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02/02/2000 - NEW HANOVER COUNTY BOARD OF HEALTH Dr. Thomas Fanning Wood Memorial Conference Room New Hanover County Health Department AGENDA Date: February 2, 2000 Time: 8:00 A.M. Place: Dr. Thomas Fanning Wood Conference Room New Hanover County Health Department Presiding: Mr. William T Steuer, Chairman p/J-~e5 Invocation: I -- -::r Minutes: Dr Michael Goins January 5, 2000 - Recognitions: - Mr William T Steuer Chairman SUDer Staff Award Carol Drummond, Clerical Specialist, Community Health Personnel New EmDlovees ~ Yolanda (Kaye) Hitko, Physician Extender, Community Health/Jail ~ ANCBH Director Emeritus Members , Carl ~urham (Post.hurnous) - Jt9A r'\ t.tJ/J~r ~ ~ Dr. Michael E. GOInS \, _ ;rJa-II'; f/~ Amaryllis Rehder '.l.. / ..L ~ .5qt"Q Nq,.1t I EC..{-{. '5fuclPl1/l 11l1~rll . Departmental Focal: Food Establishment Permits Ms. Dianne Harvell Envirz~~~ fe', 1')-5"0<<- - j ,~ 1<1 - . . NHCBH Agenda February 5, 2000 Page 2 8--- J Monthly Financial Report: j December 1999 Ms. Cindy Hewett Business Officer Committee Reports: /V - J.-?- ^ Budget Committee (Budget Review and Approval) - Ms. Anne Braswell Rowe 1J( { . Budget Committee Chairman *fu;;::;~ ~(~~'j~""WHIi=TS""~ Unfinished Business: Generators/Hookups at Emergency Shelterel rilr ~ )/ . ?3 Board of Health Committee Appointments ~:B"t;iJ ifll~l~ Comments: - Mr William T Steuer - Mr. William Steuer Board ofHealth Members 1ttttlfh IAre~t j ~. ttf. J.fEfJ ~ ~f€1> -'#/f1tfrR... Health Director ~~ J- ~. ^~ \:'It' - Mr. David E. ~'j........k. O I State Health Di~t rs NCLBIt Meetings - January 20-21 ,2000 fh...o~ ~.fr- rr-'.... ~~ 2. "Doctor To The Front"lDr. Thomas Fanning Wood Presentation - faiillii'ty 7, 2000 vyu 3 Disaster Preparedness Meeting - January 12,2000 {lItC (;/ 4 Cape Fear Area United Way Allocations Team If- A ~ \ 5 Staff Appreciation Luncheon-'h,ct.OO ' · . ,f'5 U. t. f' /./' f 5' 'fCjC, \ · fV(;.,fL 'f). ~'XJI'tIIf?h. "'...MI/,c.../ · F{)ori EdrtC4-a~ p~oA / Other Business: 0' frtJCtJl1 Olio:roe.'.:> CI.fJ. III . Adjourn: ~~~~ Mr William T Ste er ~~ W~~ I I I 106 Mr. William T. Steuer, Chairman, called the regular business meeting ofthe New Hanover County Board of Health to order at 8: 15 a.m. on Wednesday, February 2,2000. Members Present: William T. Steuer, Chairman Wilson O'Kelly Jewell, DDS, Vice-Chairman Henry V. Estep, RHU Michael E. Goins, 00 Robert G. Greer, Vice-Chair, County Commissioners Gela N. Hunter, RN, Nurse Practitioner W. Edwin Link, Jr., RPH Anne Braswell Rowe Philip P. Smith, Sr., MD Melody C. Speck, DVM Estelle G. Whitted, RN Members Absent: Others Present: Mr. David E. Rice Lynda F. Smith, Assistant Health Director Frances De Vane, Recording Secretary Invocation: Mr. William T. Steuer gave the invocation. Minutes: Mr. Steuer asked for corrections to the minutes of the January 5, 2000 New Hanover County Board of Health meeting. The minutes of the January 5, 2000 Board of Health meeting were corrected and approved by the Board of Health. Recognitions: Super Staff Award Mr. David E. Rice, Health Director, presented Carol Drummond, Clerical Specialist, Community Health, recipient of the Semi Annual Super Staff Award. Ms. Drummond received the award in recognition of her public health service. She was nominated by her peers and selected by the Executive Committee of the Board of Health. Association of North Carolina Boards of Health (ANCBH) Directors Emeriti Mr. Rice announced three former members and one current member of the New Hanover County Board of Health were recognized as Directors Emeriti of the ANCBH Annual meeting on January 20, 2000. The Director Emeritus members recognized were Dr. Michael Goins, Mr. John Coble, Ms. Amaryallis Rehder, and Carl Durham (Posthumous). This is an honor bestowed to public health leaders who have served on the ANCBH Board of Directors. Mr. Steuer recognized Dr. Goins, Director Emeriti, for this honor and a round of applause followed. Personnel 1 107 Student Intern Department Focal: I Mr. Rice introduced Ms. Sara Nutt, East Carolina University Intern, who is serving an internship in the Nutrition Division of the health department. Food Establishment Permits Ms. Dianne Harvell, Environmental Health Director, presented a department focal on Food Establishment Permits. She gave the definitions, types of food establishment permits, and exemptions. Ms. Harvell explained permits are issued by the type of establishment and governed by food service establishment regulations. Ms. Harvell advised restaurants are governed by North Carolina General Statute 130-A-248. Private clubs are exempted from the foodhandling regulatons. Upon a transfer of ownership, a transitional permit is issued to any food service establishment. This permit gives the health department an opportunity to get 100% compliance and the new owner an opportunity to meet sanitation requirements. Ms. Harvell explained a great amount of staff time is spent on the review of plans and equipment for food service establishments. Food service facilities are restaurants, foodstands, drinkstands, push carts, mobile food units, school lunchrooms, meat markets, and temporary food establishments. Local Board of Health regulations govern foodstand facilities at public festivals. The North Carolina Department of Agriculture governs curb markets. Ms. Harvell emphasized due to the growth in New Hanover County, the Environmental Health workload I has significantly increased. Restaurateurs pay an annual fee of $25 to the N.C. Department of Environmental Health and Natural Resources, Division of Environmental Health. The state statute prohibits local fees for services related to the permitting and grading of restaurants. Dr. Goins advised the cost of foodhandling inspections and permits are largely county funded. Mr. Steuer asked if the Board of Health would like to confer with local legislators regarding the feasibility of charging higher user fees to foodhandling facilities. Mr. Greer inquired whether the health department receives any of the $25 fees. Ms. Harvell responded Environmental Health receives approximately $10,000 annually. Ms. Hunter concurred state legislators should be asked to review the $25 foodhandling facility fee based upon cost for services. Mr. Greer suggested the Board review this request with Mr. John Coble, Past President North Carolina Restaurant Association, and to ask Mr. Coble to review the fee request with the restaurant association. MOTION: Mr. Greer moved and seconded by Ms. Hunter to present a request to Mr. John Coble for the consideration of the North Carolina Restaurant Association to increase in the $25 annual foodhandling fee or to request the support of a petition for legislators to change the state statute to allow the establishment of local user fees for Environmental Health foodhandling services based upon cost. Mr. Steuer requested Mr. Rice prepare a letter to Mr. Coble regarding the above proposed fee increase or petition for a change in state statute to allow the local user fees for Environmental Health foodhandling services. Mr. Steuer thanked Ms. Harvell for her presentation. I 2 I I I 108 Monthlv Financial Report - December 1999 Ms. Cindy Hewett, Business Officer, referred the Board to a chart and a summary of the December Revenue and Expenditure Reports. She reported the monthly reflects the expenditure and revenue line items are on schedule. Committee Reports: Budeet Committee Budeet Review and Approval - FY2000-2001 Mr. Steuer recommended from the Executive Committee for the Board of Health to approve the FY 2000- 2001 New Hanover County Health Department Budget as presented. He explained the Executive Committee endorsed purchasing a 4x4-conversion van for Animal Control Services instead of a 4x4 pickup truck at a cost increase of $500. This change is included in the budget request. Ms. Cindy Hewett, Business Officer, gave a Power Point summary of the Health Department FY2000- 200 I Budget Request ($10,192,451). A projection for salary market adjustment or merit were not included. The budget overview included summaries of expenditures, capital outlay requests, projected salary and fringe for 20 new positions and 1 position increase from part-time to fulltime, and projected revenue. Ms. Hewett presented Program Expenditure Changes from FY 1999-2000 excluding Salary and Fringe Benefits. The total increase in expenditures is $286,534 (14%). The Capital Outlay request is $594,334, a 6% decrease from FY 1999-2000. Computer Equipment Requests are ($215,350). Other Capital Outlay requests ($454,934) include 2 mowers, 2 trucks, 2 conversion vans, 1 electronic gate, 2 generators, 1 transport unit, 1 storage unit, 1 concrete patio, 1 partition for auditorium, 1 fire/smoke alarm suspension system, 12 workstation cubicles, 1 paper tray for copier, 2 copiers, 1 audiometer, 1 case management module, and 9 workstation cubicles. Mr. Greer inquired why the Administration budget increased approximately $140,000. Ms. Hewett explained all computer requests and building improvements were placed in Administration budget request. She advised that she consulted with the New Hanover County Information Technology Department to assess health department computer needs to provide a more comprehensive computer system. The Computer Support Specialist new position request is to provide technical support for the personal computer based environment. Ms. Hewett reported Projected Salary and Fringe ($644,171) includes 20 new positions and one part-time to full-time position. The county appropriation ($247,779) is for 8 new positions and I part-time position. Ms. Betty Creech, Community Health Director, advised the Board of Education will fund 9 Public Health Nurse and 1 clerical position requests. Dr. Goins endorsed the need for additional School Health Nurses. Ms. Creech informed the Licensed Practical Nurse position is needed in the Jail Health Program that is not meeting state requirements. The National Commission on Correctional Health Care identified additional nursing staff is needed for the Jail Health Program. Ms. Hunter stated speaking from 3 109 experience it is a disservice to Hispanics not to provide an interpreter and that the new interpreter position will be cost effective. Mr. Steuer stated new positions requests are essentially what is needed to perform agency duties. He expressed the budget request is a minimum request. Mr. Greer stated he knew the positions and requests were probably needed. He expressed concern regarding the possible expiration of grant funding, the fast growth of government services, and budget expansion every year. He reported the County Commissioners will have a retreat this weekend and address the county's growth and needs. Ms. Hewett gave the following Budget Summary Report: Total Cost to New Hanover County Salary and Benefits Operating Expenses Capital Outlay $ 7,857,281 1,741,399 594.334 Total Expenditures $10,192,451 Difference from FY99-00 $ 930,698 Total State/Federal Revenue $ 4,402,776 Difference from FY99-00 $ 486,768 Total Increase to County $ 443,930 Ms. Hewett explained the net county increase ($443,930) is an 8.30% increase. She presented the following projected Revenue Report: Summary of Projected Revenue State Money Fees Medicaid Other ($ 55,884) 2,500 71,663 468.489 Total Increase in Revenue $486,768 Ms. Hewett reported the projected revenue ($486,768) is a 12% increase. Ms. Rowe thanked the Budget Committee and health department staff for their work on the budget. The Board of Health Budget Hearing will be at the County Commissioners meeting on May 15,2000. Mr. Steuer thanked Ms. Rowe for serving as Chair of the Budget Committee, the Budget Committee, and Ms. Hewett for her budget presentation. I I I 4 I I I 110 MOTION: Mr. Steuer moved from the Executive Committee for the Board of Health to approve the FY 2000-2001 New Hanover County Health Department Budget as presented. Upon vote, the MOTION CARRIED UNAMIOUSL Y. Executive Committee Mr. Steuer, Chairman, Executive Committee, reported the Executive Committee met at 7:00 a.m. prior to the Board meeting on Wednesday, February 2, 2000. Items are listed under New Business on this agenda. Unfinished Business: Generators/Hookups at Emereencv Shelters - Meetine February 21 Mr. Steuer reported by June 2000 according to the project timeline electrical transfer switches will be installed in the schools used for disaster shelters. A meeting is scheduled for February 21, 2000, to address generator/hookups expenses. New Hanover County Board of Health Committee Appointments Mr. Steuer appointed the New Hanover County Board of Health Committees for the Year 2000. The committee assignments are as follows: Executive Committee Mr Wilham T. Steuer, Chairman Dr. Wilson O'Kelly Jewell Mr. Henry V. Estep Mr. W. Edwin Link Ms. Anne Braswell Rowe Personal Health Committee Mr. Henry V. Estep, Chairman Dr. Wilson O'Kelly Jewell Ms. Gela N. Hunter Ms. Estelle G. Whitted Dr. Melody C. Speck Budeet Committee Ms. Anne Braswell Rowe, Chairman Animal Control Services Advisory Committee Dr. Melody C. Speck Environmental Health Committee Mr. W. Edwin Link, Chairman Ms. Gela N. Hunter Dr. Michael E. Goins Ms. Anne Braswell Rowe Dr. Philip P. Smith, Sr. Association of N. C. Boards of Health Dr. Michael E. Goins Mr. Steuer thanked the members for accepting Board of Health Committee appointments. New Hanover Board of Health Compensation Mr. Steuer recommended from the Executive Committee for the Board of Health to consider the concept of increasing the monthly allowance for the Chairman and the Board of Health members with the amount of the allowance to be determined after accessing the compensation of other comparable boards. He 5 111 confirmed the monthly allocation for Board members is currently $20 and for the Chair is $25 and has not been increased since 1982. I A discussion followed on the considering a monthly increase for the Board Chair and members. Dr. Speck expressed she views serving on the Board a community service and not monetary. Dr. Smith and Ms. Whitted concurred with Dr. Speck. Dr. Goins suggested if the allocation is raised, there should be a greater differential between the allocation increase for the Chairman and the Board members. Mr. Steuer stated his concern was not compensation; however, increased compensation might be an incentive to get qualified people to continue to serve on the Board of Health. MOTION: Mr. Steuer moved from the Executive Committee for the Board to consider the concept of increasing the monthly allowance for the Chairman and the Board of Health members with the amount of the allowance increase to be determined after accessing the compensation of other comparable Boards. Upon vote, the MOTION CARRIED UNAMIOUSL Y. Mr. Steuer requested Mr. Rice submit a report to the Executive Committee on the compensation of other Boards of Health and comparable agency boards. Health Director's Performance Appraisal Mr. Steuer distributed Performance Appraisal forms for the evaluation of Mr. Rice, Health Director. He requested the appraisals be completed and returned in the self-addressed envelopes by February 15, 2000. I Mr. Steuer explained there is a rating scale of 1 to 5. The rating scale is as follows: 1. Exceptional, 2. Above Expected, 3. Expected, 4. Needs Improvement, and 5. Unsatisfactory. Dr. Goins stated the evaluation process is a valuable tool. It lets the employee know areas of good performance and improvement. Mr. Greer advised expected is standard norm. Mr. Steuer emphasized the importance of a fair evaluation. The Board of Health was asked to comment on how they scored. Mr. Estep emphasized the importance of obtaining a quantitative value since it could be mean the difference between being awarded or penalized. Mr. Greer stated this is a very valid statement, since you don't want the rating to look anymore or less than it is. The Board of Health agreed to submit comments on all ratings other than 3 (Expected). Based on a better understanding of the rating scale, it was acknowledged that the Health Director's performance would be rated higher compared to last year's process. Comments: Board of Health Members ,or. Smith encouraged Board members to obtain flu shot prior to the next flu season. Mrs. Rowe announced the Health Department Budget Hearing with the County Commissioners is scheduled for May 15, 2000. Ms. Smith will notify the Board of a definite time to attend the morning meeting. I 6 I I I 112 Health Director State Health Directors/ANCBH 14th Annual Meetine: - January 20-21.2000 Mr. Rice reported Dr. Jewell and he attended the Annual Association of North Carolina Boards of Health (ANCBH) and Annual N. C. State Health Director's Conference held on January 20-21, 2000, in Raleigh, North Carolina. The State Health Directors focused on "Emergency Preparedness - How Well Are We Prepared?" The ANCBH topics were Dental Health Access in North Carolina: "Where is the Tooth Fairy?" and County Dental Health Access Experiences". Dr. Jewell reported the demands for dental access is a statewide Issue. "Doctor to The Front: Dr. Thomas Fannine: Wood Presentation - January 7. 2000 Ms. Rowe, Ms. Smith, and Mr. Rice attended the "Doctor To The Front"/ Dr. Thomas Fanning Wood Presentation on January 7, 2000, held at the Cape Fear Museum. Mr. Donald Koonce presented it on his grandfather, Dr. Thomas Fanning Wood. Dr. Wood was known as the Father of Public Health in North Carolina. Disaster Preparedness Meetinf: - January 12. 2000 Mr. Rice, Ms. Betty Jo McCorkle, Women's Health Director; and Ms. Dianne Harvell, Environmental Health Director, attended a Disaster Preparedness Conference for Health Directors held in Greenville, North Carolina. The focus of the meeting was to explore how state and local agencies can work together in future hurricanes. Press releases are to be prepared in advance. Cape Fear Area United Way Allocations Team Mr. Rice reported he plans to serve on the Cape Fear Area United Way Allocations Team. Staff Appreciation Luncheon A tentative date of April 6 was proposed for the Health Department Staff Appreciation Luncheon. Since April 6 is Azalea Festival, another date will be selected and announced. Animal Control Services Update Ms. Jean McNeil gave an update on the Animal Control Services (ACS) concerns. She expressed her appreciation for the new ACS positions. Ms. McNeil reported the backlog of data from June 1999 - December 1999 has been entered, reminder cards were sent to residents, and pre-citation letters for November 1999 licensing were mailed on January 21,2000. The ACS staff is working with a collection agency to process delinquent account citations. Ms. McNeil advised approximately 600 field citations dating back to August 4, 1998 will be processed by a collection agency. Mr. Rice advised Mark Boyer, New Hanover County Public Information Officer, will prepare press releases for ACS. Dr. Speck requested media releases are sent to local veterinarians. Board of Health Information Mr. Rice referred the Board to information in their packet on ACS Update, NCALHD Resolution (Brunswick, Davidson, Rowan and Watagua Counties), Food Education Packet, and a Roster of ANCBH Directors Emeriti. 7 Other Business: There was no other business. Adjournment: Mr. Steuer adjourned the regular meeting ofthe New Hanover County Board of Health at 10:35 a.m. //~ (/ ~ William T. Steuer, PE/RLS, Chairman New Hanover County Board of Health David E. Rice, M.P.H.,M.A., Health Director New Hanover County Health Department Approved: March 3, 2000 113 I I I 8 . . . Health Director Coastal AHEC Board of Directors Ms. Smith announced Mr Rice was selected to serve on the Board of Directors of the Coastal Area Health Education Center NCALHD Plannin!! & Policv (Le!!islative Committee) Ms. Smith advised Mr Rice was appointed to serve on the Policy and Planning Committee of the N. C. Association of Local Health Directors. ANCBH 14th Annual Meetin!! - January 20-21,2000 The Annual Association of North Carolina Boards of Health (ANCBH) meeting will be held on January 20-21, 2000, in Raleigh, North Carolina. The topics are Dental Health Access in North Carolina: "Where is the Tooth Fairy?" and County Dental Health Access Experiences" A reception will be held on Friday, January 20 at the Sheraton Capitol Center Hotel. The Annual N. C. State Health Director's Conference - Januarv 20-21. 2000 The Annual N. C. State Health Director's Conference will be held in conjunction with the ANCBH meeting. The topic is "Emergency Preparedness - How Well Are We Prepared?" It will be held at The McKinnon Center in Raleigh, North Carolina. Board of Health members were invited to register and attend the ANCBH 14th Annual Meeting and the Annual N.C. State Health Director's Conference. Blood Drive Ms. Smith reported the Winter County Blood Drive was held yesterday, Tuesday, January 4 Board of Health members may donate blood at the Red Cross Center through January 21 Danl!erous DOl! Determination Hearinl!s Reoort Ms. Smith referred the Board to the Animal Control Services Dangerous Dog Determination Hearings Report in their Board packets. Time Caosule Board members were invited to a Millennium Time Capsule Ceremony to be held at 8:15 a.m. on January 6, 2000, at the Health Department. A Millennium Memories Time Capsule containing items from each division will be buried at the Administration front entrance to mark the Health Department's entrance into the new millennium. Museum Pro!!ram 1/7/2000 on Dr. Thomas Fannin!! Wood 11 a.m. Ms. Smith announced Mr. Donald Koonce, scholar and Wilmington native, will present a program on his research on Dr Thomas Fanning Wood, known as the Father of Public Health in North Carolina, at 11 a.m. on January 7, 2000 at the Cape Fear Museum. Dr. Wood was the founder and organizer of the first North Carolina State Board of Health located in Wilmington. " 6 . . . New Hanover County Health Department FY99-00 MONTHLY REVENUE REPORT As of December 31, 1999 Summary lor the New Hanover County Health Department Cumulative % 49.98% Month Reported Month 6 of 12 Dee 99 CuneD! Year Prior Year Type of Budgel8d Revenue Balance % Budgel8d Revenue Balance % Revenue Amount Earned Remaining Amount Eamed Remaining Federal & State 1,333,781 632,196 701,585 4740% 1,365,798 607,138 758,660 44.45% AC Fees 516,453 174,260 342,173 33.75% 493,100 175,760 317,340 35.64% Medicaid 852,684 324,703 528,181 38.07% 624,754 294,460 530,294 35.70% Medicaid Max 192,301 192,301 100.00% 250,066 250,065 1 100.00% EH Fees 312,900 108,768 34.76% 238,000 114,223 121,n7 48.40% Heakh Fees 109,515 65,611 59.91% 98,065 55,472 42,593 58.57% Other n5,ln 396,489 51.15% 566,457 323,4n 242,980 5711% Note: County Appropriation is not calculated above. The County appropriation is the dlfferance between the tolalamounts on the program expendfture report and the totsls on the program revenue report. The budgetad amount for County Appropriation for FY 99 - 00 Is ($9,379,936 - $ 4,093,006) c $ 5,286,930. The expended amount for County Appropriation for this FY (year-to-<late) is ($3,9n,098 - $1,894,348) c $ 2,062,750. Revenue Summary For Month of December 1999 8 . . . New Hanover County Health Department FY99-00 MONTHLY EXPENDITURE REPORT As of December 31,1999 Summary for the New Hanover County Health Department Cumulative % 49.98% Month Reported Month 6 of 12: Dee-99 Current Year Prior Year Expended Balance % Budgeted Expended Balance % Amount Remaining Amount Amount Remaining Typa of Expenditure Budgeted Amount Salary & Fringe Operating Capftal Outlay Expenditure Summary For Month of December 1999 9 e. DAVID E. RICE, M.P.H., M.A. Health Director To: From: Date: Subject: NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 SOUTH 17TH STREET WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6500, FAX (910) 341-4146 Evaywherc. Everyday. Everybody. LYNDA F. SMITH, M.P.A. Assistant Health Director New Hanover County Board of Health Executive Committee Cynthia Hewett, Business Officer~ January 19,2000 Budget Workbook Fiscal Year 00-01 . Enclosed is your Budget Workbook for Fiscal Year 2000-2001. The first 12 pages provide summaries of the information contained within the workbook. Our total Budget Request FY 2000-2001 is $10,191,951. This is an increase 0[$930,198 from the Approved Budget FY 00 amount of$9,261,753. A significant portion ($644,164) of the increase is due to the request for 20 new positions, along with, the increase of one position from part-time to full-time status. Revenues through federal and state grants, fees, Medicaid, and other sources show an increase of $486,786. The net increased cost to the county is $443,430 (8.30%). The budget request does not include a projection for salary market adjustment or merit. Our Budget Request FY 2001 is due to the County Budget Office on February 15,2000; for review by the County Manager, Allen O'Neal, and his Budget Committee. In May we will receive the County Manager's Recommended Budget FY 2001 for the Health Department. Any revisions to our original Budget Request will be presented to you at a later date. On May 15,2000, a Pubic Hearing on budget is scheduled and you will have an opportunity to appear before the Commissioners to discuss budget matters. . c: Board of Health Budget Committee David E. Rice, Health Director Lynda F. Smith, Assistant Health Director Health Department Management Team MWOiH' ~ - 'l1k~M 10 ~l.\.dqE;+ WOR.kbod<... TABLE OF CONTENTS . Index Summary of Expenditures and Revenues Salary and Fringe for Requested New Positions Temporary Salaries and Overtime' On-Call Capital Outlay Requested Summary of Computer Requests Operating and Capital Outlay Revenues Organization Line Items and Revenue Requests 5111 Environmental Health 5112 Vector Control 5114 Animal Control 5121 Laboratory 5131 Administration 5132 Board Members 5133 Child Health Services Coordination 5141 Women, Infants and Children 5142 Nutrition 5151 Epidemiology 5152 Tuberculosis 5153 Teen Aids Prevention 5154 Intensive Home Visitation Program 5155 Child Health Child Care Consultant 5156 Komen Grant 5158 Temporary Aid to Needy Families 5159 Maternity Care Coordination 5160 Health Check 5161 Personal Health 5162 Maternal Health 5163 Family Planning 5165 Breast and Cervical Cancer Control Program 5166 Partnership for Children 5167 Child Health 5168 Dental Health 5169 School Health 5172 Neurology 5174 Jail Health 5178 Children's Special Health Services 5180 Risk Reduction 'Injury Prevention 5181 Project Assist 5182 Health Education 5183 Safe Communities Temporary Salaries Overtime' On-Call Salaries New Position Requests . . 1 2 3 4 5 6-10 11 12 13-420 13 34 52 79 89 110 116 129 143 153 176 191 200 213 222 230 238 246 257 270 285 302 309 320 333 342 355 365 377 389 398 408 419 421 431 441 11 . oj - 'I: QI E .. 0 - e QI i . ::l '" '6' c '" ",en.,. ~ CD '" .. 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E ~ = .. ~ i! tl i 1 i ~ i ~ iZ ~ :! .a D:: i E U :i ;; ~ 'e' = -Ii 0 ~ 0 0::: 0.. ::t lI) I- m ~ m m ~ ~ ~ 2 ~ ~ g in in in in in in :;; in in in in 22 . . . NEW HANOVER COUNTY BOARD OF HEALTH Committee Assignments 2000 Executive Committee: Mr. William T Steuer, Chairman Dr. Wilson O'Kelly Jewell Mr. Henry V Estep Mr. W Edwin Link Mrs. Anne Braswell Rowe Bndl!et Committee: Member Division Mrs. Anne Braswell Rowe, Chairman Administration Mr. William T. Steuer Animal Control Services Mrs. Gela N. Hunter Child Health Services Dr. Melodv C. Soeck Communicable Disease Dr. Philip Palmer Smith, Sr. Communitv Health Dr. Wilson O'Kelly Jewell Dental Health Mr. W. Edwin Link Environmental Health Mrs. Estelle G. Whitted Laboratorv Dr. Michael E. Goins Nutrition Mr. Henrv V. Estep Women's Health Care Envlroumeutal Health Committee: Mr. W. Edwin Link, Chairman Mrs. Gela N. Hunter Dr. Michael E. Goins Mrs. Anne Braswell Rowe Dr. Philip Palmer Smith, Sr. Personal Health Committee: Mr. Henry V Estep, Chairman Dr. Wilson O'Kelly Jewell Mrs. Gela N. Hunter Mrs. Estelle G. Whitted Dr. Melody C. Speck Animal Control Services Advisorv Committee Dr. Melody C. Speck Association of NC Boards of Health Dr. Michael E. Goins 23 . . . - . . . . -===fAWgjgJ~ - - 1999 l\.oster of I!Hrectors <!emeriti (or tbe ~!)!)ociation o( ~ortb Q[arolina jBoarb!) o( ~ealtb c The Director Emeritus is an honor that is bestowed only on those leaders in public health who have served on the ANCBH Board of Directors. Directors Emeriti are entitled to: . Attend all Board of Director meetings and functions . A lifelong subscription to the ANCBH newsletter . Receive the ANCBH annual meetings at no charge . Be guests of honor at an annual reception . Be represented on the current Board of Directors (The retiring ANCBH past president will automatically serve as the Directors Emeriti representative.) Margery Adams Suzy Conner Catawba County Davidson County ( 1986-1987) (1991) Lee Barro, M.D Shirley Cooper C Gaston County Cumberland County (1995-1997) (1986-1987) Ruth Brandon F Payne Dale, M.D Buncombe County Pitt County (1986-1991 ) (1986-1991 ) Bill Buchanan, CPA Jane G. Doughton Nash County Appalachian District ( 1993-1997) (1991-1994) Walker Campbell, M.D Hattie Ellis Wayne County Wilson County (1986-1987) (l988-1992) Moses Carey, J.D Howard Fitts, Ed.D Orange County Durham County (1989-1991) (1988-1994) Donald Carney Judith French Iredell County Caldwell County (1994-1996) ( 1986-1988) Carolyn Carpenter Michael E. Goins, OD Cabarrus County New Hanover County (1992-1995) (1991-1992) Paula Chewning-Bass Jean Gosnell Pender County Davidson County (1992-1996) ( 1986-1987) Dolores Clement Mozelle Hall Durham County Yadkin County (1986-1991 ) (1990-1991 ) . . . aLftf,David E Rlc:e T'fr 01/27/2000 11:17 AM '. ~~"..,~",~:-~;:,.." ~~;;' "'" 'H;<I~,\r"'~< ..~~~~"!:" "\<IIIlta,'I'....~,;,,,k>...t<"';~..'-""',.:"~~q'~"-'.,.. To: Pat Melvin/NHC cc: Lynda Smith/NHC, Jean McNeil/NHC, wsteuer541@aol.com Subject: Re: Animal Control Services Update Pat, Attached is the requested update for the Board of County Commissioners, I will give this update to the NHCBH at its meeting on February 2, Thanks for all your help, Dave Rice :.) til , 999-?000 lie!! t .......___......___... Forwarded by David E RicelNHC on 01/27/2000 11:26 AM .---......---.---.....---.. Jean McNeil 01/27/200010:35:28 AM To: cc: David E Rice/NHC@NHC Subject: Re: Animal Control Services Update The following is a copy of the information we discussed concerning ACS's implementation of the new Chameleon software and the county licensing fee process, at r.hmr.t.vr.om New Hanover Countv Health DeDartment Animal Control Services UDdate Representatives from Health, Finance, Information Technology, Legal and the County Manager's Office have been meeting regularly to implement and resolve Animal Control If' Services (ACS) concerns. Many thanks to the Board of County Commissioners for adding new positions to the (i ACS staff. The Accounting Technician II's have already been utilized to bring the \J backlog of licensing data to current status. They will also be instrumental in implementing the licensing procedures. . . Thanks also to the County Commissioners for approving the new software system, Chameleon, which is being utilized to maintain licensing and rabies information on county residents. The ACS staff worked diligently to learn the new program, and ACS went live with the software on October 4, 1999. (Some Chameleon users in other states were not able to utilize the licensing portion of the program for six months to one year after going live.) . The backlog of data from June 1999 until October 1999 was brought to current status in December 1999 by county staff and temporary help. The Accounting Technician II positions are continuing with data entry. . Reminder cards have been sent to residents on a monthly basis to give them an . opportunity to update their animal's licensing information. These will soon be reformatted to letterform, so the general publiC more easily understands the reminder. . November 1999 rabies data will be the first order of business in dealing with computer- generated letters, citations, and subsequent collections or small claims court, . Pre-citation letters for November 1999 licensing data were mailed out on January 21, 2000. These letters will be utilized to cleanse the system of inaccuracies in the data. Those residents that fail to bring their account to C\.IITert ~tatus wi" be mailed citations in mid to late February 2000. " , . . ACS staff met with a representative from Reilly-Gregory Collection Agency on Wednesday, December 15,1999. The Legal Department and ACS will collaborate with the collection agency to process delinquent account citations, . There are approximately 600 field citations dating back to August 4, 1998, which will be turned over to the collection agency for processing as a test group of delinquent accounts. . , o, J . . . l~U1\.l n \..;/U\.ULll"lf\. f\.~.h3\.J\....1.t\.11Vl"t vr LU\....J-\L nr...t\.L 1 n .LIll'\.n\.... 1 VA.3 ri:tgt:: 1 UJ.J MINUTES NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS Executive Committee Meeting tJirt~ fJ ~ 10 'RfJIf ~~~ ~6:r~ ~d~O CALL TO ORDER - President Maggie Dollar called the meeting to order a : 10 am and announced that the Association would need to fmd other m ting room arrangements next year. (See Attachments, Attendance Roster.) November 18, 1999 Wake Co. Public Health Center Raleigh, MC APPROVAL OF MINUTES - Wayne Raynor presented the minutes of the October 20. 1999 Full Association Meeting. Minutes were approved as submitted with two corrections "formally" instead of formerly and "slate" instead of state. TREASURER'S REPORT - Wayne Raynor presented the Treasurer's Report which was approved as presented. (See Attachments) ANNOUNCEMENTS Dr. Ann Wolfe gave an update on Department cuts/revisions mandated to assist counties adversely affected by Hurricane Floyd. Jim Baluss thanked everyone for all the support rendered to Edgecombe County during recovery from Hurricane Floyd. President Dollar announced that funding for Health Check positions was never approved. COMMITTEE ACTION ITEMS . Education 61 Awards Curtis Holloman encouraged members to nominate individuals for the Ham Stevens Award which is to be presented at the January 2000 State Health Director's meeting. Nominations must be received by December 31, 1999. . Nominating 61 Bylaws http://ncalhd.comlncalhd/I999/nmII1899.htm 01124/2000 l"tUK 111 L.f\..KULll'li\. 1\.~~UL.ll\.llVl"l vr LV\....J-\.L n.r..J-\.L 1 n U.l.lU::,"-' 1 V~ .1 G!;~ ~ V.1 J , No Action Items. . . Environmental Health Committee No Action Items. . Epidemiology Committee No Action Items. . Hospital Association Network No Action Items. . Managed Care 61 Reimbursement No Action Items. . Policy 61 Planning No Action Items. . State 61 Local Relations No Action Items. . . Technology No Action Items. . Women's 61 ChUdren's Health Wanda Sandele provided an update regarding minors consent to health services. She discussed a resolution that came from Commissioners in Rutherford County (not passed by that board) was mailed to all County Commissioners urging them to pass it and forward it to the Commissioners' Association. The resolution calls for the Legislature to repeal the statute that protects the confidentiality of minors seeking birth control at Health Departments. The resolution was passed by Davidson County without the item requiring the Health Department to prepare a position paper in support of the resolution. Wanda presented a resolution "Access to Preventive Health Care for Minors" (See attached Resolution). Some discussion ensued regarding the timeliness of presenting the resolution to the legislature. Motion: It was agreed that the NCALHD should take the position at present but proceed no further with regard to formally taking the issue . to the MCACC at the present time. Motion passed. http://ncalhd.comlnca1hd/I999/nmII1899.htm 01124/2000 , . . . -. .- -- -- -- --.......-.-.- NOR.TH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS RlI'JilOL1JTION ACCESS TO PREVENTIVE REALm CAllE FOil MINORS WHEREAS minors in the state ofNortb. Carolina have had the legal rigb& to .. preventive health eare services without parental COllSllDt since the passage ofGS 90-21.5 in 1971, and this rigbs appears to have coJdribuIeCl sipiticamty to lmproveme:J'tJlln the health status ofyouIl& people- partiGl1larly In the rdudiou of North CaroliJl&'s teeD pregnancy ~ and WHERE.AS the North Carolina MIlO_on of Local HAlthDirectorB IJI'!lClI its membm who serve minors to rounseI JDinors to involve their puentaln decisions about their health care rat1u:r than requiring such involvement. WHEREAS many minors do IIlJt have eitbm'the suppcnt or &dvico of their parents on seeking preventive services and are thus at high-risk of poor health outc:omea inducting preguancy and 'O"lIally trBDsmitted diseud; and WHBllEAS statistks OIl teeD 88lWal behavior iJpHeote that teeD8 typically are sexually active for approximately one year before .-lnng reproductive beaIth care thus diaptoviDI the IISIUsnption that prD\'ld1ng sud! care e.nc:ourapll teeDI to bet1oIDI' 88lWally active; and WHEllEAS statiatica also indicate that the rca:nt reductions in teen pregnancy rates are largely the result of teens Ilrilizi1lg efl'ective CClIItlUllpIive matbocls which are available only with prescriptions thus RqUiriDs a c1IIIIca1 vi~ II!Id WHBltBAS t_ pregIWICiea often resuh In economic and hea1tb problems both for the YOUDg parents II!Id the babies involved; IlIId WHEREAS denying minors the right to _It preventive servicea without parental IlODSent snay resu1t in the Ion of approltimately SS million _""ony in Federal Title X funding for fiunily rl.....l"g-thus severely limiting access to tlIlnIly planniDB to low- ineome adults as well as to minors; now therefbre be It RBSOL VED that the North CarolIna Assoaiatiou of Local Bea1thDireCtOrs qrp the North Carolina GcnenI Assembly to maintAin Icgia1ation wbicb p.utelllS the abilily of snlnDrs to seek preventive health care; IlIId be iJ further. Margaret B. Dollar President /.-8 . I NEW HANOVER COUNTY HEALTH DEPARTMENT WINTER 1999 c Norwalk virus: A major microscopic menace. Also in this issue... Illness Reporting-It's better to be safe than sorry Page 2 Virology 101- The dirt on Norwalk and hepatitis A viruses Page 2-3 Hepatitis A-A good news/bad news organism Page 3 Hands Oll?- The bare facts about handling food Page 4 ( \ Copyrighl1999 Pike & Fischer, Inc. 800-255-8131 Meet the New Public Enemy #1 Do you know the leading cause of foodborne illness? No, it's not Salmonella or E. coli 0157:H7 The culprn is a group of organisms you may have never heard of before, but you or one of your co-workers may have had a hand in helping it earn its top billing. Norwalk-like viruses (NLVs) were recently identified by the COC as being-by far-the biggest known cause of foodborne illness. COC estimates that NLVs (sometimes called caliciviruses or small round structured viruses) in food make over nine million Americans sick each year wnh viral gastroenteritis-that yucky "stomach flu" that includes watery diarrhea and vomning. Gastroenteritis is second only to the common cold as a cause of illness. How are NLVs spread? Quite easily, thank you, by that unpleasant fecal-oral route. The feces of infected individuals may contain millions of viral organisms, only about 10 of which are required to make someone sick, according to Dr. Stephan Monroe, a viral disease expert at COCo Just because you can't see feces on your fingers doesn't mean it's not there, he said, noting, "Food workers need to keep stool material out of the food they're serving customers by paying rigorous attention to personal hygiene." Some NLV outbreaks are blamed on shellfish and produce contaminated before harvest, but often the contamination occurs right before the food is eaten when it is touched by an ill food worker. When FDA looked into all recent outbreaks linked to food worker contamination of food, 60% were caused by viruses, and almost all involved a sick food worker. Close to 90% of the outbreaks occurred in food service settings. If NLVs are so common, why haven't we heard of them before? Only in the last 10 years or so have we had the detection tools needed to easily detect these viruses. The Norwalk virus, part of the NLV family, is named after Norwalk, Ohio. That's where, in 1968, 100 elementary school children and their teachers fell ill with a mystery illness. It took four years for researchers to identify the agent, marking the first time a virus turned up as a cause of gastroenteritis. Because NLVs cause relatively mild and fleeting symptoms, the illnesses are often not reported or diagnosed. It was only this year that COC included NLVs in its disease statistics and estimated they caused a whopping 67% of all foodborne illnesses and 7% of the foodborne-related deaths. What can food workers do to stop the spread of NLVs? Most importantly, ill food workers must not be allowed to handle ready-to-eat (RTE) foods or come inlo contact with food prep surfaces. All workers, even if they feel fine, should avoid touching RTE foods with their bare hands by using gloves or other utensils, and they should wash their hands frequently. The Food Code stales that food workers should telllheir employers if have diarrhea, fever, vomiting, or jaundice. It is the manager's job to make sure sick empioy- ees are either sent home or assigned to tasks that don't involve food contact. Sometimes food workers have no symptoms but may still be shedding disease- causing organisms in their feces. "That's why good personal hygiene is critical at all times," Monroe said, "whether a food worker is ill or not." FOOD TALK WINTER 1999 IL '---/ Better Safe Than Sorry Your new shift just came on duty and you realize you're short two employees. Just 20 minutes into the shift, one of your best employees comes to tell you that she's not feeling well. She tells you her stomach is cramping and she feels nause- ated. What do you do? Tell her to go home? Or keep her on duty because you are shorthanded? The "cure" is to play it safe-send the employee home or to a doctor. It's much better to ask your customers for patience because you are short- handed, than to risk an outbreak. Keep in mind, the FDA states in the 1999 Food Code that an employee should be "excluded" from work if he or she is diagnosed with an illness due to: . Salmonella Typhi, . Shigella spp., . E. coli0157:H7 or . Hepatitis A virus. Employees should be restricted from handling food if they have the following symptoms: . Diarrhea, . Fever, . Vomiting, . Jaundice or . Sore throat with fever. Food workers should feel obligated to tell their bosses when they are sick, and employers should feel obligated not to risk the safety of their customers or employees, according to Tim Weigner, manager of food safety programs for the Food Marketing Institute. Instilling this sense of obligation is the job of top management, he said. The price to a business for keeping sick food handlers on the job, particularly if they are later found to have a communicable disease, can be quite steep, he said. But how do you getan employee to report illness? "That's the $64,000 question," according to David McSwane, food safety training specialist at Indiana University. "The illness reporting policy has to be fair-you do not want to penalize workers for admitting they're ill," he said. "Workers do not want to lose the income associated with not being able to work. It may be to management's advantage to pay an employee not to become ariskrather than payout a settlement after'an outbreak." What do you do with an employee showing mild symptoms? A practical solution is to reassign that employee to non-foodhandling tasks. It's also important to reinforce proper handwashing with employees. "Good hygiene can cure a lot of ills," McSwane said. Keep in mind the cost of a foodborne outbreak on your customers, your employees, your bottom line, your reputation, and your survival in the busi- ness. It is better to be safe than sorry. , Estimated Annual Food-Related Illness and Death In the U.S. AGENT Bacterial (e.g., Salmonella, Campylobaetef) Parasitic (e.g., Giardia, Cryptosporidium) Viral (e.g., Norwalk.like, Hepatitis A) ILLNESSES HOSPITALIZATIONS DEATHS 4,175,565 36,466 1,297 357, 190 3,219 383 9,282,170 21,167 129 Total: 13,814,924 60,854 1,809 Source: CDC's "Emerging Infectious Disease Journal: Sept./Oct. 1999. WHAT YOU NEED Norwalk-Like Viruses Agent: Norwalk-like viruses are a family of small round structured viruses, including the Norwalk virus, that cause gastroenteritis. Symptoms/Onset: The symptoms of gastroenteritis (nausea, vomiting, diarrhea and abdominal pain) usually develop 24-48 hours after contaminated food or water is consumed. Symptoms are relatively mild and last for 24- 60 hours. However, the virus may still be shed for 48 hours after symptoms disappear. Common Causes: NLVs are spread fecal-orally, often b"-'. contaminated food or watEi Raw or inadequately steamed shellfish and salad ingredi- ents are the foods most often implicated in Norwalk out- breaks. Other foods are contaminated by ill food handlers. Those At-Risk: Anyone who ingests the viruses can get sick, though NLVs are more likely to cause diarrhea in adults and older children. Treatment: Symptoms can be treated, but there is no vaccine. Once people are infected with NLVs, they are not likely to get sick from the same or similar strain for up to two years. Prevention: Thorough handwashing, particularly after using the bath- room, adequate cooking of shellfish and use of potable water can help control spread of NLVs. WINTER 1999 /. FOOD TALK I TO KNOW ABOUT: Hepatitis A Agent: Hepatitis A virus, which infects up to 200,000 Americans a year, is a highly contagious virus that attacks the liver. Symptoms/Onset: A month or more may pass before someone infected with hepatitis A shows symptoms; these initially include fever, fatigue and nausea often followed by jaundice. Infected individuals can unknowingly infect others two weeks prior to feeling ill themselves. Up to 22% of adult Americans who contract hepatitis A require hospitalization. ,;:qmmon Causes: Hepatitis C ' 1 spread by the fecal-oral " "LIte, and contamination of a variety of foods by infected workers in food processing plants and food service facilities is common. Those At Risk: About 15% of reported cases involve children or employees at daycare settings. Hepatitis A is also common in institutions or crowded living areas where poor sanitation allows water supplies to become contami- nated. Treatment: Hepatitis A vaccines are available and are recommended for chil- dren and other high-risk individuals in areas where the virus is more common. Immune globulin shots can be given within two weeks after exposure to prevent infection. Most people who contract the infection develop a life-long immunity to reinfection. Prevention: Wash hands and practice good personal hygiene and avoid raw seafood. Hepatitis A Is Bad News An Italian restaurant at Sea World in California made national news recently. So did a steakhouse in Smithfield, NC, and a popular restaurant in St. Louis. Each of these restaurants got some unwanted publicity because one of their food handlers was found to be infected with the hepatitis A virus. Once a worker is diagnosed with hepatitis A, everyone who may have consumed foods prepared by the worker must be notified immediately so that they can receive an immune globulin shot before the infection spreads. The larger the restaurant, the wider the ~ publicity, and what business K needs that kind of press? /: -I:=; I ^""'.........A~" / ~ destroy an establishment, even if g'/Y. c.~ no one falls seriously ill. One " /t / recent hepatitis A outbreak ~r-.' _(.: blamed on an infected food i /. / handler ran up costs of over , $800,000 including the price of ;Y.<Y....) ,l1l. ~ giving immune globulin shots to , \ ..'-~ some 5000 customers who could L1- have been exposed. Restaurants ./1/- . want their customers to have 1"-e:l<<;5 memories of a pleasant dining experience; not of a painful shot \ in the arm. How doyou protect \ ~ ~L1t\ ~. . 1'\1<E.S A ~'\' 1..&\1' f~ your food service establishment . from such a nightmare? And now for the good news: The good news is hepatitis A is preventable. A few years ago, two vaccines against hepatitis A came on the market. The vaccines are not cheap (with a two-shot series running as high as $150), but food service establishments can work with their local health departments to shave about $100 off that price. Compared with the cost of an outbreak, foodworker vaccination can be a very wise investment. Having food workers vaccinated "is like taking out an insurance policy," noted Steve Grover of the National Restaurant Association. His group supports voluntary vaccinations of food workers against hepatitis A, particularly in areas where the disease is widespread. CDC recently identified several states where hepatitis A rates are high enough to justify routine vaccination of children. Those states include: Arizona, Alaska, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah and Washington. CDC is not currently calling for all food workers to be vaccinated against hepati- tis A. Foodborne outbreaks of hepatitis A are not all that common compared with those in other settings, CDC notes, and food handlers are not at particular risk of contracting the disease on the job. CDC recommends vaccination be considered for foodservice employees "who work in areas where community-wide outbreaks are occurring and where state and local health authorities or private employers determine that such vaccination is cost-effective." Before vaccinating food workers, a few factors should be considered. First, if the rate of hepatitis A infection is high in the community, there's a greater chance a food handler will bring the disease to work. Second, once someone has had hepatitis A (roughly a third of the U.S. population), they develop a lifelong immunity, so not all foodworkers need to be vaccinated. A simple blood test can determine if the vaccine is needed. Third, strictly following good hygienic practices, like handwashing and no bare-hand contact of foods, helps reduce the risk of a hepamis A outbreak. For more information, call the Hepatitis Foundation International hotline at 800/891-0707, or visit the group's web site at <www.HepFI.org.> FOOD TALK WINTER 1999 , '. Bare Facts About Hands Should the bare hands of food workers and ready-to- eat (RTE) foods ever meet? That was the question FDA re- cently put to the members of the National Advisory Committee on Microbiological Criteria for Foods, who advise FDA and USDA on food safety matters. After a thorough review, the panel concluded: . Bare-hand contact of RTE foods can contribute to the spread of disease. . Disease spread can be interrupted by keeping ill food workers away from RTE foods and food sur- faces, and making sure workers wash their hands regularly and thoroughly; and . While bare-hand contact of RTE foods should be avoided, most members of the panel felt there wasn't enough science to support a bare-hand ban. To help the NACMCF in its discussion, FDA devel- oped a document summarizing what's known about bare-hand contamination of food by food workers and practices or products that control the spread. Some highlights: . Handwashing for 10 seconds appears to be just as effective as washing for 20 seconds, provided proper handwashing technique is followed. . The verdict is still out on whether there are any clear advantages to using antibacterial products. . Rings and artificial fingernails may interfere with handwashing or trap food debris and microorganisms. . Gloved hands can spread disease-causing organ- isms, and gloves should be changed regularly with adequate handwashing before and after. FoOD TALK ~ New Hanover County Health Department Environmental Health Division 2029 South 17th Street Wilmington, HC 28401 DAVID RICE HEALTH DIRECTOR HEALTH DEPARTMENT Printed on recycled paper You'd Better Wash Your Hands --'\ I . .-J (Inspired by The Beatles' "I Want to Hold Your Hand") Oh yeah, /'11 tell you something I think you'll understand For the sake of sanitation You'd better wash your hands You'd better wash your hands You'd better wash your hands Before and after meals And when you use the can Soap and water for 20 seconds Should be part of your plan That's how you wash your hands That's how you wash your hands And when you're finished you'll feel happy inside Washin'so thorough that microbes They can't hide, they can't hide, they can't hide Make sure you clean your nails And dry with towel or fan Prevent those nasty microbes From spreadin' 'cross the land You'd better wash your hands You'd better wash your hands (Repeat 3'" and 1" verses) Put your hands together for that wacky singing professor, Dr. Carl Winter of the University of California, Davis, who included this little musical morsel on his new CD, "Sanitized forYour Consump- tion." To hear his latest food safety tunes or to order his CD for free (though Winter does welcome donations for singing lessons), go to his web site at <http://foodsafe.ucdavis.edulmusic.html> 'J v NEW HANOVER COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 2029 SOU1ll17'" STREET WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6667, FAX (910) 772-7810 j . t1 II~ . ). ~ .. ~~~ . --..-. DAVID E. RICE, M.P.H., M.A. Health Director LYNDA F. SMITH, M.P.A. Assistant Health Director MEMORANDUM TO: Food Service, Child Care Facility, Institution And Other Retail ManagerslEmployees Dianne Harvell, Environmental Health Director ~ DATE: January 12, 2000 FROM: SUBJECT: Hepatitis A Vaccine and Preference Survey - Serving Safe Food Certification Course . Hepatitis A Vaccine Literature published by one of the hepatitis A vaccine manufacturers, SmlthKllne Beecham, is included in this packet of materials. SmlthKllne Beecham has also produced an informative video about hepatitis A. We have copies available for establishment managers/employees interested in learning more about this highly infectious disease. You may get a copy of the SmlthKllne Beecham hepatitis A video by calling our office at 910-343-6667. The health department administers hepatitis A vaccine Monday, Tuesday, Wednesday and Friday between 8:15 a.m. and 4:30 p.m., and also on Thursday between 8:15 a.m. and 6:45 p.m. Appointments are not required. The cost is $25.00 per immunization with the need for a booster at six to twelve months. During the forthcoming "Serving Safe Food Certification Course", students will be offered the immunization at a reduced rate of $17.00. Further information about hepatitis A immunization can be obtained by contacting Ann Lawrence, RN at 910- 343-6523 or Cammie Marti, RN at 910-343-6532. Preference Survev - Serving Safe Food Certification Course - We have taught several sessions of the National Restaurant Association's "Serving Safe Food Certification Course" annually for the past four years. In January 1998, Cape Fear Community College partnered with us in this initiative to enhance food safety knowledge within the local food service industry. As an II,.. ~'1r/d-~~" ~ incentive, Cape Fear Community College's Department Of Continuing Education and the New Hanover County Board Of Health began awarding in 1998, a special plaque of recognition to establishments that have five or more employees attend and successfully complete a session of the certification course. The plaque is presented during a Board Of Health meeting. McDonalds, New Hanover Regional Medical Center, the University Of North Carolina At Wilmington and Clarence Foster's Restaurant are all recipients. ... ~',;Y~'f;;,.;C""~"{'''-;'' ~. . j; . Brian Fleishman of Clarence Fo_s Restaurant displays a plaque of recognition presented at the PEc:eluber 1,1_ New Hanover County Board Of Health meeting. Bryan and four of his employees __ the July 1_ Serving Safe Food Corti_on Course. Pictured left to right are: Allison Rankin, Associate Dean, Center For Business, Industry And Government, Cape Fear Conmunlty College; Brian Fleishman, Manager, Clarence Foster's Restaurant; Alicia Pickett, Envlronmentel Health Program Specialist, New Hanover County Health Peparlment: and, Isabel Charlelon, Director Of Corporate Training, Cape Fear Community CoIIep. Additionally, a business regulated under state "Rules Governing The Sanitation Of Restaurants And Other Foodhandling Establishments" qualifies for "a credit of two points on its score for each inspection if a manager or other employee responsible for operation of that establishment and who is employed full time in that particular establishment has successfully completed in the past three years a food service sanitation program approved by the Department. Evidence that a person has completed such a program shall be maintained at the establishment and provided to the Environmental Health Specialist upon request. An establishment shall score at least 70 percent on an inspection in order to be eligible for this credit". The first session of the certification course to be offered this year is scheduled for January 25 and 27, and February 1 and 3 from 4:00 to 8:00 p.m. You may register by contacting Cape Fear Community College's Department Of Continuing Education at 910-251-5696. Cost and textbook information can be found on the enclosed bulletin from Cape Fear Community College. It may be beneficial to begin reading the textbook before the first day of the course. To create greater opportunities for participation in the certification course, we need a better indicator of suitable daysltimes. Please answer and return to us at your earliest convenience questions on the enclosed survey card. We will use your response to schedule future sessions. If you require any additional information, please feel free to contact us at !U0-343-6665. - WHAT IS HEPATITIS A? . . An infectious liver disease . It attacks the liver and can make you very sick WHAT ARE THE SYMPTOMS OF HEPATITIS A? HEPATITIS A Symptoms of hepatitis A include': . Fever . Fatigue . Loss of appetite . Nausea . Abdominal discomfort . Dark urine . Jaundice (yellow coloring of skin and white part of eyes) WHAT PEOPLE WHO HANDLE FOOD SHOULD How SICK CAN HEPATITIS A MAKE YOU? KNOW Most people are sick for less than 2 months; 10% to 15% of people with hepatitis A start to feel better, only to get sick again.' Their symptoms may continue on and off for up to 6 months.' Infected adults on average lose more than 5 weeks of work, resulting in $2600 in lost wages." . Hepatitis A can be serious in adults; 11 % to 22% of infect- ed adults require hospitalization' and some even die.3 Average hospitalization costs are $2800 per adult case.' How CAN YOU BECOME INFECTED WITH HEPATITIS A? Hepatitis A Vaccination Plus More The virus is most often passed from person to person, most- ly through fecal contamination and then hand-to-mouth con- tact-but it can also be spread through contaminated food and water.' The virus can even survive incomplete cooking and freezing, and can live for up to 10 months in water'" After infection, people are contagious for about 2 weeks before showing any symptoms.s Infected food handlers can pass the virus on to other~ven before they know they are sick themselves. . WHO IS AT RISK OF GETTING HEPATITIS A? It is estimated that up to 134,000 people are infected each year in the United States.' People who live in, work, or even travel to places where the disease is more common are at a higher risk of getting the virus.' How CAN YOU PROTECT YOURSElF? Good hygiene including careful handwashing is very impor- tant in protecting yourself and others against hepatitis A. . But you can't be sure that other people practice good hygiene, so the best protection is vaccination. HEPATITIS A Hepatitis A vaccines stimulate your body's immune system, protecting you if you are exposed to the virus. To make your protection last longer, you will need two shots-the first and then a "booster" shot.' WHAT PEOPLE WHO HANDLE The hepatitis A vaccine is considered safe and effective. It uses an inactivated (killed) virus, so the vaccine will not give you the disease.' FOOD SHOULD Vaccination will protect you at work and if you travel to any areas where hepatitis A is endemic, including Mexico and parts of the Caribbean.' KNOW For more information, talk to your employer about the A+ program-a hepatitis A prevention program for people working in food service. . Hepatitis A Vaccination Plus More Provided as an educational service by sn SmrrhKlme Beecham References: 1. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book. 5th ed. January, 1999.2. Hadler SC. Global impact of hepatitis A virus infection: . Changing patterns. In: Hollinger FB, Lemon SM, Margolis HS, eds. Viral Hepatitis and Liver Disease. Ballimor MD: Williams & Wilkins; 1991 :14-20. 3. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance Program, 1993. In: Atlanta, GA: April 1996:1-17 4. Battegay M, Gust 10, Feinstone SM. Hepatitis A virus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. New York: Churchill Livingstone; 1995;1636-1638.5. Centers for Disease Control and Prevention. Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Motbidity and Mortality Weekly Report (MMWR). 1996:45(No. RR-15):1-31. HAl096 Sept. 1999 flSmithKline Beecham, 1999 (j Printed in U.SA . EPllnformation January 2000 New Hanover County Healtll Department Betsy Summey, F N P Editor . Meningococcal vaccine is now being offered at New Hanover County Health Department. This occurred after the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control CCDC) changed its recommendation to endorse giving the vaccine to certain high-risk groups, especially college freshmen living in dormitories. Components The vaccine contains antigens from Group A, C, Y, and W-135 from Neisseria meningilidis. It will not protect against other etiologic agents, including N. meningilidis, serogroup 8, that cause meningitis. Protective antibody levels may be achieved within 7-10 days after vaccination. As with any vaccine, 100% of those immunized may not be protected. . The vaccine will not be administered to patients under 2 years of age as clinical trials have shown it ineffective in that age group. Protection wanes after 3-5 years, making re- vaccination of those who continue to be at great risk for meningococcal disease a consideration. Routine vaccination is recommended for the following high-risk groups: I) Deficiencies in the complement components C3, C5-C9 2) Functional or actual asplenia 3) Persons with laboratory or industrial exposure to N. meningitidis aerosols 4) Travelers to and residents of sub-Saharan Africa 5) College students, especially those living in dormitories Households or institutional contacts of persons with meningococcal disease, and medical and laboratory personnel at risk for exposure should be considered for vaccination, although it should not be considered as treatment for disease. !11111"i'llilil~flll Salmonellosis continues to be an ongoing problem in New Hanover County with 2 cases occurring in the same child care facility during December Public health officials continue to caution us about reptile-borne Salmonella, and its possibility as the source of some of the infections. A large outbreak here in early fall, where many of the cases were of the same rare serotype (Javiana) continues to cause puzzlement since no common source was identified. The J aviana strain is associated with reptiles and even though a reptile was not present in households of ill patients, indirect contamination is possible through a visitor in the household. Carriers Several case studies conducted by the CDC in Atlanta have depicted very severe cases of Salmonella infection, some being fatal, where the source of infection was indirect. Commonly the patient was infected by a care giver who handled a reptile and did not conduct proper handwashing afterwards. In fact, many families are unaware that turtles and rep,tiIes can be carriers. For most of the affected families, iguanas and snakes were the source. Subsequent surveys by the CDC to state health departments revealed only a very few states had regulations for the sale of reptiles or distribution of information about salmonellosis. Pet store owners are in a unique position to educate because customers get most of their information about their pet from pet store personnel. The CDC and the Pet Industry Joint Advisory Counsel have developed educational posters and brochures for use by veterinarians and pet store owners on safe pet-reptile handling. The CDC has developed recommendations for preventing transmission of Salmonella from reptiles to humans. . Pet store owners, veterinarians, and pediatricians should provide information to owners and potential purchasers of reptiles about the risk of acquiring salmonellosis from reptiles. . Persons should always wash their hands thoroughly with soap and water after handling reptiles or reptile cages. . Persons at increased risk for infection or serious complications of salmonellosis (e.g., children aged <5 years and immunocompromised persons) should avoid contact with reptiles. . Pet reptiles should be kept out of households where children aged <I year and immunocompromised persons live. Families expecting a new child should remove the pet reptile from the home before the infant arrives. . Pet reptiles should not be kept in child care facilities. . Pet reptiles should not be allowed to roam freely throughout the home or living area. . Pet reptiles should be kept out of kitchens and other food-preparation areas to prevent contamination. Kitchen sinks should not be used to bathe reptiles or to wash their dishes, cages, or aquariums. Ifbathtubs are used for these purposes, they should be cleaned thoroughly and disinfected with bleach. .' ~lllliJI.llil!!:I~!:~!!;;; As was mentioned in a previous EPI Info, a new tuberculosis control manual has been issued by the state. Please contact Ginger Clegg, RN, at 343- 6689 for an update to the 1992 edition. 'x- ... "," " "u 'Iii"'''' '"'''''' ,,'.", '.,..~",::'j"''' '..... f<^ ~'3~ ~'!"R.n~:; '~~""~'~ <...::..f.;~.,~. .~.............,..~ .)~~\;,~. "," ' Copies of the Rabies Manual published by New Hanover County Health Department are still available. The manual contains valuable information on definitions for exposures, treatment for exposures, preventive treatment, and resources. A copy may be obtained by contacting Anne Lawrence, RN, at 343-6523. -. 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