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Developing Tools for Infection Control in Group Care Facilities: The DOH-Manatee Outbreak Information Packet

State: FL Type: Promising Practice Year: 2017

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Florida Department of Health in Manatee County
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Developing Tools for Infection Control in Group Care Facilities: The DOH-Manatee Outbreak Information Packet
Brief Description of LHD: The Florida Department of Health in Manatee County (DOH-Manatee) is a local branch of the Florida state health department system, and serves approximately 342,000 residents in six municipalities. The municipalities encompassed by Manatee County include Bradenton, Palmetto, the City of Anna Maria, Bradenton Beach, Holmes Beach, and Longboat Key. The largest age segment in Manatee County is 25-64 and the population is somewhat diverse with 87% White, 9% Black, 16% Hispanic, and 4% other. 11% of the population of Manatee County is below the poverty level. There are an estimated 73,326 children aged 0-19 years in Manatee county. Of those, 19,079 are Hispanic and 10,576 are Black, comprising 41% of the age group. Manatee County is situated in central Florida on the gulf coast, extending from the densely populated areas around Port Manatee to rural areas farther inland. Public Health Issue: According to Florida Statutes, outbreaks of any disease… found in the general community or any defined setting (e.g., hospital, school)” are reportable to the local health department. Communicable disease reporting exists to protect the public's health, and to monitor the extent of disease in the community so that an emergency situation can be identified and addressed. For surveillance to be effective, communicable disease reporting must be timely and consistent. Epidemiology staff at DOH-Manatee have identified a lack of accessible information regarding the importance of outbreak reporting and first steps for infection control in settings such as schools and assisted living facilities (ALFs). Goals and Objectives: The Outbreak Information Packet (OIP) was developed to address the gaps in knowledge and practice related to the reporting of outbreaks by group care facilities in Manatee County. The OIP is meant to inform healthcare professionals in group care facilities of first steps in infection control recommendations as well as to encourage these facilities to report outbreaks by educating staff members on requirements of reporting as mandated by Florida Statutes. The goals and objectives for developing, distributing, and implementing use of the DOH-Manatee Outbreak Information Packet are as follows: Goal 1: Develop a comprehensive guide to the early stages of infection control and outbreak response for use by DOH-Manatee epidemiologists and staff in group care facilities including assisted living facilities, schools, and daycares. Objective 1.1 Identify most common types of communicable disease outbreaks in group care facilities. Objective 2.2 Identify best early practices for infection control of most common types of communicable disease outbreaks in group care facilities. Goal 2: Distribute Outbreak Information Packet to group care facilities in Manatee County. Objective 2.1 Identify all relevant group care facilities in Manatee County. Objective 2.2 Engage group care facilities in order to provide education about how, why, and when to use the OIP. Implementation and Activities: To develop the OIP, epidemiology staff determined the most common types of outbreaks. This resulted in the OIP comprising of three sections: 1) gastrointestinal, 2) influenza-like, and 3) rash-like illnesses. Letters including the importance of outbreak reporting, HIPAA, and the role of DOH-Manatee were added. Each section contains isolation, diagnostics, and cleaning recommendations. When an epidemiologist at DOH-Manatee is notified of a communicable disease outbreak in a group care facility, they can then use the OIP to initially address infection control measures depending on the outbreak. Then, in turn, the group care facility can also utilize the OIP to further implement infection control measures as well as coordinate any necessary specimen collection and data entry that could be helpful to inform the investigation. Results and Outcomes: Since January 2016, the OIP has been utilized during multiple outbreak responses including: a gastrointestinal illness in an ALF; and two influenza-like illnesses (ILIs) in a preschool and elementary school. For the gastrointestinal illness outbreak, epidemiology staff used the OIP for guidance on infection control measures. The ILI outbreaks used two pieces of the OIP, including the Florida Statute about reporting and line lists. During each outbreak scenario the OIP was easily accessible, and able to be quickly utilized to address the outbreak. Public Health Impact: These materials facilitated the reporting process, provided initial infection control measures for use by the facility, and improved the response from DOH-Manatee. Having concise information about measures that can effectively control outbreaks made DOH-Manatee's response faster, more thorough, and more impactful. Website: http://www.manatee.floridahealth.gov
Statement of the Problem and Public Health Issue: Florida Administrative Code describes the diseases and conditions reportable to the Department of Health by healthcare providers, laboratories, and other community partners. Each disease or condition reported has a unique investigation and response. A variety of diseases and conditions are reported in Manatee County including: enteric infections such as Salmonella and E. Coli, vaccine preventable diseases such as Varicella and Pertussis, and travel-associated diseases including Dengue and Chikungunya. In addition to individual disease reports, outbreaks or clusters of any disease are also reportable to the health department upon their suspicion. Group care facilities in Manatee County are sometimes unaware of their reporting responsibilities, and may be susceptible to infectious disease outbreaks because of their immunocompromised clientele and consolidated living quarters. Additionally, in Manatee County, outbreaks of gastrointestinal, influenza-like, and rash-like illnesses are most commonly reported and are most often identified in long-term care facilities with medical staff who are familiar with the role of the health department and the importance of reporting. Sporadic reports come in from schools and daycares, but with limited experienced medical staff in these facilities there is concern that outbreaks may be under-reported due to lack of understanding of Florida Statutes for reporting communicable disease outbreaks. Target Population Affected by Problem: There are nearly 50 Agency for Health Care Administration (AHCA) registered assisted living facilities and 53 elementary, middle, and high schools in Manatee County. The OIP is also targeted for use in daycares and preschool facilities. There are an estimated 73,326 children aged 0-19 years in Manatee county. Percentage Reached: The OIP continues to be utilized for outbreak investigations in group care facilities in Manatee County. At this time the OIP has been used during multiple outbreak investigations to address first steps in infection control, collect specimens, and other relevant data on the ill in order to control the outbreak. What Has Been Done to Address the Problem: Prior to the OIP, DOH-Manatee epidemiologists would investigate outbreaks in group care facilities on a case-by-case basis. When a facility would call in to DOH-Manatee to report an outbreak the process involved asking leading questions to try to understand as much as possible about the kind of outbreak occurring. This kind of investigation would usually entail quick background research via the websites of the Centers for Disease Control and Prevention or the Florida Department of Health, in addition to consulting numerous print texts to identify control measures based on what kind of outbreak was suspected at the time. Oftentimes these resources are abundant, very specific, and are most helpful when the exact type of illness is known. Why the Current or Proposed Practice is Better: The OIP provides resources to not only DOH-Manatee epidemiologists, but also the group care facilities experiencing outbreaks themselves that are generalizable and adaptable for multiple kinds of outbreaks. When DOH-Manatee receives a call notifying epidemiologists of an outbreak, the responders are able to locate first steps in infection control quickly and therefore address the outbreak sooner than they might otherwise. In addition, the OIP serves as a guide to outbreak investigation for the facility itself that can be used by healthcare professionals to facilitate the process of infection control, specimen collection, and appropriate outbreak response. The OIP also reminds facilities that they are bound by Florida Statute to report outbreaks of any disease, case, and cluster of cases, or exposure to an infectious disease. Finally, the OIP helps build awareness and support with our community partners whom we rely on to report communicable disease outbreaks and maintain the health of the public. Innovation of the Current Practice: Reference guides for communicable diseases are not particularly new, however the concept of adapting a generalizable guide for group care facilities is an innovative use of this existing practice. Not only is the OIP easy to use due to its concise presentation of information, but it addresses the most frequent types of outbreaks that can occur in group care facilities and thus allows for adaptability and sustainable use.
Healthcare-associated Infections
Goals and Objectives of this Practice: The success of implementation of the OIP relies on continued community partnerships with DOH-Manatee. The main diseases encompassed within the OIP are informed by the experiences of group care facilities, and their willingness to participate in outbreak investigation and control. The OIP is a resource that serves to assist healthcare professionals in group care facilities in controlling outbreaks as well as connect them to DOH-Manatee for more specialized assistance. Goal 1: Develop a comprehensive guide to the early stages of infection control and outbreak response for use by DOH-Manatee epidemiologists and staff in group care facilities including assisted living facilities, schools, and day cares. Objective 1.1 Identify most common types of communicable disease outbreaks in group care facilities. Objective 2.2 Identify best early practices for infection control of most common types of communicable disease outbreaks in group care facilities. Goal 2: Distribute Outbreak Information Packet to group care facilities in Manatee County. Objective 2.1 Identify all relevant group care facilities in Manatee County. Objective 2.2 Engage group care facilities in order to provide education about how, why, and when to use the OIP. Actions Taken to Achieve these Goals and Objectives: In order to determine what kinds of information would need to be included in the OIP, epidemiology staff from DOH-Manatee consulted with a regional epidemiologist from the statewide Florida Department of Health. Given the information necessary to conduct outbreak investigations, DOH-Manatee epidemiology staff constructed the OIP to include three separate sections for gastrointestinal, influenza-like, and rash-like illnesses. Furthermore, each section includes first steps in infection control guidance for facilities experiencing these kinds of outbreaks, as well as specimen collection information, and line lists tailored differently for specific kinds of outbreaks. Finally, the OIP contains a description of the Florida Statute that mandates outbreak reporting and how each facility can utilize the health department when experiencing an outbreak. The OIP was then (and continues to be) used for outbreak response when outbreaks in group care facilities are reported to the health department. When a facility reports an outbreak to the health department, the OIP is used as a quick reference guide internally when providing infection control recommendations. Additionally, a copy of the OIP is distributed to the facility experiencing the outbreak for further information and the facility is guided through the process of utilizing the line lists to keep track of the spread of the outbreak as well as any specimen collection that is possible depending on the situation. Criteria to Receive this Practice: Any group care facility in Manatee County, Florida is eligible to receive this practice regardless of whether or not they are experiencing an outbreak at the time of distribution. When a school is experiencing a communicable disease outbreak the point of contact for the health department tends to be a school nurse, similarly when ALFs or other group care facilities the point of contact is typically a Director of Nursing for that establishment. Continued distribution also occurs when any kind of group care facility calls the health department to report an outbreak, wherein the OIP can be used for that investigation and further distributed. Timeframe of the Practice: The initial development of the OIP began in October of 2015. Research, outreach, and review with experienced epidemiologists continued until January of 2016. During this time the structure of the OIP was determined and the information concerning outbreak infection control facts was compiled. From January 2016 until May of 2016, DOH-Manatee consulted with a graphic designer to streamline the appearance of the material within the OIP. Once the information had been compiled, the OIP was utilized in outbreak reporting and response for multiple outbreak scenarios from January 2016 on. Stakeholders Involved: Given the nature of outbreak response and reporting, DOH-Manatee frequently worked with community partners, specifically group care facilities, to implement and evaluate this practice. DOH-Manatee utilized connections with Directors of Nursing and school health nurses in these facilities to apply this practice, and to continue to provide resources and support from the local health department. In addition to the key stakeholders from the impacted community itself, DOH-Manatee sought out guidance and information from epidemiologists at the Florida state level to best inform the material within this practice. Through compiling this general information within the OIP, epidemiology staff can further specialize outbreak response after the initial implementation of this practice. Since the OIP can help to identify what kind of outbreak is occurring, through the use of line lists and aided specimen collection, DOH-Manatee can respond to outbreaks more purposefully while utilizing the OIP. This also further influences consistency in outbreak reporting to the state with better accuracy. Start-up Costs and Funding: Design and printing of 100 bound Outbreak Information Packets = $3,000
Extent to which Objectives Were Achieved: Goal 1: Develop a comprehensive guide to the early stages of infection control and outbreak response for use by DOH-Manatee epidemiologists and staff in group care facilities including assisted living facilities, schools, and daycares. Objective 1.1 Identify most common types of communicable disease outbreaks in group care facilities. Objective 2.2 Identify best early practices for infection control of most common types of communicable disease outbreaks in group care facilities. Goal 2: Distribute Outbreak Information Packet to group care facilities in Manatee County. Objective 2.1 Identify all relevant group care facilities in Manatee County. Objective 2.2 Engage group care facilities in order to provide education about how, why, and when to use the OIP. The processes identified in these objectives were informed with assistance from DOH-Manatee's Director of Disease Control and Health Officer as well as State-level Regional Epidemiologists. A DOH-Epidemiology staff member consulted with each of these individuals as to what information would be most helpful while developing the OIP. While preparing the OIP and gathering advice from other epidemiologists, DOH-Manatee chose to focus on the utility of the OIP. The OIP was designed as a quick reference packet that emphasized the importance of brevity and clarity while initially addressing outbreaks. Each outbreak presented a unique scenario with adjustments being made based on the type of illness, and environment in which the outbreak is taking place. This particular factor in outbreak investigation and response informed DOH-Manatee's decision to make the OIP as generalizable as possible in the hopes of being applicable in multiple scenarios. Through an inclusion of the most common types of outbreaks, in addition to letters detailing the importance of communicable disease outbreak reporting DOH-Manatee was able to create a resource for use in many different outbreak situations. Evaluation of the Practice: In order to evaluate this practice, DOH-Manatee has been asking for feedback from the community partners that are utilizing the OIP. Since DOH-Manatee has been implementing the OIP, its effectiveness in outbreak response has been well reported. Facilities that have been able to utilize the OIP have noted they appreciate that the information is condensed in one place, easy to find, and easy to understand. Future evaluation plans include soliciting feedback from facilities who have been in receipt of the OIP to determine ease of use and understanding of the material.
Lessons Learned: The use of the OIP reaffirmed the importance of adaptability with an emphasis on plain language when responding to outbreaks in the general public outside of a more clinical setting. This specific tool was constructed for use in many different kinds of outbreak situations and as such there was an emphasis placed on its ease of use. Infection control measures can often be perceived as very technical and clinical, with guidance from an editor and graphic designer the OIP was adapted to utilize plain language that is understandable for health professionals with a variety of backgrounds and experience. Stakeholder Commitment: The OIP is available in print form, and continues to be available via the internet on DOH-Manatee's Disease Control Division webpage. Group care facilities in the county have been contacted to participate in a seminar wherein the OIP and other relevant public health topics will be addressed. So far interest has been expressed from Directors of Nursing in long term care facilities to Infection Control Practitioners from local hospitals in Manatee County. This seminar will serve to educate these critical points of contact in the community, and DOH-Manatee will distribute the OIP for future use when these kinds of facilities are experiencing outbreaks.
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