Integrated Food Safety Centers of Excellence:

Data Driven Best Practices

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National Association of Environmental Health Annual Educational Conference & Exhibition

Orlando, FLJuly 14, 2015

Presented By:David Dekevich, MPH – Central OfficeMelissa Brock, REHP – Brevard County

Dana Grissom – Okaloosa County

Outline

» 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

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Food Safety Centers of Excellence

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

Mission

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Main Activity Areas

» 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

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www.CoEFoodSafetyTools.org

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CoE Quarterly Newsletter

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Food Safety Southeast App

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

» Developed by broad range of experts from local, state, and federal agencies

» Aid government agencies responsible for investigating, managing, and preventing foodborne disease

CIFOR Guidelines For Foodborne Disease Outbreak Response

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» 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

CIFOR Toolkit

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» 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

CIFOR Toolkit Focus Areas

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» 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

Acronyms

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Food and Waterborne Disease Program Regions

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Melissa Brock, REHPEnvironmental Health DirectorFlorida Department of Health

Brevard County

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Focus Areas» 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.

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Area 2: Necessary Resources

» 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

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» 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

Area 2: Necessary Resources

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» 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

Area 4: Notification/Complaint Systems

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» 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

Area 4: Notification/Complaint Systems

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» 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

Area 7: Epidemiology Investigation

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» 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

Area 7: Epidemiology Investigation

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Dana GrissomEnvironmental Health & Epidemiology Section ChiefFlorida Department of Health

Okaloosa County

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Focus Areas» 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.

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» 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

Area 2: Necessary Resources

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» 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

Area 2: Necessary Resources

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» 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

Area 2: Necessary Resources

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» 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

Area 4: Notification/Complaint Systems

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» 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

Area 4: Notification/Complaint Systems

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» 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

Area 4: Notification/Complaint Systems

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» 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

Area 7: Epidemiology Investigation

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» 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

Area 7: Epidemiology Investigation

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Questions?

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Contact Information

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David Dekevich, MPHFlorida Center of Excellence LiaisonBureau of EpidemiologyFlorida Department of Health850-245-4444 ext. 2437David.Dekevich@flhealth.gov

Dana GrissomEnvironmental Health & Epidemiology Section ChiefOkaloosa CountyFlorida Department of Health850-689-7859 ext. 1110Dana.Grissom@flhealth.gov

Melissa Brock, REHPEnvironmental Health Director

Brevard CountyFlorida Department of Health

321-633-2100 ext. 52322Melissa.Brock@flhealth.gov

Florida Integrated Food Safety CoEwww.FoodSafetyFlorida.org

www.CDC.gov/FoodSafety/Centerswww.CoEFoodSafetyTools.org

@FoodSafetyCoE