsheet. Ensure spreadsheets are filled out completely; providing all requested information is important for the contact investigation and reporting in the Wisconsin Electronic Disease Surveillance System (WEDSS).
3. Send completed contact list to LTHD using a secure sending method.
It is suggested that the spreadsheet be password protected and sent via an encrypted email or through WEDSS as an attachment to WebReport.
In the message, indicate whether the facility is monitoring exposed staff. The LTHD can provide monitoring support if needed.
4. Notify LTHD if a health care worker, staff member, or volunteer who is being monitored reports symptoms of concern.
The individual should isolate and observe for rashes or lesions until they can be evaluated by a medical provider. The medical provider may test for monkeypox if lesions are compatible or provide an alternative diagnosis.
5. Once the 21-day monitoring period is complete, document monitoring completion.
Health care facilities may also use the monkeypox exposure contact list to document monitoring outcome by adding an additional column for “Outcomes.”
Ensure documentation includes outcomes, such as whether an individual being monitored developed symptoms, got tested, or was given PEP. Consider adding additional notes if isolation and evaluation details are necessary.
6. Send monitoring outcomes to LTHD using a secure sending method.
Health care facilities may send updated contact list with an additional “Outcomes” column. In the message, also include a summary statement of how many individuals completed monitoring and if additional cases were identified.
Questions?
Questions regarding the health care worker contact investigation process can be directed to LTHDs or by emailing the DHS Bureau of Communicable Diseases (DHSDPHBCD@dhs.wisconsin.gov) or calling them at 608-267-9003.
Resources
DHS: Monkeypox in Wisconsin
CDC: Infection Prevention and Control of Monkeypox in Healthcare Settings
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