Procedure: Identification and Escalation of Potential Respiratory Illness Clusters
Agency: Sara Companions Home Care Agency
Applies To: Field Staff, Nursing Staff, Home Health Aides, Personal Care Aides, Supervisors, Schedulers, Patient Services Staff, and Administrative/Office Staff
Effective Date: 10/1/2026
Review Date: 10/6/2026
Policy/Procedure #: IC-EP-_100126____
Approved By: __Stacey White, RN, DPS____
1. Purpose
The purpose of this procedure is to ensure that Sara Companions Home Care Agency staff can:
- Recognize signs of a potential respiratory illness cluster or outbreak.
- Take appropriate infection prevention measures.
- Promptly report and escalate suspected clusters to agency leadership.
- Protect patients, caregivers, and other staff from unnecessary exposure.
- Ensure appropriate agency personnel know how to contact the Local Health Department (LHD) when an outbreak or unusual increase in respiratory illness is suspected.
- Maintain appropriate documentation of suspected cases, interventions, notifications, and follow-up.
2. Scope
This procedure applies to all Sara Companions employees and contracted personnel who provide or coordinate home care services.
It applies to respiratory illnesses including, but not limited to:
- Influenza
- COVID-19
- Respiratory syncytial virus (RSV)
- Pneumonia associated with infectious disease
- Pertussis
- Other communicable respiratory illnesses identified by public health authorities
3. What Is a Respiratory Illness Cluster?
A respiratory illness cluster may be suspected when there is an unusual occurrence of respiratory illness involving multiple individuals who may have a connection to the agency, a patient, a household, or a care setting.
Examples include:
- Two or more patients receiving services from the agency developing similar respiratory symptoms within a short period.
- Multiple caregivers assigned to the same patient becoming ill.
- Several employees reporting similar respiratory symptoms during the same period.
- Multiple individuals in the same household developing respiratory illness.
- A patient or caregiver having a confirmed communicable respiratory infection after recent contact with other agency personnel.
- An unusual increase in respiratory illness compared with what is normally expected.
Staff do not need to determine whether an outbreak officially exists. Their responsibility is to recognize, report, and escalate concerning patterns.
4. Responsibilities
A. Field Staff
Field staff are responsible for:
- Recognizing signs and symptoms of respiratory illness.
- Asking appropriate questions when respiratory illness is suspected.
- Following Standard Precautions and applicable Transmission-Based Precautions.
- Using appropriate personal protective equipment (PPE).
- Reporting suspected illness or clusters promptly to the appropriate supervisor/agency contact.
- Documenting observations and actions taken.
- Avoiding unnecessary exposure to other patients and staff.
- Following instructions provided by nursing leadership or agency management.
B. Supervisors/Nursing Staff
Supervisors and nursing staff are responsible for:
- Evaluating reports received from field staff.
- Determining whether additional infection-control measures are needed.
- Identifying potential patterns or clusters.
- Notifying agency leadership.
- Coordinating patient/caregiver follow-up.
- Ensuring appropriate documentation.
- Determining whether public health consultation or notification is appropriate.
C. Office Staff
Office staff, including scheduling and patient services personnel, should:
- Take reports of respiratory illness seriously.
- Immediately communicate reports to the designated clinical/administrative contact.
- Avoid attempting to diagnose the illness.
- Track reports that may indicate a cluster.
- Notify the appropriate supervisor when multiple related reports are received.
- Maintain confidentiality of patient and employee information.
Schedulers should not independently determine that an outbreak exists.
5. Recognizing Possible Respiratory Illness
Staff should be alert for symptoms such as:
- Fever or chills
- New or worsening cough
- Shortness of breath or difficulty breathing
- Sore throat
- Runny or stuffy nose
- Nasal congestion
- Headache
- Muscle or body aches
- Fatigue
- New loss of taste or smell
- Increased respiratory secretions
- Other symptoms associated with a known communicable respiratory disease
Emergency Symptoms
Staff should immediately seek emergency medical assistance when a patient demonstrates signs such as:
- Severe difficulty breathing
- Blue, gray, or pale lips/face
- New confusion or inability to awaken
- Severe chest pain or pressure
- Significant deterioration in condition
- Other symptoms requiring emergency medical attention
Call 911 for a medical emergency.
6. Immediate Actions When Respiratory Illness Is Suspected
Field Staff Should:
1. Protect themselves and the patient.
Follow appropriate infection prevention practices, including:
- Hand hygiene.
- Appropriate PPE based on the suspected illness and exposure.
- Respiratory hygiene/cough etiquette.
- Increased ventilation when appropriate and safe.
- Cleaning and disinfection of frequently touched surfaces as indicated.
2. Limit unnecessary exposure.
Avoid unnecessary close contact with other individuals in the household and avoid moving between patients while symptomatic unless agency leadership determines that reassignment is appropriate.
3. Notify the appropriate agency contact.
The caregiver should promptly notify the designated:
- RN/supervisor,
- Director of Patient Services,
- On-call nurse, or
- Other agency-designated clinical contact.
4. Document the situation.
Documentation should include:
- Date and time symptoms were identified.
- Symptoms observed/reported.
- Patient’s condition.
- Infection-control measures implemented.
- Persons notified.
- Instructions received.
- Any subsequent follow-up.
7. Identifying a Potential Cluster
Agency personnel should consider whether there is a possible cluster when more than one person develops similar respiratory symptoms and there is a potential epidemiological connection.
For example:
HHA A reports that Patient A has developed a new cough and fever. Two days later, HHA B reports similar symptoms after working with the same patient.
This should be escalated because there may be a connection between the cases.
Another example:
The scheduling department receives reports that several HHAs assigned to different patients have developed similar respiratory symptoms within several days.
This should be reported to agency leadership for assessment.
Important
Staff should not wait until a specific number of cases is reached before reporting a concern.
When in doubt:
REPORT → ESCALATE → DOCUMENT → FOLLOW INSTRUCTIONS
8. Agency Escalation Procedure
When a possible respiratory illness cluster is identified:
Step 1 — Staff Report
The employee reports the concern immediately to the designated supervisor/clinical contact.
Step 2 — Clinical Review
The RN/supervisor evaluates:
- Number of potentially affected individuals.
- Symptoms.
- Dates symptoms began.
- Relationship between affected individuals.
- Patient/caregiver assignments.
- Known exposures.
- Testing or confirmed diagnoses, if available.
- Infection-control measures already implemented.
Step 3 — Notify Agency Leadership
The supervisor notifies the designated agency leadership personnel according to the agency’s Infection Prevention and Emergency Preparedness Plan.
Step 4 — Initiate Enhanced Infection Prevention Measures
Depending upon the situation, the agency may implement:
- Additional PPE requirements.
- Increased hand hygiene monitoring.
- Additional environmental cleaning.
- Patient/caregiver reassignment.
- Increased monitoring of affected patients.
- Staff illness/exclusion procedures.
- Additional communication to patients, families, and caregivers.
- Consultation with healthcare providers or public health officials.
Step 5 — Determine Whether Public Health Consultation Is Needed
Agency leadership or the designated infection prevention/emergency preparedness personnel will determine whether the situation should be reported to or discussed with the Local Health Department.
Staff should not independently contact the LHD on behalf of the agency unless specifically authorized to do so.
9. Contacting the Local Health Department
Sara Companions will maintain current contact information for the appropriate Local Health Department(s) serving the agency’s patient population and service areas.
Because Sara Companions provides services across multiple geographic areas, the agency should maintain a readily accessible Local Health Department Contact List containing:
| Jurisdiction | Health Department | Telephone | After-Hours/ Emergency | Website |
| Nassau County | 200 County Seat Dr. North Entrance, Mineola, NY 11501 | (516) 227-9697 | (516) 742-6154 | nassaucountyny.gov/1652/Health-Department |
| Suffolk County | 3500 Sunrise Hwy #124, Great River, NY 11739 | (631) 854-0000 | (631) 854-0333 | suffolkcountyny.gov/Health-Services |
| New York City | 90 Church Street – 4th Floor New York, NY 10007 | (212) 417-5550 | 311 | nyc.gov/site/doh |
When contacting the LHD, authorized agency personnel should be prepared to provide:
- Agency name and contact information.
- Nature of the suspected respiratory illness.
- Number of potentially affected individuals.
- Approximate dates of illness onset.
- Patient/caregiver relationship or exposure information.
- Known laboratory-confirmed diagnoses, if available.
- Infection-control measures already implemented.
- Any serious illness or hospitalization.
- Other information requested by the health department.
Only the minimum necessary patient information should be disclosed, consistent with HIPAA and applicable New York State requirements.
10. Confidentiality and Privacy
Patient and employee health information must be handled confidentially.
Staff must not:
- Discuss a patient’s illness with unauthorized individuals.
- Share patient information through personal social media.
- Photograph or distribute medical information unnecessarily.
- Discuss suspected outbreaks with other patients or caregivers who do not have a need to know.
Information should be shared only with individuals who have a legitimate need to know in order to protect the patient, employees, or public health.
11. Documentation Requirements
Sara Companions should maintain documentation of significant respiratory illness events and suspected clusters.
Documentation may include:
- Patient record documentation.
- Employee illness reports.
- Incident reports.
- Supervisor/clinical notes.
- Infection-control interventions.
- Communication logs.
- LHD communications.
- Public health recommendations.
- Follow-up actions.
- Final resolution of the event.
Documentation should be objective and factual.
Example:
Appropriate:
“HHA reported that patient developed fever and productive cough on 10/6/26. Supervisor notified at 10:15 AM. HHA instructed to use appropriate PPE and follow infection-control procedures. RN notified. Follow-up planned.”
Avoid:
“Patient probably has the flu and may have infected everyone.”
Staff should document what they observed, what was reported, what actions were taken, and who was notified rather than making an unsupported diagnosis.
12. Staff Illness
Employees who develop symptoms of a potentially communicable respiratory illness must follow Sara Companions’ employee illness/exclusion procedures.
Employees should:
- Notify the appropriate supervisor.
- Avoid exposing patients and coworkers.
- Follow agency instructions regarding work restrictions, testing, medical evaluation, and return to work.
- Follow applicable public health recommendations.
Employees must not conceal symptoms or exposures in order to report to work.
13. Prevention
Sara Companions promotes respiratory illness prevention through:
- Hand hygiene.
- Respiratory hygiene and cough etiquette.
- Appropriate PPE.
- Cleaning and disinfection.
- Appropriate ventilation.
- Staying home when ill in accordance with agency policy.
- Appropriate vaccination education.
- Staff education and training.
- Early identification and reporting of illness.
- Prompt communication with patients, families, healthcare providers, and public health authorities when appropriate.
14. Emergency Preparedness Integration
Respiratory illness cluster management should be incorporated into Sara Companions’ Emergency Preparedness Plan and Infection Prevention and Control Program.
The agency should ensure that:
- Staff know who to call when a respiratory illness concern arises.
- Supervisors know who is responsible for escalation.
- Agency leadership knows how to contact the appropriate LHD.
- Current LHD contact information is readily accessible.
- Backup personnel are identified for after-hours situations.
- Staff receive periodic education on respiratory illness recognition and reporting.
- The agency evaluates lessons learned following significant respiratory illness events.
15. Staff Quick Reference
STOP – PROTECT – REPORT – DOCUMENT – ESCALATE
STOP
Recognize a possible respiratory illness or cluster.
PROTECT
Use hand hygiene, PPE, respiratory precautions, and other appropriate infection-control measures.
REPORT
Notify the RN/supervisor or designated agency contact.
DOCUMENT
Record symptoms, date/time, actions taken, and notifications.
ESCALATE
Agency leadership evaluates whether additional precautions, healthcare-provider notification, or Local Health Department consultation is necessary.
Staff Reminder
You do not have to diagnose an outbreak.
Your responsibility is to recognize a possible problem, protect yourself and the patient, report the concern promptly, and follow agency instructions.
When in doubt — report it. Early reporting can help prevent additional infections.