| Course | D028 Advanced Health Assessment for Patients and Populations |
|---|---|
| Task | Task 2 |
| Paper type | Outbreak assessment presentation |
| Length | About 1,200 words, 2 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for D028 Task 2
Communicable Outbreak Assessment: A Cluster of Legionnaires' Disease in a Composite Small Town
Student Name
Leavitt School of Health, Western Governors University
D028: Advanced Health Assessment for Patients and Populations, Task 2
Course Instructor
Month Day, Year
Slide 1: Overview
A cluster of severe pneumonia in a small town
Eleven cases, two deaths, three weeks in August
How the outbreak was recognized, confirmed, investigated and controlled
Speaker notes: This presentation walks through an outbreak of Legionnaires' disease in a composite town of about 22,000 people. I will follow the standard steps of an outbreak investigation and point out where the advanced professional nurse contributes at each stage.
Slide 2: The Alert
Community hospital admits four adults with pneumonia in six days
All four positive on Legionella urinary antigen testing
Usual baseline: fewer than two cases per year in the county
Speaker notes: The outbreak was first noticed by the hospital's infection prevention nurse, who saw four positive Legionella urine antigen tests in less than a week, compared with a county baseline of one or two cases a year. The nurse reported the cluster to the county health department the same day. Recognizing an excess over the expected number of cases is the first signal of an outbreak, and it often comes from a nurse who is looking at the data every day.
Slide 3: Case Definition
Clinical: pneumonia confirmed by chest imaging
Person and place: lived in, worked in or visited the downtown district within 1 mile of Main Street
Time: symptom onset August 1 to 31
Confirmed: positive urinary antigen or Legionella culture
Probable: clinical and epidemiologic criteria, no confirmatory test
Speaker notes: A case definition sets clear rules for who counts as a case, so everyone searching for cases uses the same standard. It combines clinical criteria with person, place and time. We separated confirmed cases, which have laboratory evidence, from probable cases, which meet the clinical and exposure criteria but lack a test, and suspect cases, which have compatible symptoms and exposure and are still being evaluated. Using categories lets the team act quickly without waiting for every test while still being honest about certainty.
Slide 4: Steps of the Investigation
Prepare the team and establish that an outbreak exists
Verify the diagnosis and define cases
Find cases and describe them by person, place and time
Develop and test hypotheses
Implement control measures, communicate findings and maintain surveillance
Speaker notes: These steps follow the standard outbreak investigation framework used in public health practice (Centers for Disease Control and Prevention [CDC], 2012). In reality they overlap: control measures began before the source was proven, because waiting would have allowed more exposures. The team included the county health officer, two public health nurses, the hospital infection prevention nurse, an environmental health specialist and the state epidemiologist.
Slide 5: Surveillance and Case Finding
Passive surveillance: routine laboratory and provider reports
Enhanced active surveillance: daily calls to hospitals, urgent care clinics and laboratories in three counties
Line list: 11 cases (9 confirmed, 2 probable), ages 48 to 83
Ten of 11 had spent time downtown in the 10 days before illness
Speaker notes: Before the cluster, the county relied on passive surveillance, waiting for laboratories and providers to report cases. Once the outbreak was suspected, public health nurses moved to active surveillance, calling every hospital, urgent care clinic and laboratory in the region daily to ask about new pneumonia with positive Legionella tests. Nurses interviewed each patient or family about where they had been in the 10 days before illness. The line list showed that most cases were older adults, several were smokers or had diabetes, and ten had spent time in the downtown district.
Slide 6: Mode of Transmission and the Epidemiological Triangle
Agent: Legionella pneumophila serogroup 1
Host: older age, smoking, chronic lung disease, diabetes, weakened immunity
Environment: warm, stagnant water in building systems that is aerosolized
Transmission: inhaling contaminated water droplets; not spread person to person
Speaker notes: Legionella lives in water and grows best in warm, poorly maintained building water systems such as cooling towers, hot tubs and large plumbing systems. People become infected by breathing in small droplets of contaminated water; one sick person cannot pass it to another, which is an important message for families and hospital staff (Centers for Disease Control and Prevention, 2024). The epidemiological triangle helps explain this outbreak: a virulent agent, a group of susceptible hosts and an environment that allowed the bacteria to grow and spread.
Slide 7: Cumulative Incidence
Population at risk: about 6,200 residents and workers in the downtown district
New cases: 11 during August
Cumulative incidence: 11 / 6,200 = 17.7 per 10,000 in one month
County baseline: well under 0.1 per 10,000 per month
Speaker notes: Cumulative incidence is the number of new cases during a period divided by the population at risk at the start of that period. Using the estimated 6,200 people who lived or worked in the downtown district, 11 cases in August gives a cumulative incidence of about 17.7 per 10,000 for the month. Even allowing for uncertainty in the denominator, since visitors are hard to count, this is far above the county's usual rate and confirms a real outbreak concentrated in one place.
Slide 8: Finding the Source and Controlling It
Hypothesis: a cooling tower on a downtown hotel
Environmental sampling: Legionella found in tower water, matching patient isolates
Control: tower shut down, cleaned and disinfected; water management plan required
Hospital water tested to rule out a second source
Speaker notes: Mapping cases showed them clustered within half a mile of a downtown hotel with a rooftop cooling tower, downwind of it on the prevailing wind. Environmental health staff sampled the tower and found Legionella matching the strain from patients. The tower was shut down, cleaned and disinfected, and the hotel was required to adopt a water management program. Outbreaks like this one are often traced to preventable maintenance failures; a review of outbreaks investigated by the CDC found that every one with enough information had at least one deficiency in water system maintenance (Garrison et al., 2016).
Slide 9: Prevention and Communicating Findings
Primary: water management programs for buildings with cooling towers
Secondary: alert clinicians to test pneumonia patients for Legionella
Tertiary: early appropriate antibiotics and follow-up for survivors
Public message: not contagious; seek care for fever and cough
Speaker notes: Prevention works at three levels. Primary prevention stops exposure, through water management programs in buildings with cooling towers. Secondary prevention finds disease early, which is why the health department sent an alert asking clinicians to test pneumonia patients with downtown exposure. Tertiary prevention limits harm through prompt treatment and follow-up. Public health nurses answered calls from residents, explained that the disease does not spread between people and encouraged anyone with fever and cough to seek care.
Slide 10: Maintaining Surveillance and the Nurse's Role
Enhanced surveillance continued for two incubation periods after the tower was closed
No new cases with onset after September 3
Nurses: recognized the cluster, interviewed cases, found contacts, educated the public, monitored for new cases
Speaker notes: Enhanced surveillance continued for at least two incubation periods, about four weeks, after the source was controlled, and no new cases appeared. Across every step, nurses were central: an infection prevention nurse recognized the cluster, public health nurses interviewed cases and built the line list, and nurses educated patients, families and the public. The advanced professional nurse brings assessment skills to the population level, turning individual patient findings into a pattern that protects a whole community.
References
Centers for Disease Control and Prevention. (2012). Principles of epidemiology in public health practice: An introduction to applied epidemiology and biostatistics (3rd ed.). U.S. Department of Health and Human Services. https://archive.cdc.gov/www_cdc_gov/csels/dsepd/ss1978/index.html
Centers for Disease Control and Prevention. (2024). About Legionnaires' disease. https://www.cdc.gov/legionella/about/index.html
Garrison, L. E., Kunz, J. M., Cooley, L. A., Moore, M. R., Lucas, C., Schrag, S., Sarisky, J., & Whitney, C. G. (2016). Vital signs: Deficiencies in environmental control identified in outbreaks of Legionnaires' disease, North America, 2000-2014. MMWR: Morbidity and Mortality Weekly Report, 65(22), 576-584. https://doi.org/10.15585/mmwr.mm6522e1
What the D028 Task 2 instructions ask
The second D028 task asks you to assess a communicable disease outbreak, usually as a presentation with notes. Most versions ask for a case definition, the steps of outbreak investigation, surveillance methods, mode of transmission with the epidemiological triangle, a calculation such as cumulative incidence or attack rate, control and prevention measures, communication of findings and the advanced nurse's role. Your course may supply the outbreak scenario. Either way, evaluators look for sound epidemiologic methods, correct calculations with the formula shown, and control measures that follow from the identified source and transmission route. Many versions also ask how findings would be communicated to the public.
How this D028 Task 2 example is built
The presentation is organized in the order an investigation unfolds. The first slides establish the alert and the case definition, with criteria stated precisely. The investigation steps follow the standard sequence from preparing the team to communicating findings. Surveillance is split into passive and active case finding. The transmission slide places agent, host and environment in the epidemiological triangle. The incidence slide shows the population at risk, the case count and the calculation. The source slide explains the hypothesis and how it was confirmed, and the final slides cover prevention levels, communication and ongoing surveillance, with speaker notes carrying the explanation. The prevention slide separates primary, secondary and tertiary measures.
Where the D028 Task 2 rubric puts the marks
Each D028 Task 2 aspect is rated competent, approaching competence or not evident. A case definition aspect checks that clinical, laboratory and epidemiologic criteria are clear. Investigation and surveillance aspects look for correct steps and methods. A transmission aspect asks for an accurate epidemiological triangle. A calculation aspect wants the right formula applied correctly, with the population at risk defined. Control, prevention and communication aspects look for measures that fit the source. A role aspect asks what the advanced nurse contributes. Evaluators check CDC sources and APA citations, and they expect slides that are readable with notes that explain. Presentations that show the population at risk explicitly, with its source, make the calculation easy to verify, and notes written in full sentences carry the reasoning evaluators need to see.
D028 Task 2 help: what sends it back
Outbreak presentations come back most often because the calculation is wrong or unexplained. State the formula, the numerator, the denominator and the time period. Second, case definitions omit one of the three criteria types; include clinical, laboratory and person, place and time elements. Third, transmission is described generally. Name the agent, host factors and environmental source. Fourth, control measures do not match the source. If the source is a cooling tower, remediation and water management come first. Finally, keep slides brief and put the explanation in the notes, since crowded slides are hard to follow and the notes are where evaluators find your reasoning. Rehearse the notes aloud to check timing.
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D028 Task 2 questions, answered
What goes in a D028 outbreak case definition?
Clinical criteria, such as symptoms and laboratory findings, plus person, place and time: who is included, where they were exposed and during which dates. Most definitions also separate suspect, probable and confirmed cases by the strength of the evidence.
How do I calculate cumulative incidence for D028?
Divide the number of new cases during a defined period by the population at risk at the start of that period, and state both the population and the time frame. Multiply by a convenient base, such as 1,000 or 10,000, so the figure is easy to read.
Does the D028 outbreak scenario use a real disease?
The course scenario provides its own details. Model presentations like this one use a different composite outbreak so the structure can be studied without copying the course's scenario; your submission should use the data your scenario provides.
How do I calculate cumulative incidence for D028?
Divide the number of new cases during the period by the population at risk at the start, then express it per 1,000 or 10,000. The sample shows each number on its incidence slide.
Where can I find a free D028 Task 2 sample paper?
The complete outbreak presentation and speaker notes appear above with margin comments. For a presentation on your own outbreak scenario, share the D028 task and the first custom version is free.