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10/02/2002 New Hanover County Health Department Revenue and Expenditure Summaries for August 2002 Cumulative: 16.66 % Month 2 of 12 e Revenues Cunent Year Prior Year Type of BUdgeted Revenue Balance % Budgeted Revenue Balance % Revenue Amount Earned Remaining Amount Earned Remaining Fed/State 1,692,429 113,684 $. 1,578,745 6.72% .$ 1,294,050 26,876 $ 1,267,174 2.08% AC Fees 533,044 89,922 $ -443;122 16.87% $ 533,044 93;936 $ 439,108 17.62% Medicaid 1,035,386 76,988 $ 958,398 744% $ 961,934 94,441 $ 867,493 9.82% Medicaid Max #DIV/O! $ #DIVlO! EH Fees 16.18% $ 312.900 268,205 14.28% Health Fees 27.67% $ 112,850 23.16% Other 16.32% $ 1,249,681 5.50% Expenditures e Current Year FY 03 Prior Year FY 02 Type of Budgeted Expenditure Amount Expended Amount Balance Remaining % Expended Amount Balance Remaining % 12.37% 8.48% Note: County Appropriation is not calculated above. The County appropriation is the difference between the total amounts on the program expenditure report and the totals on the program revenue report. The budgeted amount for County appropriation for FY 02-03. $10.787,097-$5.013,610)=$5.773,487. The expended amount for County Appropriation FY to date is ($1.405,632-%579.054) $826,578. Budgeted Actual % FY 02.Q3 FY 02-03 Expenditures: Salaries & Fringe $ 8,798,590 $1,183,481 13.45% Operating Expenses $ 1,839,543 $ 220,134 11.97% Capital Outlay 148,964 $ 2,017 1.35% Total Expenditures $10,787,097 $ 1,405,632 13.03% Revenue: $ 5,013,610 $ 579,054 11.55% e Net County $$ $ 5,773,487 $ 826.578 14.31% Revenue and Expenditure Summary 9 For the Month or August, 2002 Date (BOH) Grant Reauested Pendinll Received Denied Safe Kids Buckle Up Program-North Carolina 10/212002 Safe Kids $5,000 $ 5,000 Developing Geographic Information Systems (GIS) Capacity in Local Health Department In Eastern North Carolina-Duke University Nicholas School of the Environment and Earth Sciences (NSEES) $18,000 $18,000 9/4/2002 No activity to report September,2002 81712002 No activity to report for August 2002 7/3/2002 No activity to report for July 2002, Prenatal Health Education and Information/Referral Services- March of Dimes 6/5/2002 Community Grant Program $49,975 $49,975 5/112002 No activity to report for May 2002. 4/3/2002 No activity to report for April 2002. 31612002 No activity to report for March 2002. 2/6/2002 No activity to report for February 2002. 11212002 No activity to report for January 2002. Diabetes Education, Management and 12/5/2001 Prevention - CFMF $60,000 $30,000 $30,000 Youth Tobacco Prevention Project- Robert 111712001 Woods Johnson Youth Center $11,800 $11,800 Teens Against Tobacco Use (TATU)-Health Action Council of NC $350 $350 Healthv Carolinlans- NC DHHS $10,000 $10,000 Family Assessment Coordination- March 9/5/2001 of Dimes $16,500 $16,500 Folic Acid Prolect- March of Dimes $16,618 $3,000 $13,318 Safe Kids Coalition- State Farm"Good Neiahbo~' $500 $500 TB Elimination and Prevention - CDC, 8/1/2001 NCDHHD, DPH, TB Control Proaram $10,000 $ 9,200 $800 Teen Aids Prevention ITAP)- CFMF $45,500 $25,000 $20,500 Diabetes Today - Diabetes Prevention & Control 7/1112001 Unit, NCDHHS $10,000 $10,000 Lose Weight Wilmington - Cape Fear Memorial Foundation $75,000 $75,000 Totals $329,243 $54,975 $117,850 $156,118 , . NEW HANOVER COUNTY HEALTH DEPARTMENT BOARD OF HEALTH (BOH) APPROVED GRANT APPLICATION STATUS FY 02-03 e e 16,70% 35,79% e Pending Grants 2 14% Funded Total Request 6 43% Partially Funded 4 29% Denied Total Request 2 14% Number of Grants Applied For 14 100% As of 912112002 . NOTE: Notification received since last report, 4742% 30 . " ,,1 e e e " _ Betty Creech ;;IJiJJ!:0912312oo2 03:22 PM To: David E Rice/NHC@NHC ee: Lynda SmithlNHC@NHC, (bee: archive) Subject: Nurses The request below is in addition to the one full time nurse request I sent on September 12, 2002. This makes the school system's request for five and one-half nurses. The earlier request was to enable us to have full time nurses at two more elementary schools. The new request below is to enable us to have full time nurses at all middle schools. The request is based on the fact we have students with fragile conditions related to heart disease, diabetes, seizures, cerebral palsy, injuries and other chronic conditions. In one school we are dealing with a Do Not Resuscitate order The students' conditions are very unstable, frequent assessment is necessary, care provision is complex and school staff, with good reason, worry about litigation and exposure to infectious materials. Please request that these positions be established. The Budget Expenditures: $165,768 Salary FICA Ret Ins Dis Supplies Uniforms Milage Training 126,731 9,695 6,273 19,158 267 825 2,294 200 325 Revenues: $165,768 - Forwarded by Betty Creech/NHC on 0912312002 03:01 PM- . "ALFRED H LERCH" '. . <alerch@nhcs.k12.nc. ". us> 0912312002 12:14 PM To: <bcreech@nhcgov.com> ee: (bee: archive) Subject: Nurses Please increase our nurses contract by four and one half nurses effective after the October Board meeting. Funding is from our medicaid account. 31 B9/BB/2BB2 B4:46 91B2544352 SUSAN PAGE Bl ~ "-DDj~UD~ --- .. .... COUH1Y SCIDU DIt D. JOHN MORRIS. JR. s.,..'11l!dde1ll llII. AlRIEIl H. LEIlCII, JR. AII/JIInI s.,e._tIIIII - SIJ/IIIlIfI p....... -,.,..., -., MEMORANDUM TO: Betty Creech FROM: fIJ Lerch (Jl RE: Nu.... Request DATE: September 12, 2002 ID: FY03#04 Plesse consIder thllletter al a request for 2 additional half time nursing position.. One half time position would be at Pine Valley and the other half time would be at Holly Tree. Both schools have severe diabeUc children enrolled who need to be monitored. Thank you for your eooperetion. c: Tony Lopah Dr. Norm Shearin e410c-... _ FlooD'_"""" c-...211412' _ (010) 2Il1 1aQe' F.. (810)2Il4 41112 32 ".- ,\ J . e e e ,. ,j, " . e e I- Z w :2: Q Z w :2: ~ I- W CJ Q ::) m w en z w D.. >< W '" ~ ~ I '" ;!: ;j ... l5 z o o 1-...- T'" 10 M CD ""'" 10 0 'It 10 M (J) ""'" 10 CO N 0 (J) N Z ...HIl ""'"_ CO N T'" N CD N l'!. M ::l 0 a: a> cD X:!j CO (J) N 0;:.... N T'" :;EzO T'" ~'=-C + ... . + + + + + + + + + 0 01-1- LULUZ I/)C):J -00 iii:J:E It:mo:( 1-1-1- ZLUZ LUC):J It:oO 1t::J::::e am 0:( LU LU ~ ...J ll. 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Ul Em.!!! zO 1:: E :5E e ., E Q. 0 ll.C Q) 0 34 . j . , . .~ . New Hanover County Health Department CPT Codes and Fees e Rates for New Codes Replacing Y and W Codes (Y and W Codes are State-created codes which have been in use by Local Health Departments for billing Medicaid) New Codes and Rates Effective October 1,2002 e 35 . , . . . -. e e New Hanover County Health Department CPT Codes and Fees CPT/ New Medicaid NHCHD Clinic / Service Code Codes CPT / Medicaid Description Fees 11976 Remove Norplant $19711 11977 Remove/Reinsert Norplant $553.00 57170 Diaphragm Fitting $89.00 58301 Remove Intruterine Device $95.00 CD: 87164 Dark Field Exam $41.00 56501 Destroy Vulva Lesion (s) $132.00 54050 Destruction/Lesion/Condvloma $120.89 46900 Destroy Anal Lesion(s) $162.26 Y2013 STD and Y2012 T8 Control, combined into one code T1002. Max is 4 units dailv (in 15 minute increments). CD: Medicaid Code 11002 Y2013 STD Control Treatment $80.00 T8: 86580 TB Intradermal Test $5.00 18: Medicaid Code 11002 Y2012 TB Control Treatment $89.00 X-Rays: 71010 Chest X-Rav/PA $40.00 71020 Chest X-Ray/PA & Lat $70.00 71021 Chest X-Ray/Lordotic $40.00 Child Health: 96110 Developmental Tesll Limited $168.00 92551 Pure Tone Audiometrv, air $30.00 93770 Blood Pressure Check NC CH: Medicaid codes 59442 W8203 Childbirth Education classes $87.00 W8010 & W8016: Child Hlth Screening Periodic & Interperiodic combined into 1 numeric codes, aQe specific and based on New or Established Patient. 99381-99385 & 99391-99395 W8010 Child Health Screenina Periodic $90.00 99381-99385 & 99391-99395 W8016 Child Health Screenino Interperiodic $90.00 11016 Y2155 Child Service Coordination $89.00 99502 Y2048 Newbom EPSDT Screen Home Visit $65.00 MH: Medicaid Codes 11001 W8204 Maternal Care Skilled Nurse Home Visit $88.00 W8201 MCC Initial, W8202 MCC Subsequent, & Y2044 MCC Home Visit combine one code for Initial, SubseQuent, or Home Visit with Max 6 units per month. 11017 W8201 MCC Initial $110.00 11017 W8202 MCC Subseauent $55.00 11017 Y2044 MCC Home Visit $72.56 Same W8205 Parentino Education classes $74.59 99501 Y2046 Postpartum Assessment Home Visit $60.00 96152 Y2049 Intensive Psvchosocial Counseling $40.00 99502 Y2047 Newborn Assessment Home Visit $60.00 New Fees $19.50 FR $19.50 FR FR FR $21.50 o $90.00 &90.00 $21.00 $65.00 $88.00 d into $12.00 $12.00 $12.00 $60.00 $13.25 $60.00 Legend: AF Administrative Fee NC: No Charge HF Handling Fee LC: Lab Corp FR: Flat Rate (sliding fee scale does not apply) Revised 09/24/02 36 . , , (I e e New Hanover County Health Department CPT Codes and Fees CPT/ New Medicaid NHCHD Clinic / Service Code Codes CPT / Medicaid Description Fees Y2525 MOW Brief, W2526 MOW Standard, & 2527 MOW Extended combined int one code S9445. No separate code based on length of contact. 59445 Y2525 MOW Brief $20.00 59445 Y2526 MOW Standard $55.00 59445 Y2527 MOW Extended $85.00 IMM: 90700 52 DTAP vaccine 1M $13.71 90702 52 DT vaccine 1M $13.71 90707 52 MMR virus vaccine SC/jet $13.71 90707 MMR virus vaccine SCliet $35.00 90716 52 Chicken Pox Vaccine $13.71 90716 Chicken Pox Vaccine $50.00 9071252 Oral poliovirus vaccine $13.71 9071352 Poliomyelitis vaccine SC $13.71 90647 52 HIB vaccine, PRP-OMP, 1m $13.71 90632 HEP-A vaccine, adult, 1M $25.00 90633 HEP A Pediatric / Adolescent $25.00 9074452 HEP-B Vaccine PED/AooIIM under 11 $13.71 9074552 HEP-B Adolescenll Ped High Risk (11-19) $13.71 9074652 HEP-B vaccine, over 201M $13.71 90746 HEP-B vaccine, over 201M $40.00 90281 52 Immune Globulin $13.71 90665 Lvme Disease vaccine, 1M $55.00 90782 Iniection CSC) / (1M) $5.00 95115 Immunotherapy, one iniection $5.00 95117 Immunotherapy injections $10.00 90657 52 Flu vaccine $13.71 90657 Flu (Child - 6 - 35 months) $12.00 90658 52 Flu vaccine $13.71 90658 Flu (Adult/ 3 years+) $12.00 90732 Pnueumococcal vaccine $20.00 90732 52 Pnueumococcal vaccine $13.71 90676 Rabies vaccine $78.00 90733 Meninaococcal Vaccine (Private Stock) $65.00 GOO08 Medicare Administration Fee (FLU) $4.00 New Fees o $11.00 $11.00 $1100 FR FR FR FR FR FR FR FR FR FR FR FR FR FR Legend: AF Administrative Fee NC: No Charge HF Handling Fee LC: Lab Corp FR: Flat Rate (sliding fee scale does not apply) Revised 09/24/02 37 . , . e e New Hanover County Health Department CPT Codes and Fees (,;t'TI New Medicaid NHCHD Clinic I Service Code Codes CPT I Medicaid Description Fees GOO09 Medicare Administration Fee (Pneu) $5.00 90471 IMM Administration Sino Ie Dose $20.00 90472 IMM Administration( Single charge for all add. dose $10.00 IMM: Medicaid Codes 90471 W8012 Immunization Update $20.00 90472 W8012 Immunization Update-> 1 with EP modifier $0.00 00124 Adult Drug Injection (Medicaid) $2.35 House Lab: 82465 Assay Serum Cholesterol $15.00 House Lab: 81001 Urinalvsis, auto, w/microscopic $12.00 81003 Urinalysis, auto, without microscopic $8.00 85027 Coulter Hematologv Profile $13.00 850180W Hemoglobin $10.00 86592 Serologv, qualitative (trust) $18.00 86593 Seroloov, ouantitative (trust) $15.00 87081 GC Culture $20.00 87210 Wet Smear $15.00 87205 Gram Stain $15.00 36415 Venipuncture/Fingerstick $14.00 GOO01 Venipuncture CMedicaid) $3.99 84450 SGOTI AST $15.00 84460 SGOT AL T $15.00 82247 Bilirubin, Total $15.00 82565 Assay Creatinine $15.00 82947 Glucose, quantitative $13.00 82962 Glucose, blood reaoent strip $20.00 83615 Lactate (LD) (LDH) enzvme $15.00 84075 Assay Alkaline phosphate $15.00 85651 RBC SED rate, non-auto $20.00 82270 Test Feces BloodlOccult Bid) $10.00 81025 Urine Pregnancv Test $1100 87070 Throat culture $34.00 87086 Urine Culture, platina and colony count $15.00 Referred Labs: 8718426 Urine Culture (Identification) and Susceotibilitv Studies LC 87077 26 Nose, throat, bacteria culture HF 83655 26 Blood Lead HF 8015626 Assav Carbamazeoine NC New Fees $20.00 FR Legend: AF Administrative Fee NC: No Charge HF Handling Fee LC: Lab Corp FR: Flat Rate (sliding fee scale does not apply) Revised 09/24/02 38 r\ i4Ti-. I- . e e - Highlights of the Family Assessment Coordination Open House <"?,.,. 1~~ t?' r (,. ~ A,. September 12, 2002 History of Family Assessment (cont'd) . In January, 2001, private funding was secured to initiate Family Assessment Coordination services in Southeastern North Carolina . Other 'Universal Screening' models were looked at to develop a 'Best Practices' approach Development of Universal Screening . Decision was made to make Universal Screening 'self-reported' (no interviewer or chart review) . Screening Forms were designed to be 'user friendly' and simple to complete . Personalized booklets: Resource information is matched with each client's eligihility information and survey responses to produce a customized directory History of Family Assessment in New Hanover County - In 1998, the need for a 'Universal Screener' was documented at the NC Dept. of Health and Human Services - In 2000, a pilot program of 'Universal Screening' was initiated in 3 counties (Nash, Onslow, and Buncomhe) Design of the Universal Screening Tool . The Screening tool includes 52 items from 10 categories . Each item is designed to assess high-, medium-, and low- risk factors associated with the early parenting experience . Based on models used by Healthy Families America, and NC DHHS guidelines Community Resources ./368 resources in the database: '" 186 Local Agency Listings '" 182 Pamphlet, Website, and Specialized Information listings '" 23 Listings for Spanish-speaking clients "'Over 1,300 listings when cross-referenced with related Survey items 1 Oirections: .". t..u.t",w"".tMi_/mpfNWIttD,.."../wMthr,"-'nt.ml1y. Slmp/yput.dJ.amMt"'l/II'fIhInfIlMt__~OF"""'tD,...,. PNgflllnc:Y_.QfptN6".".IfJ'lllll_IIOt,..""."rlO 1:1 This.. my first preg..ncy o I'Ve bMI probleml wItb. pregMncy before 1:1 l.m afnIkll won't 1M18 -good-lMrent o I'm afraid my IIIdIW won't be e good IMrent o I'm not SUN wMt to do ebout thll ,....llIIncy o I.... thEnIdag ebout ""!nO e" nortloll o I em thinldag ebout glvbtO my Nby upfor edoptlon o My boyfriend, husbalnd, or pllrents don't ..lit me to h..,.tt1l1b11by I'dlibtofIrlclOllt_oboUL o .weightpEn during pregllllncy o ...mlng sIg.. to.ntch _ for o ..dMIlng with-morning skknea" o .breast or bottler.lleUng ... which II blatter7 o .wblttoexpec:t:wlMn Igo Into labor o ..cuttIng bIIck on smoldag whDe I em pregnent o .medlcatlons tt1d eN ..... for me to tlIktl whU. I em ,......nt Food/Nutrition (I hG~ quutions obaut_) o .!tow mudllhould my bilby/child ut? CI .Itowdo I knoW If my bIIby II getting enOlllhto eaU o .getttng free or low coft foocl for me end my bIIby (Wle end other progrllml like It) lob/Employment (I'd lib to ~ __ obout...) o .f1ndlng e Job o ,Job lkUlI trlllnlng o .wtult type of Job would be good for me7 o .tlme orrfrom work when someone En my fIlmlty II lick (f'eml1y Medical LellVeAct) Mo....y (Check If you would lib to ~ IIlON obaut_l o .pIIylngorroldblUs Q .f1Ungforchlldlupport Q ..MttIng e budget you can live on Q .epptyl... for money to help IMY for everydey needs (house, food, heat, phone. etectrtclty) Implementation . In June, 2001, Universal Screening was initiated at New Hanover Regional's Family Birthplace, and 2 area OB clinics . Presentations were made to other area DB and Pediatric clinics Children (I weuIclllb rllf~ ebeut_) o .wn,. to dlldpllne my dllld o .tMChlng my cblld to rud Q .heIp wIttI ftndl.. child caN a ..chlld-proofing my home o .uslngCllrSeetJproperty Q ..If my child's growth. sIdIIs or belie..r ere DOnnel (1-- . ~ :.~~-' ';,: ~'lt.~. Clothing (PIeose eheek if any of these ore true) a I need more clothes that nt my child Q I need Mltemlty dotItes tblt wIJl nt me a We don't Ilave enough clothes for every _n Educ:otiOll(I'dlikemareinfarmotianaboutm) o ~toflnlshlllghschoolorgeteGED []~ngetredelldloolorcot.... o Grants (money) to help me go to ldlooI Me.dieal (CMc:k tile Bole If you MH...) 1:, a .HeIp paylng for lIulttl c.re a .Reguler lleatth or ......1 care D....'. "..,......... f.".. ."..,,1111' _ : ~ Support (PI- elleek OIly of the.. ttlat _ tNl) [] I get: streued or worried e lot o I gill: Ingry end 10M my temper e lot o Sometimes I feel 10 hope\ea tlld I..... willi I wasn' allYe o I don't "'we .ny friends or fIlmlly wllo Cllre about me o I'm efnIld someone J know wID lIult me or my blby a J don't Iwlve anyo... I can blk to ebout my protllems CI I'd like help ftndlng e church where I 1'''' comfortable [] I'd like Infonnetlon.bout IMrent IUpport groups or d... Transportation (please ctlack ony thot opply) o Idon't"'wereJlabletraftS9Ol"bltlon [] I CIIn barely' afford thIl transportation I h... now [] I cIon't......IIIl.IIU to get to tt1estore or .pjXlMtmentl; Current Status . 7 out of 9 area OB clinics are offering Universal Screening to their clients . Over 225 screenings are conducted monthly . Plans are being made to expand Universal Screening to the Pediatric Setting ~1 - e e 2 , ~ 4t e e I-Year Statistics Total Births (est): 3600 Screenings offered 3150 Screenings completed 2250 % of Births offered screening 78.0% % Screenings Compleled 71.4% Top Ten Responses (Overall) ~.... ,.. - 1 F1Ddihloutllmych1ld'.arowlb,lldllaordenloplBelll 597 al"1!llOnDlIl 2 How do limo.. lhay IW>r ulettu. -uab to cat! 434 3 Howllludltbouldlll)'baby/cblldw1 380 4 .lea<:blDamy cblldto read 366 5 ......yl10 dildplln.lilY c:bUd 349 6 ..nnlllokdp_F10 tdoool 345 7 ..pplyl"lforllloneyIo.....ppay ror"".rydayAeedl 345 8 .plllll8 rn.e or low-cod food for Die aDd my baby 339 9 .chlldprooftqIlly holDe 334 10 .hclpwUhnndmaehlldtllR 329 Overview . 10 Items on the Universal Screening Tool were identified as presenting significant risk for Domestic Violence, or Abuse/Neglecl 260 clients from New Hanover, Pender, and Brunswick counties were identified as having significant risk factors. . Demographic tables showing Age, Marital Status, Income, and Number of Children are being reviewed to see if demographics are predictors of at-risk status 1-YearStats (cont'd) . Tolal Responses: 8802 . Screenings compleled 2250 . Avg. Number of Responses 4.6 . % of Surveys with I or more 74.8% response 'Red Flags' - At-Risk Clients Questions used 10 Identify At-Risk Clients -I get stressed or worried a lot -I don't have anyone I can talk to about my problems -I'm afraid someone I know will hurt me or my baby -I don't have any friends or family who care about me -Sometimes I feel so hopeless that I wish I wasn't alive -I get angry and lose my temper a lot -I'm not sure whallo do about this pregnancy -I'm thinking about having an abortion -I'm thinking about giving my baby up fOf adoption -My boyfriend, husband, or parents don't want me 10 have this baby 3 Future Plans Futur~~ns: :. . , ,,^' '. .;i~t?W"; ,;~,;,: ~"':;, ~;/;_~;', 'M"""-'""".",,,,,; "'.""._","" . Exanrineexpanmonof Universal Screening to the entire Southeastern NC region Look at Sustainability considerations Future PIlJ,lls Initiate Community Assessment Project with UNC- W School of Nursing . Develop a plan for collaborative Case ManagementlFollow.Ups . Phase-In Database Upgrades Questions/Ideas ??? Brett Schoen, RN, BSN 2029 S, 17'" Street Wilmington, NC 28401 (910) 343-6717 8schoen(ci)nhcaov.com .. 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Access to health care (Issues #7, 11 & 5) -+ Based on family income, some can access kindergarten health assessment cheaper in the community that through the health department clinic -+ Volunteers have become essential to the provision of services. Child Health is presently using 3 volunteers to perform clerical functions and client outreach. -+ Vision Screening: The New Hanover County Diabetes Coalition and the Cape Fear Lions Club are sponsoring a Free Vision Screening on October 11, 2002, from 1 Dam til 4pm. The screenings will be conducted in The North Carolina Lions Vision Van in the parking lot of the New Hanover Community Health Center -+ Foot Screening: The New Hanover County Diabetes Coalition along with local health agencies is sponsoring a foot screening will be from 9 am - 12 noon at the Senior Center So far, there are two podiatrists who are volunteering. There will be various information/screening stations around the big multi-purpose room. John Rader is providing a massage therapist and perhaps a nurse. Carol Bottoms, Health Department Nutritionist, will provide some basic nutrition info for people with diabetes and folks can get a one on one 10 minute counseling session and maybe a short talk to a small group. -+ II. Preventive services & lifestyle-related risks (Issues #12 & 15) -+ On August 19 and 20, 2002, Donna Forsythe, Public Health Dental Hygienist, presented a program at four area Head Start Centers entitled "Lifetime of Smiles" "Lifetime of Smiles" focused on good nutrition, brushing, flossing, sealants, and the need for regular dental visits. In addition, good oral health practices such as proper brushing and flossing were demonstrated. "Lifetime of Smiles" is an important part of our Community Dental Health Education Outreach Program. -+ School Nurses using age appropriate info to train students regarding blood borne pathogens -+ Several Child Health staff are participating with other community professionals, who work with special needs children, in transition discussions. These professionals are trying to insure that children, birth to age five years, are receiving all needed services from community agencies and are transitioned smoothly during the preschool period. -+ On July 30, the laboratory began testing for fecal occult blood on clients 35 years of age and older in Women's Preventive Health. -+ ACS staff pursued completion of an adoption packet to go home with all new pet owners. This was identified as an area of concern from local veterinarians, when people adopted pets. They felt that the owners needed additional information on proper pet care. -+ Child Safety Seats: An instructional presentation was made to NHC Transportation Drivers regarding proper installation and use of child passenger safety seats. NHCHD, with help from Cape Fear Area United Way, provided several convertible seats, and hi-back and low-back booster seats. -+ Carbon Monoxide Detectors: Mary Piner has worked with the Fire Department to get carbon monoxide detectors for our clients' homes with gas appliances. -+ Control Measure Violators: Warrant issued for control measure violator who has previously served two years in prison on same charge. Another control measure violator in jail, and working with court-appointed attorney, DA's Office. and Sentencing Options program to have long term drug treatment as part of the Judge's sentence. Substance abuse treatment is essential to compliance with health laws. -+ Flu Vaccine: Influenza vaccine kick-off scheduled for October 14, DendinD receiot of t 'I .\ . " vaccine. -+ III. e Communication, education & marketing (promotion> Issue #1 & 4 in art -+ Carol Bottoms, RD, presented two sessions on "Five a Day" to Cape Fear Community College faculty. She also spoke to residents at Kelly House on eating disorders and helped teach "Color Me Healthy" curriculum to daycare providers. -+ The end of year Child Fatality Prevention Team report has been passed to David Rice to share with the BOH and County Commissioners. Twenty Two deaths were reviewed, with 86% being attributed to prematurity or other congenital problems at birth. No trends were identified. -+ The health department received an invitation from the Safe Kids Buckle Up Program to apply for a $5,000.00 grant to purchase child passenger restraint seats. Collaboration with referral and distribution will be carried out through assistance by neighbor agencies to include childcare facilities, United Way and DSS -+ ACS started another year of their Paws To Recycle campaign. Recycle cans are collected for three months from September through November each year Last year ACS won the wild card drawing to receive $500 for the animals. -+ Articles appeared in the August and September issues of Paw Prints Magazine featuring the quest for the ACS spay/neuter facility addition. -+ Postage Stamp: A postage stamp for Spay/Neuter awareness will be issued by the US Postal Service on September 20. -+ Chickens for Sale: ACS collected forty hens from a residence at Fort Fisher Beach this past week. The co-owner of the property requested pick up of the flock, when his partner left the house. The birds will be available for the general public on Wednesday, September 18, 2002. -+ Health Fairs: Staff will be participating in a health fair on Saturday, 9/21/01 at St. Andrews Episcopal Church. We will be providing women's health information. The Harvest Time Christian Center is having a Fall Festival on Saturday October 5. They have requested information pertaining to child health, chronic disease prevention, promotion of NHCHD services, and injury prevention. Please contact Elisabeth Constandy if you have any information that would be pertinent for this group. If you desire additional information or would like to be present at this event, please call Diane Lucas at 371-0259 or Ramona Covington at 794-1859. -+ IV. e Facility utilization & Information technology Issues #6 & 4 in art -+ Meeting with several members representing NHHN to discuss possibility of improving reporting to NHCHD through use of electronic reporting. Committee established to work toward this goal. Improving public health infrastructure is component of bioterrorism preparedness. -+ Committee formed to evaluate readiness for implementation of new internet based NC Immunization registry, to be piloted within few months. -+ On August 19, 2002, the Board of County Commissioners gave a unanimous okay to build the on-site spay/neuter facility with adoption play area. The item was on the consent agenda, and no questions were given for discussion on the project. Property Management will not be able to fit us into their schedule until some time in 2003. -+ NHCHD Website: Elisabeth Constandy is maintaining our website. All changes should be sent to her Dave Rice and Alene Mabry will assist her -+ We have purchased the domain name, NHCHD.org. In the near future, we will be able to access our site via this address, rather than nhcgov.com/HL TH/HL THmain.asp. -+ Several of our web pages have "hit counters." The NHCHD Website had 745 visits. For the month of August, our top five web pages were:Animal Control Services (268), Environmental Health (148), Department Information (135), Board of Health (96), and FAQs (85). -+ Expenditure Report Payment: We have received notice that within 3 business days our account will be deposited electronically with $123,441.92. As soon as the State payment report comes with the breakdown L nda will do the de osit sheet to dis erse this revenue into the e .... , + e e e appropriate revenue accounts and this will show up on the county's Greenbar Report A203 Detailed listing of Revenue vs Budget Report for September and the Financial report going to the Board of Health in November for September's financial activity .. Medicaid Cost Analysis: There is some Urgent Dated Material that Lynda will be getting back to Carol Chandler, NC DHHS Office of the Controller by September 16, 2002 In the next couple days, program specific information with a deadline will be copied to those Division Directors involved in this data collection. Good News: This year only one time period is required instead of the usual three periods. Carol and Steven Garner have worked hard with the Division of Medical Assistance (DMA) to allow us to change our cost reporting from Federal to State fiscal year .. County Mail Room: Has been moved to the first floor of the NHC Administration Building on Chestnut/4th Streets. .. Operable Partitions: Still waiting installation of several missing partitions. Contacted Precision Walls regarding final installation of missing partitions, and hope to have a final date shortly .. Impact Printer' This printer in the computer room is being retired. Based on age, maintenance costs, operational and paper costs, noise levels and periormance problems a decision was made to purchase a high speed laser printer and produce all output using 8 1/2 X 11 paper The impact printer is no longer attached to the AS400. .. Electronic Calendars: Related to a discussion at previous meeting, steps have been taken to implement a lotus notes electronic calendar for the Thomas Fanning Wood Conference Room. Specifics are being worked out to pilot the Wood Conference Room. .. V. Water quality, storm water management & drainage; & Air aualitv (Issues #3 & 8) .. Lead Paint: NHCHD Staff have worked with New Hanover County Schools regarding lead paint present at Forrest Hills Elementary A supportive editorial was in the September 17 Wilmington Morning Star .. VectQr Control Program Ramps Up For West Nile Virus: The NHCo Commissioners appropriated $100,000 from the contingency fund to support increased mosquito control as the first human case of West Nile virus in North Carolina was confirmed. A part time temporary employee has been an added resource for applying larvicide and adulticide since early August. However, rains during late August and early September periected the late summer environment for mosquito eggs to hatch and mature. An Environmental Health Specialist position and additional pesticide treatment products were among the items approved. .. VI. Emerging health risks (Issue #13) .. Bioterrorism Update: Meetings with the Community Coalition are scheduled for September 16 and 30. A meeting regarding potassium iodide (KI) distribution was heid on August 23 with Dr Greg Smith from the State, Brunswick County Health Department, and NHC Emergency Management. EpiTeam training with Brunswick County Health Department has been scheduled for August 28-29. A meeting has been scheduled on September 17 in Raleigh with the infectious disease physicians (Dr Charles Schleupner, Dr Jan Rhyne, Dr Greg Steinkraus, Dr John Sanders), Dr Bill Atkinson, Dr Steve Cline, and Dr James Kirkpatrick. .. West Nile Virus Update: State will no longer test dead birds once 5 from a single county have been determined positive for West Nile Virus. Resources at that point should shift entirely to control and prevention activities. We are establishing a contact mechanism for the public to use during weekends if they encounter dead birds. Staff are advised to familiarize themselves with recommendations on use of personal protective products such as DEET Updated news releases have been distributed to Staff and Board of Health. -+ Meningococcal Disease: COD received report of 64 year old woman hospitalized with meningococcal disease. Family members (close contacts) were prophylaxed. -+ Diarrheal Illness: Physician called to report an increase in patients seen with diarrheal illness. State lab has agreed to test some serology and stool to identify causative organism if possible. State lab reports lots of enteroviral gastroenteritis statewide. Handwashing can never be overstated...remind your family and friends! -+ Subtropical Storm Gustav' Is beginning to take a turn to the north and is expected to turn to the northeast later today The center is located about 130 miles south of Cape Hatteras and is moving to the north at 9 mph. Maximum sustained winds are at 60 mph. A tropical storm warning is posted from Cape Fear, N.C. to Parramore Islands, Va. -+ Bioterrorism Update: State training for PHRST on October 6. Public Health Grand Rounds on Bioterrorism on September 27 BTL Team met with PHRST on September 17 to work on the revision to NHCHD's Emergency Response Plan. -+ VII. Population growth & diversity (Issue #2) -+ VIII. Discontinued services picked up by Health Department (Issue #9) -+ IX. Staff Development & continuing education (Issue # 14) -+ On August 28 and 30U', the lab interim director attended the Bioterrorism Preparedness and Epidemiology Training hosted by PHRST - 2. -+ Communities That Care: Janet attended the Communities That Care quarterly meeting last week. SPINNC, with UNCW, will have some trainings on use of the internet, and how to use their site for community information, volunteer opportunities, and funding strategies. UNCW is really pushing volunteer hours with students in all degrees, with many also being required to do internships. They are all free volunteers, except computer science students, who get paid to work in the community. SPINNC would like to limit their first series of classes to 1 person per agency, since it will be hands on in a computer lab. Classes start 9/19. -+ Grant Writing: Also, the Center for Research at UNCW (in SW department) will help community agencies with grant writing and are charged with helping with collaborative grants. -+ Volunteer' Child Health has a new volunteer, Susan Holland, starting today. Another SW student will start next week. -+ Volunteers: The pursuit of volunteers continues as we navigate through changes with delivery of our services. The following volunteers are being utilized within the WHC Division: Ophal Midgett - Social Worker, and a Work First Client. -+ We will be working with an RN student to provide public health experiences. -+ X. Evaluation of services I (Issue #16) -+ On August 15, Emma Barbosa, of the UNC School of Public Health, spent the day interviewing WIC staff and Latino WIC clients. Infonmation gathered will be combined with information from 10 other WIC programs across the state and recommendations will be made for actions the state and/or local agencies can take to improve/enhance the quality of the WIC Program services offered to the Latino community. -+ COD reviewing staffing for essential and mandated services, some staff assignments changed to accomodate needs. -+ ACS staff consulted the county attorney's office to evaluate better methods of gaining rabies certificate surrender comnliance bv several countv oroanizations. " , ., . e e .. " e e e -+ Organizational Analysis Update: Meetings with Divisions and Staff are ongoing. Due to a delay in the UNC Institutional Review Board (IRB) approving the survey and focus group process, the target date for processing has been moved to the week of September 9. The target date is tentative and is based on IRB approval. -+ NCALHD Meeting: Dave Rice attended the North Carolina Association of Local Health Directors meeting on August 22. Items discussed were: State budget concerns regarding case management and Medicaid, proposed changes in communicable disease law, flu vaccine availability, clustering/collaborative proposal (accreditation, best practices, and demonstrations committees formed), WCH streamlining progress, community fellows proposal focusing on health disparities, and the Leadership Masters in Public Health Program (information at: http://www.sph.unc/phlp). -+ Tax on Cigarettes: At least 15 NC local boards of health have approved resolutions requesting increases in cigarette taxes. -+ HIPAA. The HIPAA Entities Subcommittee has completed the Business Associate Agreement and it has been discussed with and sent for review by legal. On Monday 8/26/2002, the compliance extension electronic form was reviewed with Holt Moore, Assistant County Attorney Holt is working on the Extension Compliance Form for the County, but NHCHD will send a separate compliance form. The Extension Compliance Form will be submitted by the end of this week. The compliance extension gives us until October 15, 2003 to become compliant with HIPAA Electronic Health Care Transactions and Code Set Standards. We still have to the April 2003 compliance date for privacy standards. -+ Workfirst: Janet McCumbee attended a Workfirst Plan review meeting yesterday at DSS. The county plan must be sent to Raleigh by November In order to assist Workfirst clients with finding jobs, the Employment Security Commission has 2 workers out posted at DSS. The good news is that most are getting jobs, the bad news is that these are low paying and part time jobs, and transportation is still a problem. Other services in place are a SEC substance abuse counselor stationed at DSS, and job readiness classes through CFCC. -+ Child Health Division: Reviewing year end data for the annual report revealed that even though the Child Health Division lost a position, visits and contacts were up from the previous year This was crucial for revenue to sustain other positions; however, staff feel they are comprising quality for quantity Some other notable accomplishments: Health Promotions and Child Health provided 226 car seats to low income families, Child Care Nursing reviewed 2923 immunization records in child care facilities with F/U of 404 delinquents, Health Check participation county wide continues to increase yearly, over 2000 prenatal and post partum surveys were completed. -+ Strategic Planning Retreat: Elisabeth Constandy and Bill Herzog have developed a preliminary plan and agenda for the October Strategic Planning retreat, and are awaiting BOH Personal Health Committee and NHCHD Management Team approval to proceed. "Pre-work" will include surveys of those who plan to attend in regard to: 1) the update of the 2000 Strategic Plan process, and 2) Review and discussion of the draft report from the Organizational Analysis. A short telephone survey will be conducted with some of the same stakeholders identified in the 2000 process. The Health Statistics, Demographics, and Provision of Services will be updates and distributed prior to the October 26 retreat. The Strategic Planning Priorities 2000 will be updated to include major achievements of the past 2 years, impact of staff and budget reductions, and future needs and priorities. -+ Organizational Analysis Update: The NHCHD Survey has been distributed to Staff. The "Quick Scan"questionnaire should be completed by September 12. All Staff are encouraged to participate. The Focus Groups will be conducted September 10,11 and 12. -+ Health Choice: The Health Choice enrollment freeze has been delayed, at least a month. Our Health Choice Coalition, through Smart Start, has received a grant to provide additional outreach. Smart Start will be hiring a part time outreach worker -+ Child Fatality Prevention Team: Joyce Hatem is submitting the annual Child Fatality Prevention Team reoort to Raleioh. It must also be submitted to the BOH and Countv II .. Commissioners. The team reviewed 22 deaths this year, with no significant trends noted. 86% of the deaths were related to prematurity or congenital problems in newborns. The mothers all had prenatal care. -+ Organizational Analysis Update: The NHCHD Survey has been distributed to Staff. The "Quick Scan"questionnaire should be completed by September 12 (93 questionnaires completed). The Focus Groups will be conducted September 10,11 and 12. -+ Medicaid Cost Study: Carol Chandler will be here on January 14, 2003 for the Medicaid Cost Study Packets of information which need to be filled out and returned by October 31, 2002 have been distributed to Division Directors involved in the study -+ Y and W Codes: The Health Department received notification of new coding and reimbursement rates for Y and W codes which will be effective 10/1/02. Reimbursement will be converted to units with maximum allowable amounts. We are in the process of evaluating the conversion and determining how and/or if we can continue providing some services. -+ Organizational Analysis Update: Approximately 120 questionnaires were completed by NHCHD Staff Focus Groups were held on September 10, 11, and 12. Attached is an electronic memorandum from the NCIPH Team to all NHCHD Staff. -+ HIPAA Compliance Extension: Electronic Health Care Transactions and Code Sets Standards Compliance Extension for New Hanover County Health Department was sent electronically September 12, 2002. -+ Medicaid Fee Changes: Y and W Procedure Code Changes will go to Board of Health on October 2, 2002. We are working with programs regarding specific info which will be entered in the QS charge and procedure tables to make these changes effective October 1, 2002. We are also working with programs regarding the changes to the billing form (encounter forms), so these can be revised. -+ HIPAA Video Conference: Kim Roane and Lynda Smith (or Cindy Hewett) will be attending this HIPAA Video Conference in Fayetteville on October 21 -+ Family Assessment Coordination: Brett Schoen hosted an Open House - annual review of Family Assessment Coordination (part of the NAVIGATOR Program)- Thursday September 12. Approximately 25 community professionals came through to view his displays and power point. He will repeat his presentation for the BOH in October and again for staff in Child Health and Women'~ Health soon. We are looking at the year's data on needs of prenatal and post partum families and will be making program revisions based on this. -+ Lead Program: The Lead Program is revising nursing protocol and will distribute this to appropriate divisions by November Changes are necessary to reassign duties of staff to shift resources to CSC, to accommodate the new billing system. -+ e e e \ (' .~ e - - 1M __ David E Rice q ~ 1010112002 12:22 PM To: annerowe@beIlsouth.nel, eweaver@ec.rr.com, Iinkrx@aol.com, gelajim@hotmail.com, hankestep@isaac.nel, freemanm@wrighlcorp.com, ppsmilhsr@aol.com, bgreer@co.new-llanover.nc.us, wsteuer541@aol.com, wojewell@aol.com, Heallh_ManagementTeam ee: cgrubb@nc.rr.com, Janel_A1exander@unc.edu, penny- whileside@unc.edu, sheilaJlfaender@unc.edu, bherzog@intrex.nel Subject Strategic Planning Retreat NHCSH / NHCHD Strategic Planning Retreat Participants: Attached is the advanced wor1l for our October 26 Strategic Planning Retreat. Please review the instructions in the "Participant Lette'" and complete the attached surveys. iii 1M 1M Participant Letteu EXPECTATIONS SP.r EXPECTATIONS OA.r Thanks, David E. Rice, Health Director New Hanover County Health Department 2029 South 17th Street Wilmington, NC 28401 Phone (910)343-6591 Fax (910)341-4146 drice@nhcgov.com http://www.nhchd.org -- Forwarded by David E RicelNHC on 10/011200212:13 PM- Elisabeth K Constandy 0913012002 05:38 PM To: David E RicelNHC@NHC ee: (bee: archive) Subject: strategic Planning Retreat Attached please find the 2 pre-surveys to be completed by SOH, Team, and other participants (have they been ID'd yet?). I have also done a cover letter explaining the process, due dates, why we are doing this, etc. The retreat binders will not be ready until the week before the retreat, so that they can include the OA results. The only other "pre" wor1l that might need to be done would be for DO's only....possibly identifying the "most Important" highlights from the past 2 years of SP updates...1 need to chat with Sheila about that before I know a definite on that aspect. There will not be any other "homewor1l" for SOH or other members, however iii iii iii Participant Letter.do EXPECTATIONS SP.do EXPECTATIONS OA.dc I will weit until Team mtg tomorrow before fOlW8rding this to Team and SOH with email access. I will also have print versions available to distribute. Elisabeth . , NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 SOUTH 17TH STREET WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6500, FAX (910) 341-4146 -_._. DAVID E. RICE, MP.R, MA. Health Director LYNDA F. SMITH, MP.A. As.btsnt Health Director October 1, 2002 Dear Strategic Planning Retreat Participant, We are reaching the final stages of planning for the October 26th retreat, and the time has arrived for your input! Please take a few moments to complete the following "homework" assignment, to address your expectations for both the Strategic Planning and Organizational Analysis components of the retreat. Many of you were involved in the October 2000 retreat, and will recognize some similarities in these advance surveys. It is our hope to compare the results of the 2000 process with the results of our current efforts. However, for those of you that have not had the pleasure of experiencing a planning retreat, we still ask that you complete these surveys to the best of your abilities. ~ease complete the two surveys, entitled "Expectations from Strategic Planning Process" and "Expectations m Organizational Analysis Process", and return them to Elisabeth Constandy no later than Friday, October 1 th Results will be compiled and inserted into the retreat binder, to be distributed prior to the retreat. Please feel free to complete these and submit them in the format you are most familiar with (printed hardcopy, handwritten, or email). Your retreat binders will also include updated health statistics and provision of services, a follow-up phone survey with Key Stakeholders, and an updated version of the Strategic Planning priorities that were generated during the 2000 process. The results of the Organizational Analysis will also be discussed during the retreat. Thank you in advance for your input and participation. Please feel free to address any questions or concerns to Elisabeth at any time, 343-6658 or econstandv@nhcllov.com. On Behalf of the Planning Team, Elisabeth K. Constandy, MS, CHES Health Promotion Coordinator - " Your Health - Our Priority" e - . EXPECTATIONS FROM STRATEGIC PLANNING PROCESS 1 What does the concept of "strategic Planning" mean to you? 2. If nothing else, what one or two things would you like to see achieved during the strategic Planning component ofthe October 26"' retreat? 3. What are your primary concerns about the Strategic Planning effort, as you understand it? 4. How successful has New Hanover County Health Department been in implementing and following through on ideas from the retreat of Odober 2000? ., e e e 5. Please describe 3 successes or achievements from the Odober 2000 effort. 6. What changes, if any, of your own role or program resulted from the October 2000 retreat? 7 What barriers or limitations most impeded successful implementation of ideas generated during the 2000 strategic Planning Process? Thank you for taking the time to complete this survey" The results will be compiled and shared with "Strategic Planning 2002" participants prior to the retreat. 'J e e . EXPECTATIONS FROM ORGANIZATIONAL ANALYSIS PROCE~~ 1 In what ways have you been involved in the Organizational Analysis process? 2. In what ways do you anticipate being involved in implementing ideas developed as a result of the Organizational Analysis process? (Roles, etc?) 3. What are your primary concems about the Organizational Analysis process, as you understand it? a.) Initial concems? b.) How well have your initial concems been addressed as the process has developed? e - . 4. How successful do you believe that the New Hanover County Health Department will be in implementing and following through on ideas developed during the Organizational Analysis process? Thank you for taking the time to complete this survey. The results will be compiled and shared with "Strategic Planning 2002" participants prior to the retreat. , .~ NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 SOUTH 17TIlSTREET WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6500, FAX (910) 341-4146 Everywhere. Evcryday. Everybody. DAVID E. RICE, M.P.H., M.A. Health Director LYNDA F. SMITH, M.P.A. Assistant Health Director New Hanover County Child Fatality Prevention Team Year End Summary 2001-2002 I. Purpose and Responsibility of Local Teams e The New Hanover County Child Fatality Prevention Team is a group comprised of community representatives from diverse agencies and disciplines. Our team currently has 17 members each appointed by their agency board or by the County Commissioners. We currently have two vacant memberships. The mission of the New Hanover County Child Fatality Prevention Team is to promote the development of a community wide approach to understanding the causes of childhood deaths, identify deficiencies in the service delivery of public agencies to children and their families, and to make and carry out recommendations for changes to prevent future child deaths. The New Hanover County Child Fatality Prevention Team meets on a quarterly basis in the following months: August, November, February, and May. Several members of this team also participated in two state fatality reviews initiated by Department of Social Services, separate from the routine reviews below. II. Trends Identified During the fiscal year of 2001-2002, our local team reviewed 22 child deaths. Of these deaths, 86% were due to extreme prematurity or complications associated with congenital problems of the newborn. In these deaths appropriate prenatal care was obtained. Of the remaining deaths reviewed, we saw one due to closed head injury, the perpetrator was tried and convicted. One death involved a hit and run with a bicycle, that perpetrator was also charged and convicted. The third was a death due to a medical condition, this child w.as under a doctor's care and was receiving consistent medical follow up. In this fiscal year there were no child death patterns or trends identified. III. Training Needs Identified e The Team Review Coordinator and the representative Health Care Provider attended a state CFPT update via teleconference in Brunswick County in October 2001. The information from that training was shared with the rest of the team at the next quarterly meeting. There are no current training needs that have been identified. " Your flealtlt - Our priorit'!" , e e e . " IV. Team Activities and Accomplishments The New Hanover County Child Fatality Prevention Team used its budget to purchase car seats that were distributed to local low income clients. Ipecac syrup was also purchased to distribute to all families with children, served in Health Department programs, along with Poison Control Center contact information. The CFPT chairperson attended the local press conference for Dr. Marcia Herman- Giddens regarding her book Not Invisible, Not in Vain and read a vignette to the audience. During this past fiscal year the New Hanover County Child Fatality Review Team has worked to improve its member participation, which was seen in increased attendance at the quarterly meetings, as well as follow up from members who were not able to attend. We have not been able to obtain a medical examiner for the team in several years. The Health Department Child Health Staff continues to work with local fire departments to distribute smoke detectors to low income families with children. The fire departments still have a supply of smoke detectors purchased with CFPT funds in years past. Staff have also started a new initiative with the local fire department to put carbon monoxide detectors in homes with gas appliances, with a focus on prenatal and early childhood periods. Respectfu ly Submitted, ~e atem, CSW Review Coordinator September 6, 2002 .~ " . SANITATION TIPS FOR FOOD WORKERS FALL 2002 Also in this issue... A Security Checklist Page 2 A New Foe-Some Salmonella resist antibiotics Page 2 E. coli 0157:H7-Portrait of a killler ( Page 3 About those long fingernails Page 3 Know Your Enemy-A guide to the major food pathogens Page 4 1-1Jb: f rl~l,~ e[ (" -0' I f_ ~ r- <') <BW> as \ \ 0 /0 \ 0 "'" "Guess it's too late to ask if your chef had food security training!" Copyright 2002 Pike & Fischer. Inc. 800-255-8131 Food Security: What Can You Do? Food security-protecting food against deliberate contamination-has become a very real concern for public health and law enforcement officials. The rise of terrorist activity in the United States and abroad, and the availability of information over the Internet on how dangerous agents can be spread by air, water or food is fueling their concern. As food service operators develop plans to respond to outbreaks of food borne illness, they should also think about how to cope with threats of terrorism. Bioterrorism is typically directed at food and water, according to U.S. Air Force Colonel Larry Barrett, chief of the State of California division of health services and chief of food, drug and radiation safety, who spoke at the Food Safety Summit in Washington, D.C., earlier this year. Of the top 10 bioterrorist agents, six are foodborne, he said. Bioterrorst attacks are likely to focus on foods that are consumed quickly, "so people consume them because they don't know others have gotten sick;' Co!. Barrett said. In a separate presentation at the Food Safety Summit, security expert Roger Viadero of Ernst & Young, a former inspector general in the U.S. Department of Agriculture, warned that access to the food is the key and that security plans should focus on this issue. Deliberate contamination of food is rare, but it does happen. Back in 1984, followers of a religious cult in Oregon who were having problems with the local planning commission wanted to swing a key vote in their favor. To keep voters from. the polls, they sprinkled Salmonella typhimurium on foods in 10 local restaurant salad bars. More than 750 people came down with salmonellosis. It wasn't until a year later, when a former cult member confessed to the plot, that local health officials learned the cause of the outbreak. Stay Alert The National Restaurant Association believes that the threat to the nation's food from terrorism is lower than the threat to individual companies from either activist groups or disgruntled employees. The restaurant association recom- mends a TEAM (threat evaluation, assessment and management) approach to food security. That basically involves developing a plan and identitying who's responsible for doing what The main advice from the security experts is to be alert to the possibility of deliberate contamination of food. 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(J)""U CO' oCO c'"'O ,m -. , ~CO Om ::::r CO o ;::l\"" - en .-+ o '00)> i2.@ "'0_ ",o::r 3.~~ a.iil'" 5.0~ ,,~o <03 S. ~ ~~. _.0 "'''''' 3 ~ '" ~~ 5' co(D:T ~OOCD ,,"''0 ,<"~ ~. as c <'03 ~m3 0-'" ,,::r_ ...;)w 0 -a. 3'" ",,,, '<- '" ~. "':;. rn () o ::::::-: o .... Olm ....... 00 ^ I=.:: .......co , z)> m::J -. a. en)> c- o C .-+ '0 c 2: c5' '" " " '" '" '" ." - '\ "J , .-+ , m -. .-+ o - o -i ::::r o en co -n o o o ;;;t r " ~ r r I\) o o I\) ~ r r I\) o o I\) -n o o o ;;;t r " FOOD TALK FALL 2002 Know Your Enemy! BACTERIA COMMON SOURCES INCUBATION PERIOD SYMPTOMS Salmonella Raw and uncooked foods . Symptoms appear 6-48 Abdominal pain, diarrhea, ~O such as poultry, eggs and houl3 after eating nausea, chills, fever and meal, and unpasteurized milk. headache " tJ tJ Can spread through cross- . May last 1-8 days contamination. StaphylococcuS Found on skin, in cuts and . Symptoms appear 30 Abdominal pain, nausea, pimples and in nose and minutes-8 hours after vomiting and diarrhea. aureus throat. Spread by improper eating Occasionally followed by o - IB _ food handling. fever, weakness, headache, .- @53-..~ dizziness, and chills. . , CD Campylobacter Raw meat, poultry or shellfish . Sy~ploms appear 2-10 Fever, headache and muscle jejuni / and unpasteurized milk days after eating pain followed by nausea, abdominal pain and diarrhea .~~ . . May last 1-10 days ~)> Listeria Milk, leafy vegetables, . Newborns: 4 days Sudden onset of flu-like monocytogenes unpasteurized dairy products, symptoms such as fever, especially son cheeses, . Adults: I-several weeks headache. backache and _c~) processed meats and sometimes abdominal pain sandwiches. Poses the and diarrhea. ComplicatIOns greatest problem to immune- can include respIratory compromised people and distress in newborns; pregnant women. miscarriages and still births Escherichia Raw or rare ground beef, . Symptoms appear 3-9 days Severe abdominal cramps coli O157:H7 unpasteurized milk, aflereating followed by diarrhea, nausea, contaminated water and diny vomiting and occasionally a V\J hands . May last up to 10 days low grade fever. Complication is hlo:molytic uremic syndrome ~~ (HUS) in children. '\ J Source: u.s. Dept. of Agriculture, Food SafaJy& Inspection Service and the Food Research Institute, University of L-Visconsin - Madison )uaW)ludaa 411uaH lOpal!a 411uaH a;)nl p!AUa lNlW1MVdlO HllVlH AlNnm mONVH MlN IO~8l IN 'NOI9NIWlIM LHlIlS HlL I HlnOS 6l0l NOISIAIO HI1YlH lYINlWNOlllANl INlWll1YdlO HI1YlH AlNnOl lIlAONYH Mll it >IlV.L 000::1 Jaded papkJaJ uo pajuPd , e e September 2002 New Hanover County Health Department West Nile Virus Update The media has kept the general public well up-to-date on the progression of West Nile Virus throughout the na- tion. As of September 10. 2002. there have been 1.086 total human cases. with 45 total hu- ~ man fatalities. f\~J" j)) Thirty-two states - / ". have reported ~ --- ,- human cases, / from the East to the West Coast. The first human case in North Carolina was reported Sep- tember 18. 2002. Since human disease for West Nile Virus does not peak in the U.S. until late August or early September. we may well see new cases for a while. Physicians should suspect West Nile in people over 50 presenting with acute febrile illness. headache. confusion. and weakness (including flaccid paralysis resembling Guillain-Barre syndrome). West Nile Virus has been confirmed in birds from 13 North Carolina coun- ties. prompting continuing efforts to educate the public on prevention. Sharing the information on page 2 with your patients will help the effort, espe- cially with the frequent questions re- garding safety of insect repellants. Influenza Vaccine New Hanover County Health Depart- ment (NHCHD) will be offering influ- enza vaccine beginning October 14. 2002. Despite some early concerns about a delay in vaccine production and consequent delay in getting the vaccine to providers, vaccine ordered from the state will begin arrivi ng the first week of October; the full order is anticipated by the end of October In early September. the FDA approved a preservative-free influenza vaccine for pediatric use. The vaccine is manu- factured by Aventis. will be available in limited quantities in November. and can be obtained by calling Aventis at 1- 800-822-2463. Hepatitis B Vaccination in Schools The July 2002 issue of Epi Information reported that the Hepatitis B vaccina- tion program for middle school stu- dents was cancelled this year due to staff reductions. Thankfully two nurs- ing positions were approved for refill after several months on hold. The Health Department will again go to the schools to administer Hepatitis B vac- cine. Although beginning later in the school year than usual. all three doses will be administered by the end of the school year North Carolina Immuniza- tion Registry Update The Division of Public Health. Immuni- zation Branch. is attempting to bring full functionality to the new North Carolina Immunization Registry (NClR). as well as expand the use of the registry beyond the public sector. The new system adapts the Wisconsin Immunization Registry (WIR) for use in North Carolina. This system is a web-based clinical tool that complies with all core Centers for Disease Con- trol and Prevention (CDq functional registry requirements. The system also cracks vaccine inventory and fulfills all state accountability requirements Betsy Summey. FNP, 343-6531 for providers. It will be a secure Inter- net-based system. Four pilot counties have been identi- fied as the first counties to implement the new NCIR. Cabarrus. Chatham. Henderson, and Pitt counties were chosen based on existing participation in the Vaccination for Everyone initiative. Currently each health department in North Carolina is assessing its readi- ness to implement the new registry. NHCHD is working on its plan to be ready to convert to the new registry at the first opportunity. NHCHD will share information with medical provid- ers about their participation so that the immunization information will be more accessible to everyone who pro- vides state-supplied vaccine. Think TBI New guidelines from the CDC and the State TB Control Program are ex- pected out this fall. The guidelines are expected to offer more options in the treatment of TB, and in many cases, shorten the length of therapy. - 'lr..~;'" ? ,Me,. -",'. ~/?~~~ .) . ,..;.1 ~ One significant change will include the option for once a week directly ob- served therapy with isoniazid and rifap- entine for TB patients who are HIV negative and have non-cavitary disease. The Health Department will keep pro- viders abreast of all the changes as they become available. ~------------------------------------------------, I I I I I I I I I I I I North Carolina Division of Public Health West Nile Virus Repellant Guidelines Insect repellants containing DEET (N.N-diethyl-m-toluamide) and related compounds are the most effective mos- ,..Q..., quito repellants on the H market. When used 101 properly along with other steps such as U wearing light-colored long sleeved tops and long pants. avoiding mosquito-infested areas and staying indoors at dawn and dusk. repellants are a good way to minimize the risk of mosquito bites. As with any such products, precautions are in order to en- sure personal health and safety. Always read and follow label di- rections and precautions carefully. . Use other methods of protec- tion like dressing infants in long- sleeved shires and pants and placing mesh covers over stroll. ers. Children Aged 6 Months to 2 Years . Use only one application per day of a DEET product made for children (10% DEET or less) and only in situations where there is a risk of getting insect bites. . Apply repellant sparingly. . Do not apply to child's face and hands. . Avoid prolonged use. . After returning indoors. wash the child's treated skin with soap and water Children 3 to 12 Years of Age . Use a DEET product made for children containing 10% DEET or less. . Do not apply more than three times per day. . Apply repellant sparingly. . Do not apply to child's face and hands. . After returning indoors. wash the child's treated skin with soap and water . Children 13 Years of Age or Older and Adults . Use products containing 30% DEET or less. . Apply repellant sparingly. . To apply to face. spray on hands first and then rub on face. Do not spray directly on to face. . After returning indoors. wash treated skin with soap and wa. ter People should check around their homes and empty any containers holding water such as tires. bird- baths, and flowerpots. Screens should be used on doors and win- dows to prevent mosquitoes from entering homes. People who are using rain barrels to collect water during the drought should be sure the barrels have screens that fit tightly to prevent mosquito breeding. e Children Under 6 Months of Age . DO NOT use personal insect repellents on babies under 6 months of age. I ~------------------------------------------------ eommunicable Disease Statistics II New Hanover County July 1, 2002 - August 31,2002 AIDS.....................................8 Campylobacter....................2 Chlamydia .........................74 Gonorrhea .........................21 Hepatitis A...........................1 Hepatitis B (acute)..............3 Hepatitis B (carrier) ............0 Hepatitis C (acute) ..............0 HIV Infection........................9 Legionellosis.......................O Listeriosis ...........................0 Lyme Disease......................1 Meningitis Pneumococcal................1 Meningococcal Disease ...............................1 Pertussis ...............................1 Rky. Mt. Spotted Fever .........1 Salmonellosis...................... 32 Shigellosis............................. 0 Strep, Group A Invasive ....... 0 Syphilis.................................. 1 Tuberculosis .........................0 Typhoid (acute) ..................... 0 Vancomycin Resistant Enterococcus .................... 0 - 'Un ited 'We Stand .,., .' .-.-. . . ~ . . . .>-0- . 0'. . ~ . .. . , .'. .... .0 Published for Members of Local Boards of Health August 2002 ~~oo President's Message ~ ~ (OOm) ~ If~,.':.",~""" \" ',1', v~, ',' , _rV~'.r'" ~! I' m : ~- As I started to write this article I thought of the many things that have happened since our last NewsBrief. On the 12~ of April, Marie Fallon and I spent the day in Baltimore, Maryland looking at possible sites for the 2003 Annual Conference. It was a hard decision because all the sites had positive things offer However, the NALBOH Board of Directors decided on the Wyndham Inner Harbor for next year's conference and preparations have already begun. @~~ 7J ~~ffIS~ @~.~ ., ~n~,jlil " . t~" ;-;','-.>}, ;>l~i:,t0_:':%~f:~1k~/~~;;;.:::-.,;" l1@=~='~.P , C ".',~"~';f~'~>"' c...,. ,:..,-,,:. 11?2 ~~ ~~ On June 20th, those who have worked on the performance standards met in Washington DC to kick off the program. Marie Fallon, Ted Pratt, Shepard Cohen, Harvey Wallace and I represented NALBOH at this landmark meeting. The many long hours that have gone into this program now seem worthwhile. Those who worked on the project were rewarded for their efforts. Marie, Shepard, and Harvey were presented certificates of achievement. It was a great opportunity to meet with the representatives from APHA, ASTHO, NACCHO, PHF, and our other partnering organizations who were in attendance. The performance standards documents are available on our website. See page 12 for more details about this meeting and the performance standards. 11:ID Iil:!m ~ ~~ On the 9~ of July, the NALBOH Board met in a strategic planning session. We spent the entire day looking at five different areas that will help move our organization ahead in a positive manner The areas are education, technical assistance, advocacy, membership, and organizational infrastructure. It is our goal to work on each of these areas over the next three to five years. We will be assigning these five areas to the different committees that now exist. We will be looking to our membership for additional help to accomplish this strategic plan. r Continued on Page 2 Local Public Health and the West Nile Virus Ronald C. Burger Chainnan, Rockdale County Georgia Board of Health State Affiliate, NALBOH The West Nile virus (WNV) has traveled quite a distance since its introduction into the United States by way of New York City in 1999. At the time of this printing, WNV has been identified in either birds, mosquitoes, horses, and/or humans in 37 states including the District of Columbia. That's every state west to a line from Texas up to the Dakotas. There are predictions that WNV will soon reach the Pacific coast. WNV was first isolated from a febrile adult woman in the West Nile District of Uganda in 1937 The ecology was characterized in Egypt in the 19S0s. The virus became recognized as a cause of severe human meninoencephalitis (inflammation of the spinal cord and brain) in elderly patients during an outbreak in Israel in 1957 Equine disease was first noted in Egypt and France in the eariy 1960s. So, WNV is an old disease, but it is new to the USA. As of August 15, 2002, the total number of reported cases of WNV disease in humans was 160. Historically in the USA, there were 62 cases in 1999, 21 in 2000, and 66 last year WNV is just one of many "arboviruses" or arthropod-borne virus. Arboviruses are maintained in nature through transmission between susceptible vertebrate hosts by blood-feeding arthropods Continued on Page 3 .-i :JOJDJQ2VlCWZ Q.C""'C::E5"QlO::J"'OQ 8' ~-g ~ ~ 8 ~ :J :E QJ -I wwz-'no lr~ =r ro<.....:r:)>c-c:J)> oroco@~:JQJ:J:J _QJ ;::j"n (t):J"O ~ ::r~=: ~cr>:Jo:J '" :EI1IA ,C"'na.., rofifcrc_oroa............ m (/l ([) a: CD fD'"C ...,. 0 ~ In mOnVl3 ~ ~ I fI)=:J co30 CD < =- nw......::J"':J'" :JCn-'C"'n- => ro .., n a. 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