1. 1 National Association of Environmental Health Annual Educational Conference & Exhibition Orlando, FL July 14, 2015 Presented By: David Dekevich, MPH – Central Office Melissa Brock, REHP – Brevard County Dana Grissom – Okaloosa County

2. » Integrated Food Safety Centers of Excellence (CoE) » Council to Improve Foodborne Outbreak Response (CIFOR) Toolkit Evaluation » Brevard County Evaluation and Implementations » Okaloosa County Evaluation and Implementations 2

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4. » Serve as a resource for local, state, and federal public health professionals who respond to foodborne illness and outbreaks 4

5. » Strengthen surveillance and outbreak investigations » Analyze timeliness and effectiveness of responses » Train public health staff in proven investigation techniques » Educate future food safety workers » Improve capacity of information systems » Evaluate and communicate best practices 5

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8. http://http://foodsafetyflorida.org/Products.aspx/8

9. » Developed by broad range of experts from local, state, and federal agencies » Aid government agencies responsible for investigating, managing, and preventing foodborne disease 9

10. » Supplement to CIFOR Guidelines » Intended to further the ability of state and local health departments to understand contents of the Guidelines, to self-assess outbreak detection and investigation procedures, and to implement appropriate recommendations 10

11. » Area 1: Relationships » Area 2: Necessary Resources » Area 3: Communications » Area 4: Notification/Complaint Systems » Area 5: Pathogen-Specific Surveillance » Area 6: Initial Steps » Area 7: Epidemiology Investigation » Area 8: Environmental Health Investigation » Area 9: Laboratory Investigation » Area 10: Control of Source and Secondary Spread » Area 11: Food Recall 11

12. » CHD – County Health Department » DACS – Florida Department of Agriculture and Consumer Services » DBPR – Florida Department of Business and Professional Regulation » DCF – Florida Department of Children and Families » ESSENSE-FL – Florida Electronic Surveillance System for the Early Notification of Community-Based Epidemics » FBI – Foodborne Illness » REE – Regional Environmental Epidemiologist 12

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14. Melissa Brock, REHP Environmental Health Director Florida Department of Health 14

15. » Area 2: Necessary Resources ˃Goal: Assess access to personnel, supplies, equipment, documents, and references to initiate a rapid and effective outbreak response. » Area 4: Notification/Complaint Systems ˃Goal: Assess receipt and processing of individual reports of possible FBI from the public that allows timely follow up of possible food safety problems and cluster detection. » Area 7: Epidemiology Investigation ˃Goal: Assess the ability of staff collect, analyze, and interpret exposure information, persons at risk, modes of transmission, and vehicle of outbreak. 15

16. » Current Activities ˃Environmental health (EH) staff food safety certified/registered sanitarians ˃Strike Team Preparedness Training ˃Clerical staff trained to conduct FBI interviews ˃Inspection reports posted on public school websites 16

17. » CIFOR Recommendations ˃Ensure members of outbreak response team know each other +Held introduction meeting with all team members ˃Exercise together to identify gaps in resources and likely problem areas +Well seasoned staff with no turnover ˃Review supplies regularly (at least twice a year and preferably quarterly) and replace missing or expired materials +Established annual review of supplies using toolkit checklist ˃Ensure staff are trained to use complaint logs and analytic software +Training was completed in office in May 2013 ˃Conduct debriefings after large outbreaks +Incorporated into outbreak response ˃Refine outbreak responses based on lessons learned +Ongoing 17

18. » Current Activities ˃Established procedures for collecting FBI complaints, walk- ins, telephone, online complaint form, and poison control ˃Local CHD website has information on reporting FBI and link to online complaint form on the EH site ˃Collect complaint information on statewide tri-agency form ˃Completed complaint forms are sent to local epidemiologist and regional foodborne epidemiologist for surveillance ˃Regulatory agencies receive copy of complaint forms without confidential information for follow up 18

19. » CIFOR Recommendations ˃Routinely distribute press releases regarding food safety that include telephone numbers and website addresses to encourage reporting by the public +Follow statewide press releases. Strong relationships with provider community, hospital infection control staff, 24/7 contact availability. ˃Compile interview data in a single database to facilitate examination of reports for exposure clustering, trends, or commonalities +Created new common use spreadsheet and placed on share drive ˃Check complaint information against national databases (ex. USDA Consumer Complaint Monitoring System) to identify cases with similar characteristics +Ongoing 19

20. » Current Activities ˃Have established policies and procedures for enteric and notifiable diseases ˃Have established policies and procedures for FBI outbreaks ˃Staff trained in conducting epidemiological interviews of diseases ˃Use questionnaires provided by the state for all diseases ˃Utilize regional resources for development of questionnaires specific to FBI outbreak investigations 20

21. » CIFOR Recommendations ˃Exercise outbreak response teams together +Suggestion of Epi staff ride along with EH staff for EH Field Assessment orientation ˃Participate in debriefings after outbreak investigations with all team members to identify lessons learned. +Ongoing 21

22. Dana Grissom Environmental Health & Epidemiology Section Chief Florida Department of Health 22

23. » Area 2: Necessary Resources ˃Goal: Assess access to personnel, supplies, equipment, documents, and references to initiate a rapid and effective outbreak response. » Area 4: Notification/Complaint Systems ˃Goal: Assess receipt and processing of individual reports of possible FBIs from the public that allows timely follow up of possible food safety problems and cluster detection. » Area 7: Epidemiology Investigation ˃Goal: Assess the ability of staff collect, analyze, and interpret exposure information, persons at risk, modes of transmission, and vehicle of outbreak. 23

24. » Current Activities ˃Internal strike teams skilled in Epi and EH ˃Coordination with state public health laboratory ˃FIRST, IFIRST, IFIRST2 training for Epi and EH staff ˃Surge capacity staff members ˃Epi Go Kits available ˃Bad Bug 2012 Exercise conducted on June 8, 2015 to provide increased knowledge and skills in disease investigation and client interviewing for surge personnel ˃Environmental Epidemiologist position hired on February 15, 2013 to bridge Epi and EH 24

25. » CIFOR Recommendations ˃Review supplies regularly and replace missing or expired materials (recommend twice per year and preferably quarterly) +Created several Local Epi Response Teams (LERT) with go kits for each team +Go kits are inventoried on a quarterly basis +Supplies are replaced as needed ˃Obtain tools to analyze outbreak data – Epi Info™ 7 +Epi staff attended Centers of Excellence Epi Info™ 7 Workshop held October 24, 2013 +Epi intern produced templates for reportable diseases 25

26. » CIFOR Recommendations Cont’d ˃Training in outbreak tools +Okaloosa held a Epi Symposium on March 6, 2015 for EH and Epi personnel from Region 1 ˃Provide job descriptions for surge capacity personnel +LERT team members are required to complete Basic Epi Skills Training with DOH-Okaloosa Epi Staff +FIRST, IFIRST1, and IFIRST2 required for LERT team members ˃Involve agency staff in disease outbreak response that might not normally be involved in FBI response +LERT teams include EH, Epi, School Health, Preparedness, and MRC volunteers and can be utilized as needed +Epi and EH staff are currently linked under a single Section Chief and the Environmental Epi position acts as an EH supervisor and Epi Team Lead 26

27. » Current Activities ˃Coordination with Regional Environmental Epidemiologist (REE) ˃Receive health updates from medical providers ˃Public Information Officer conducts press releases if needed ˃Contacts with DCF, DACS, and DBPR ˃Communication with Infection Control Nurses at Local Hospitals ˃Database for complaints and can cross reference to determine clusters ˃Respond to complaints within 24 hours or next business day ˃EH may receive complaints and forward to Epi for investigation ˃Epi On Call 24/7 phone access to Epi ˃Complaint link on DOH-Okaloosa website 27

28. » CIFOR Recommendations ˃Continue and strengthen coordination with infection control nurses at local hospitals +Epi meets with hospital ICPs (Infection Control Practitioners) and military public health annually +North Okaloosa Medical Center joined ESSENCE-FL reporting Feb 25, 2015 ˃Continue relationship with DBPR, DACS, DCF +Coordination with DCF on outbreaks in childcare centers +Constant communication with DBPR and DACS, including joint investigations on FBI complaints – DACS: Shellfish tag and fish invoice retrieval – DBPR: Joint investigations at restaurants 28

29. » CIFOR Recommendations ˃Continue to review complaint procedures to make sure each complaint is investigated +Environmental Epi Position is primarily assigned all food and waterborne complaints +Dedicated folder for all food and waterborne illness complaints filed by name of restaurant and date of complaint – Allows for surveillance and quick identification of clusters +Standard operating procedures designed for food and waterborne complaint investigation +All food and waterborne complaints are interviewed utilizing tri- agency FBI complaint form and forwarded to responsible regulatory agency (DBPR, DACS, DOH, DCF etc.) ˃Continued Coordination with REE +All tri-agency forms for food and waterborne complaints are forwarded to REE +Produces comprehensive reports on foodborne outbreak investigations 29

30. » Current Activities ˃Staff trained in FIRST, IFIRST, and IFIRST2 on interviewing techniques +FIRST and IFIRST training held at DOH-Okaloosa in April 2015 ˃Local Emergency Response Team (LERT) members named ˃Staff with expertise in Epi study design and investigation ˃Written protocols for Epi investigations ˃Communicate effectively and respond in a timely manner ˃Environmental Epidemiologist position coordinates Epi and EH ˃Debriefings after outbreak events 30

31. » CIFOR Recommendations ˃Obtain tools to analyze outbreak data before an outbreak occurs (Epi Info™ 7) +Epi staff attended CoE Epi Info 7 workshop held October 24, 2013 +2015 Epi Symposium to provide training on Epi Info™ 7 to Region 1 Epi and EH personnel ˃Produce templates for investigations +Intern produced templates for reportable diseases ˃Maintain staff knowledgeable in Epidemiology and Epidemiologic Study Design +Awarded Florida Epidemic Intelligence Service (FL-EIS) Fellow in December 2013 for 2 year fellowship 31

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33. 33 David Dekevich, MPH Florida Center of Excellence Liaison Bureau of Epidemiology Florida Department of Health 850-245-4444 ext. 2437 David.Dekevich@flhealth.gov Dana Grissom Environmental Health & Epidemiology Section Chief Okaloosa County Florida Department of Health 850-689-7859 ext. 1110 Dana.Grissom@flhealth.gov Melissa Brock, REHP Environmental Health Director Brevard County Florida Department of Health 321-633-2100 ext. 52322 Melissa.Brock@flhealth.gov Florida Integrated Food Safety CoE www.FoodSafetyFlorida.org www.CDC.gov/FoodSafety/Centers www.CoEFoodSafetyTools.org @FoodSafetyCoE