Collaboration Underlies the Success of Outbreak Investigation Team in Contra Costa County, California

Fewer residents of a San Francisco Bay Area county experience food or other outbreak illnesses as a result of the extraordinary collaborative approach of the Outbreak Investigation Team. In Contra Costa County, a San Francisco Bay Area county, the needed experts are spread across Health Services, the largest county department with 3,500 employees. Though in one department, the needed experts are located in large divisions of the department at facilities in different cities, structural impediments to coordination. And given the targeted, regulatory responsibilities, the Environmental Health Division has limited overlap with the Public Health Division.

Though this team approach was born in the early 2000s, events in this past year poignantly demonstrate the impact of the collaborative approach. The team approach was instrumental in assisting state and federal officials investigating five young children (two in Contra Costa County) that became sick from a unique strain of E. coli 0157:H7, which was eventually linked with a common exposure to raw milk. More recently, Environmental Health’s ability to protect the public by closing a popular restaurant due to employee sickness which made many sick (we now have reports of more than 100 sick) would not have been possible without the Outbreak Investigation Team.

The ability to respond to these large events is rooted in the on-going communication and cross-training to which all parts of the team contribute and participate. In the early 90s, managers from both divisions recognized the importance of collaboration, and initiated a monthly meeting of public health, environmental health, and public health laboratory experts. After September 11, 2001, emergency preparedness staff from public health, environmental health, and the sheriff’s office joined the meetings. The meetings continue, though many staff changes have occurred, sustaining, and further strengthening the collaborative relationship and the effective response.

The Outbreak Investigation Team collaboration is most appreciated by Environmental Health as we respond to indications that someone is getting sick from food. The presentator will describe a food-borne illness tracking tool developed the team and elaborate on how the team approached the outbreak associated with the raw milk and the large restaurant outbreak investigation.

Comparison of Enteric Protozoa testing Algorithms in Four Hospitals in Sydney, Australia

mdmedicine.wordpress.com

The prevalence of intestinal protozoan infections affecting Australians is relatively unknown, and estimates are often affected by the lack of routine testing and insensitive diagnostic techniques to detect them in clinical specimens. This multi-centre cross section study summarises the relative prevalence of enteric protozoa from laboratory databases, across four public hospitals in Sydney, and compares the outcome of testing algorithms used to detect enteric protozoa.

The study found that detection rates varied between hospitals, with an enteric protozoa identified in 8.8% (95%CI 7.6%-10.0%), 1.2% (95%CI 1.0%-1.4%), 6.9% (95%CI 6.4%-7.5%) and 1.3% (95%CI 1.1%-1.6%) of specimen at Hospitals A, B, C and D respectively. Higher prevalence of Giardia was found in the 0-5 age group compared with higher rates of Blastocystis being identified from Adults (>5 years old) at Hospitals A and B. Where microscopy alone was used, Hospital A detected significantly higher results for Blastocystis spp., (mean diff. 5.3%; z-score =19.542; P Enteric protozoa contribute to the burden from Gastrointestinal Illnesses in Australia, and should be routinely considered in the differential diagnosis of locally acquired gastrointestinal illnesses. This study has shown that microscopy results were comparable to enhanced testing with permanent staining methods for some protozoa. However, permamnent stained smears should remain the method of choice for the detection of difficult to diagnose protozoa such as D. fragilis.

Lights! Camera! Action! How Do We Feed Those Hollywood Stars?

Hollywood! Entertainment! Motion Pictures! This sounds glamorous. Yet in the hustle and bustle of filming, the motion picture and television (MPT) mobile caterers are charged with providing safe and wholesome food to the production cast and crew.

Our challenge in Los Angeles County Environmental Health was to take into consideration the uniqueness of the MPT mobile catering industry and determine how to sensibly permit and inspect the MPT caterers. Traditionally, the MPT caterers were issued a single Mobile Food Facility permit for the on-site mobile food truck. The industry operated beyond the scope of the permit by setting up gourmet buffet style food service fit for a movie star, and many times utilizing unpermitted mobile storage vehicles. The requirements were confusing, and to say the least, frustrating for both the industry and Environmental Health.

Environmental Health began meeting routinely with the industry to listen to their needs and concerns. A working group was developed and a new approach to permitting and inspecting ensued.

The lecture will present this innovative approach to permitting and inspecting food industries with a unique set of needs, such as the MPT mobile caterers.

Designing a Successful Collaboration Between State and Local Partners to Assess and Cleanup Former Drycleaners

fabandfru.com

Dry cleaning is an entry level business in most communities, and many buildings along business routes have at some time been used by the dry cleaning industry. Perchloroethylene (PCE, perc, or tetrachloroethylene), a hazardous air pollutant, has been used over the past 70 years and is the solvent most frequently used in the dry cleaning business. PCE remaining in soil and groundwater from past and present dry cleaning businesses has left a legacy of health risks to neighboring residences and businesses through vapor intrusion, as well as threats to municipal wells. In addition, infrastructure improvements in utility corridors can have work stoppages when PCE is unexpectedly found during excavation. For these reasons, it is useful to have knowledge of locations where PCE has been used. However, records going back more than 30-40 years may be poor. Public Health Madison and Dane County (PHMDC) has partnered with the Wisconsin Department of Natural Resources (DNR) and the Wisconsin Department of Health Services (DHS) to identify, investigate, and remediate sites of environmental contamination in order to reduce the potential exposure of Dane County residents to PCE. Currently, DNR and PHMDC are working on over 30 sites in Dane County where PCE has been identified. An additional 200 probable former dry cleaning sites have been catalogued using archived telephone listings and GIS mapping. During this interactive risk assessment session, participants will learn about how to design and implement a similar program in their community. Speakers from both PHMDC and DHS will describe the process of identifying former dry cleaners, how to conduct indoor and sub-slab air sampling, and risk assessment to determine human health hazard due to PCE exposure.

Ensuring that Community Health Issues Drive Brownfield Redevelopment in Wisconsin

Graphic from epa.gov

Brownfields are properties in a community whose expansion, redevelopment or reuse is complicated by the presence or potential presence of a hazardous substance, pollutant or contaminant. The existence of Brownfield sites in a community may contribute to social injustices related to poor health determinants in neighboring communities. Improving public health, along with economic and environmental improvements, should be a main objective when considering Brownfield redevelopment in a community. Any type of effort to improve public health assumes the necessity of including community members in long-term and in-depth dialogue. However, this type of dialogue during brownfield redevelopment is generally the exception.

This session will present a broad approach to improving public health through brownfield redevelopment.
This approach includes:

1. assessing human health risks at Brownfield sites, 
2. engaging communities to provide input on redevelopment and revitalization strategies that will reduce exposures and improve community health determinants, 
3. monitoring community health indicators related to Brownfields, and 
4. educating city planners and developers about the nexus of health and redevelopment. 

The target audience is anyone involved in or interested in the role public health plays in communities with brownfields.

Food Service Inspectors Promoting Restaurant Worker Protection- a Pilot Assessment and Intervention Study

While conducting routine food safety inspections, Bay Area environmental health inspectors identified at least one occupational hazard in approximately 69% of the 261 food facilities inspected as part of a pilot project focusing on preventing work-related injuries. Over 200,000 such injuries occur in U.S. food establishments every year. Recognizing the unique access that environmental health inspectors have to the kitchen and other areas of food facilities when conducting periodic health inspections, UC Berkeley’s Labor Occupational Health Program (LOHP) recruited two Bay Area counties to partner in the development of a pilot assessment and intervention project. LOHP worked with the inspectors of each county to develop distinct protocols for hazard identification and intervention. San Francisco opted for a limited, less time consuming version of the pilot which included a 5-item checklist of sentinel worker safety hazards for the assessment, and an intervention consisting of sharing a letter explaining the pilot effort and providing the facility operator with a brochure on restaurant worker safety. Contra Costa County developed a more time-intensive version including a 15-item checklist with an intervention that distributed the OSHA brochure, targeted safety tipsheets, on-the-spot education, and referral for trainings with LOHP.

San Francisco found that 60% of the restaurants lacked certain required labor signage and 13% of the facilities had ventilation issues. Contra Costa County staff found the most common sentinel hazard was the lack of required labor postings, slippery floors, inadequately stocked first aid kits, and absence of non-slip mats. Key challenges to the project included inspectors having to balance “core” food safety responsibilities with the voluntary pilot activities focused on worker safety. Local environmental health departments will likely need to adapt the effort for their own use – one protocol will not “fit all.” The pilot showed promise in collaborating with, as one inspector put it, “the perfect people to be communicating” about worker health and safety in food facilities. The presentation will expand on the findings of the sentinel hazard assessment, feedback from inspectors and operators on the interventions, the evaluation of the two protocols, and how they may be applicable in the participants’ jurisdictions.

 

Implications of Silver Nanoparticle (Nano Ag) Exposure on Respiratory Physiology

Silver has been one of the most commonly used materials for various applications. As the level of production and use of engineered silver nanoparticles (Nano Ag) increases, the exposure risk to Nano Ag at both occupational and non-occupational settings has become real. Despite the availability of many cellular toxicology studies, few studies have been conducted to understand the physiological impacts on respiratory system. In this study, Nano Ag of various sizes and concentrations (size ranging between 10 and100nm at varying concentrations between 10 and 1000 ppb) was homogenized in representative environmental and physiological conditions by using bovine surfactant (Calfactant) at room temperature. Both control and experimental groups of suspension/solutions were used to measure the contact angles for each sample by using a goniometer. The measured contact angles, then, were used for surface tension as a way of indirect measurement of physiological impacts. The results show that:

1. Nano Ag at 100nm size range (compared to 15nm size) causes more significant change in surface tension in a representative environmental condition without having the effects of surfactants, 
2. The effect of Nano Ag exposure in terms of change in surface tension reduction was more prominent by smaller size Nano Ag (i.e. 15nm in this case) than larger size Nano Ag (i.e., 100nm) in a physiological environment, 
3. Size effect on surface tension at 15 and 100nm is less distinctive in the concentration ranges between 50 and 100ppb of Nano Ag, while smaller Nano Ag (15nm) causes more dramatic increment of surface tension at a higher exposure concentration (1000ppb) than larger size Nano Ag (100nm). 

From the results it is concluded that:

1. human respiratory physiology can be more easily compromised by smaller Nano Ag in a size and concentration dependent manner, and 
2. it might be possible to implement preventive measures in nanomaterial induced toxicity at manufacturing facilities by better understanding the correlation between the size in nano scale and pathophysiological conditions.

Public/Private Partnerships in EH

Environmental health has grown into a multi-million dollar industry, funded by both the private and public sector. The identification of risks, development of rules, and administration of programs are performed by the public sector. But it is the private sector that implements these programs.

The standards required to meet health and safety requirements for environmental projects has created a private sector environmental public health workforce, comprised of engineers, sanitarians, public health personnel and other highly skilled individuals that implement the EH requirements mandated by state, federal and local decision makers. This workforce has the insight and knowledge of the best practices to meet the public health goals of each EH policy, yet too often are not engaged in the development and promotion of EH.

Graphic:ictnhcdiagnostics.blogspot.com

It is these rules, codes and policies that have created the EH industry. Without these EH requirements, this industry and the millions it employs not exist. It is very much in the EH industry's interest to be active in promoting the industry, before the state and federal rule making agencies, before the general public, and foremostly before Congress, the state legislatures and city and county councils that adopt EH requirements. This industry will not grow but instead decline without an active approach in promoting the economic benefits of a robust EH program. This session will discuss efforts to encourage the private sector in promoting the federal, state and local EH workforce.

What do Fish and Tetrachloroethylene (PCE) have to do with Radon?

 graphic from morrowcountyhealth.org

Radon is a naturally occurring, odorless radioactive gas that causes lung cancer. Between five and ten percent of the homes in Wisconsin have radon levels above the US EPA guideline of 4 pCi/L for the year average on the main floor. Every region of Wisconsin has some homes with elevated radon levels. Although the only way to know the radon level in a home is to measure it, and radon testing costs as little as $20, the public has not embraced this important prevention strategy. This session will discuss two case studies from Wisconsin that highlight opportunities for local and state health departments to increase knowledge about and interest in radon testing. Staff from the Wisconsin Radon Program will discuss how increased interest in home radon testing has led to increased interest in workplace testing as well. High levels of indoor radon were found in a fish hatchery run by the state Department of Natural Resources. This session will report on the implications that this finding has on other similar hatcheries statewide. Staff from the state’s APPLETREE cooperative agreement program through ATSDR will discuss efforts to increase awareness and testing of homes for radon near two sites with potential vapor intrusion issues. Session participants will learn how concern of indoor air hazards related to nearby sites can translate into increased interest in testing for radon as well.

Introducing Environmental Health to K-12 [POSTER]

Effective environmental health policy largely depends on advocacy of informed citizenship. At the present, time environmental health is not taught as a school subject. However, hardly a day goes by when there isn’t something in the news about chemicals or pollution in our environment, and teachers and parents are coming to recognize the importance of environmental health to science education. Teaching students about environmental health topics and complex concepts such as risk and exposure requires quality educational resources. For years, the National Library of Medicine (NLM) has been developing authoritative, engaging Web pages and classroom tools for students at the elementary, middle, and high school levels. Web resources include: ToxMystery, an educational game for elementary students; Environmental Health Student Portal for middle school students; and Tox Town for middle and high school students.

In addition to covering major areas of environmental health, ToxMystery and Tox Town also include sections about careers in environmental health. Recently, NLM also created a curriculum for an after school environmental health club, entitled Discovering the Connection: Your Environment, Your Health, which introduces middle school students to issues around water and air quality and chemicals in food and household products. Students research information, conduct hands-on experiments, and participate in communication and social action activities. The curriculum culminates in a debate, where students argue about whether the school’s primary source of drinking water should be bottled or tap. NLM also maintains a K-12 listserv and newsletter for educators that highlight resources and tools related to environmental health. This poster will highlight these environmental health resources and make suggestions about how to use and promote them in the community.

Lessons from a Collaborative Effort- The 2012 Democratic National Convention

A case history of the successful collaborative effort of 15 different local, state and federal jurisdictions to address food safety and other public health concerns at the 2012 DNC utilizing Incident Command Structure. The approach taken could easily be used for any large special event. Presentation will include a timeline of the 1 1/2 year advance planning and training as well as a discussion of the challenges and successes of the DNC Incident Team.
Lecture Description/Teaser: Bedbugs, BBQ and Bouts of Rain- learning to work well with all agencies involved with food safety at the 2012 DNC.

Seeking Stakeholder Input:Methods, Findings and Lessons in Change Management

Is your program in the midst of a significant change? Are you interested in performance regulations for onsite sewage systems? Do you need meaningful data and input from stakeholders before change happens? What options should you explore to get stakeholder feedback? This lecture will describe several different, real world examples of how one state agency connected with stakeholders to implement big programmatic change.

This presentation will provide a walk-through of the changes directed in the onsite sewage program by General Assembly actions, outline the stakeholder input processes used to understand stakeholder mental models and biases, provide lessons learned from change management in an environmental program, and discuss on-going conflicts from the changes made.

Model Aquatic Health Code

The Model Aquatic Health Code (MAHC) serves as a model and guide for local and state agencies needing to update or implement swimming pool and spa code, rules, regulations, guidance, law, or standards governing the design, construction, operation, and maintenance of swimming pools, spas, hot tubs, and other treated or disinfected aquatic facilities.

Several states and municipalities have adopted codes for aquatic venues, but many are either out of date or fail to address health issues. The MAHC updates current aquatic codes to ensure they reflect the latest health standards and technologies.

As a voluntary program, the MAHC relies on state and local policy makers to adopt its provisions. Without state and local authorization, aquatic health agencies cannot provide outreach to the public and private sector nor can they enforce provisions that address the latest standards or technologies; rather they address past concerns which may or may not be relevant.

This session will explore efforts to encourage state and local policy makers to adopt the MAHC and update their aquatic codes to address health concerns.

2012 Waldo Canyon Wildfire: Environmental Health Response & Recovery

The crisis forced the mandatory evacuation of El Paso County Public Health’s (EPCPH) offices from June 26 to June 29. Many EPCPH employees also were evacuated from their homes, but continued to work as part of the incident response and recovery phase. As part of El Paso County Public Health’s Continuity of Operations Plan, a temporary office was established during the evacuation, opening to take calls from the public concerning fire and non-fire related information. Smoke from the wildfire prompted concerns from the community about air quality, and as evacuations lifted, residents faced challenges related to the safe cleanup of smoke, ash, debris, potentially spoiled food and indoor and outdoor air quality.

During the summer of 2012, the Waldo Canyon Wildfire hit El Paso County, CO and the City of Colorado Springs, CO with a devastating fury. From June 23 to July 10, 2012 the wildfire forced the evacuation of approximately 32,000 residents across several jurisdictions, destroyed 347 homes in Colorado Springs, killed two residents, produced a choking cloud of smoke and burned 18,247 acres.

Environmental Health was greatly involved, during the wildfire and with the recovery, in the following areas:

• Retail food and child care sanitation field response to 80 evacuated retail food establishments and 21 evacuated childcare centers
• Mass sheltering issues
• Continuity Of Operations (COOP)
• Air quality
• Ash/debris cleanup and hauling

This presentation will focus on environmental health's response, and lessons learned during the 2012 Waldo Canyon Wildfire.