Risk Communications During "Never Events" in Medical Care: Lessons Learned From the Outbreak of Fungal Meningitis and Other Infections

Background: Quality control lapses in healthcare facilities may put patients at risk of infection.  When these practices or the resulting infections are identified, typically a patient notification is initiated.

Program background:  The outbreak of fungal meningitis and other infections, beginning in 2012, is considered one of the largest healthcare associated outbreaks in U.S. history.  It was anticipated to be a challenging ordeal for risk communications; yet, communicators at CDC, working closely with their state and U.S. Food and Drug Administration (FDA) counterparts, were able to establish a model platform for crisis communications. Media monitoring demonstrated that the public considered CDC a trusted source for crucial public health information.

Evaluation Methods and Results:  When patients receive a notification phone call or letter, they may be overwhelmed with a mix of emotions – fear, loss of trust, and lack of control.  Following risk communication principles during patient notification events is vital for addressing patients’ concerns.  CDC’s communications strategy and tactics during a patient notification are focused on empowering patients to take control of the situation by providing them concrete action steps.  As part of its public health response, CDC sent regular updates to more than 245 clinical and professional organizations, held numerous clinician conference calls reaching more than 5,500 clinicians, and partnered with online clinician communities (e.g., Medscape) to reach an additional tens of thousands of clinicians, and released 10 health advisories and updates through its Health Alert Network (HAN).   CDC used its website to transparently communicate real-time epidemiologic and laboratory information and to provide the public, clinicians, and the media with direct links and resources.  Over the course of the response, CDC’s meningitis outbreak and fungal diseases web pages were accessed more than a million times and CDC’s public inquiry line responded to more than 4,000 callers.  CDC embarked on a proactive media strategy by holding several press conferences and providing news media reporters direct access to CDC laboratories and the Emergency Operations Center.  Through these efforts, the public was rapidly informed in multiple ways about how federal resources were being used to save lives. CDC’s social media strategy during the activation was not only aimed at driving people to the CDC web site for the latest information; it was also focused on monitoring for rumors and misconceptions and providing patients with accurate information through direct replies to their questions or concerns.  One of the goals of CDC’s social media use during the response was to avoid artificially escalating alarm among people not affected by the outbreak.

Conclusions:  CDC’s response to the multistate outbreak of fungal meningitis and other infections can serve as a model for other large-scale patient notification efforts.

Implications for research and/or practice:  Given the growing move toward healthcare transparency, patient notifications are likely to increase in coming years.  Recent successes in large-scale patient notifications can serve as a model for best practices in future notification events.