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Douglas County Department of Health and Human Services Health Services Division – 2013 Annual Report Dec 2009 Jan 2010 Jan. 2011 Jan 2012 Jan 2013 Jan 2014 Deputy Dir Health Svcs. / Health Officer*/ 2011 Public Health Services Supervisor 1.0 FTE 1.0 FTE 1.0 FTE (Vacant as of May) 1.0 FTE (Vacant) 1.0 FTE (Filled April 29, 2013) 1.0 FTE Environmental Health Mgr 1.0 FTE 0.0 FTE (Revised) Eliminated NA NA NA Public Health Nurses 4.0 FTE 4.0 FTE 5.0 FTE (1 FTE-held) 4.0 FTE 5.5 FTE 4.0 FTE Licensed Practical Nurse 0.8 FTE 0.8 FTE 0.0 FTE (Position Elim) NA NA NA Environmental Health Specialists 2.6 FTE 2.0 FTE 2.0 FTE 2.0 FTE 2.0 FTE 2.0 FTE Support Staff: Clerical and Billing (Centralized support for the Department) 2.5 FTE (included this yr in totals) 2.0 FTE Total FTE 9.4 FTE 7.8 FTE 8.0 FTE 7.0 FTE 11 FTE 9 FTE *Also provided administrative oversight for the Aging and Disability Resource Center of Douglas County and the Birth to Three Program in 2010 2011. SUCCESSES AND CHALLENGES SUCCESSES: • Childhood Immunizations The Public Health Nursing Unit had the following objective in 2013: By December 31, 2013, 69% children residing in Douglas County who turn 24 months of age during the contract year will complete 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hepatitis B, 1 Varicella and 4 Pneumococcal Conjugate (PCV) vaccinations by their second birthday. The Unit achieved 67% compliance. Continued vigilance in contacting parents, updating data in the Wisconsin Immunization Registry and improving written communication pieces for parents, assisted in this successful outcome. CHALLENGES: • Staffing The County continued to recruit for the open position of Health Officer and the position was filled April 2013. Line staff nursing positions had turnover during the year for varied reasons. Two public health nursing positions were filled in 2013 and one long term public health nurse retired. Outside public health consultant service continues to be engaged for varied administrative tasks. 1 ---PAGE BREAK--- This report is formatted to demonstrate how public health services address the Healthiest Wisconsin 2020 plan that includes 23 focus areas. Focus areas span across the life span and have overarching focus on health disparities, social, economic and education factors that influence health). Health Focus Areas: Alcohol and drug, chronic disease, communicable diseases, environmental and occupational, growth and development, injury and violence, mental health, nutrition, oral health, physical activity, reproductive and sexual and tobacco. Infrastructure Focus Areas: access, capacity and quality, emergency, funding, information systems, literacy and education, partnerships, research and evaluation and workforce SECTION A: PUBLIC HEALTH NURSING SERVICES, IMMUNIZATIONS, COMMUNICABLE DISEASES AND ENVIRONMENTAL HEALTH SERVICE: (Health Focus Areas) Programs 2010 Total 2011 Total 2012 Total 2013 Total Immunizations: # of Children Served # of immunizations(general) # Child. Seasonal flu shots # HINI Children shots # of Adults Served #of immunizations (general) # Adult seasonal flu shots # HINI Adult shots # HINI (Adults& Children) 953 452 [PHONE REDACTED] 1428 791 1205 1980 177 295 101 NA 566 597 417 NA NA 111 252 22 NA 82 87 6 NA NA 137 218 74 NA 52 64 1 NA NA Referrals Out # of Children Case Mgmt - # of Children # of Encounters 27 19 54 12 22 52 12 12 25 18 23 22 Birth to 3 Referrals: Month Admissions: YTD Active: 70 61 41 87 44 49 74 32 39 111 50 42 # Health Check Screenings/cancels # ASQ Actual / Annual Goal # ASQ-SE Actual / Annual Goal 6/2 87/50 73/50 NA 53 44 NA 52 43 NA 15 15 Oral Health: Children Getting Fluoride Varnishes / annual goal 117/50 NA NA NA Oral Health: Children Getting Sealants / MCH annual goal Seal-A-Smile sealants/goal 0/50 * NA NA NA Prenatal Care Coord. Client Refs Prenatal Care Coord. Client Admit Prenatal Care Coord. Contacts 98 73 350 117 67 443 116 48 302 73 27 79 EIDP – Early Ident. And Detect. Reproductive Education Clients Pregnancy Tests Express Enrollment Assistance 300/500 7 4 NA 7 1 NA 7 2 NA 5 0 High Risk New Born Referrals High Risk New Born Admits High Risk New Born Visits/TCs 149 107 357 132 97 276 180 116 240 208 100 244 Children’s Elevated Blood Lead Levels 8mcg/dL - <10mcg/dL ) Children with Blood Lead Poisoning (>10mcg/dL) YTD Blood Level Draws 5 2 60 (WNL) 5 1 4 19 6 5 1 18 (WNL) 15 2 1 YTD # Court Ordered Urine Drug Tests (for illegal substances) % of test = + this mo. % of test = + YTD 22 75 % 44%( 11//25) 47 17%(1/6) 34%(16/47) 61 30% (3/10) 31% (19/61) 69 38% (3/8) 39% (27/69) 2 ---PAGE BREAK--- # WI Well Woman New Enrollees # WI Well Woman Re-Enrollees # Women With Cancer Diagnosis Total Number Women Served 26 109 4 135 31 92 1 123 42 75 8 117 26 67 2 93 Discussion: • Immunizations: Adult influenza vaccinations were not offered to the general public this year by the Public Health Service due to there being adequate resources throughout the County for persons to access influenza vaccinations. Vaccinations were offered to children through the VFC program, with little demand experienced. • Wisconsin Well Woman Program: Public health nursing turnover contributed to the challenges in meeting this year’s project number of women served for this program. As a new staff person took this program over new ways of connecting with women evolved and proved to be successful. Some WWW clients no longer qualified for this program as they now qualified for Medicare or had found employment that provided adequate health insurance. The Program achieved serving 84% of the projected number. SECTION B: COMMUNICABLE DISEASES AND INTERVENTIONS 2013 2012/2011 2013 2012/2011 Arborviral Infect 2 0/0 Meningitis 0 3/3 Babesiosis 1 3/6 Blastomycosis 2 0/2 Meningitis 0 0/0 Campylobacteriosis 4 5/7 4 4/2 Mycobacterial, non-TB 2 1/1 Pertussis 0 26/2 Rabies Expos. 0 0/1 E. Coli 0157:H7 & other E.Coli 2 1/1 Pneumoniae- Strep Inv 6 4/2 Ehrlichiosis –(dx. criteria chged in 2010) 31 21/32 Salmonella 4 4/7 Giardiasis 6 6/3 Shigellosis 0 3/0 Hemoph. Influ B 1 1/0 Strep Group A 1 1/1 Hepatitis A 2 1/0 Strep Group B 3 3/4 Hepatitis B 4 10/3 Hepatitis C 45 50/41 Toxoplasmosis 0 1/1 HINI Influenza A 0 1/0 TB – Active 1 1/0 Influ Assoc. Hosp. 29 14/16 Varicella 0 14/0 Legionella 0 2/1 Lice -nuisance NA NA/8 TB Prophylaxis 4 1/3 Lyme Disease (Prob, Susp, Confirm) 50 42/71 TB Skin Tests 306 417/513 Other Discussion: Diseases associated with vector-borne illness continued to be a substantial number of cases for 2013. Influenza Associated Hospitalizations were higher in 2013 than in the two years prior. In 2011, the CDC directed hospitals to report influenza associated hospitalizations to local health departments. Prior to this directive the numbers are not available. 3 ---PAGE BREAK--- SEXUALLY TRANSMITTED DISEASES 2013 2012/2011 2013 2012/2011 Chlamydia 181 191/133 Chlamydia/ Gonorrhea 7 4/0 Gonorrhea 13 11/5 HIV/AIDS 2 1/1 Genital Herpes * 0 0/0 Pelvic Inflammatory. Disease 1 0/1 * Law changed in 2008 for providers requiring the reporting of “1st Episode Only” Discussion: • All cases are tracked via WEDSS • Sexually transmitted diseases remain a major public health challenge in Douglas County as well as Wisconsin and the nation. The Centers for Disease Control and Prevention (CDC) estimates that approximately 20 million new infections occur each year with half of all new STI’s occurring among young men and women ages 15 to 24 years. More information about sexually transmitted diseases can be found at: www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet- Feb-2013.pdf. ENVIRONMENTAL HEALTH SERVICES 2010 2011 2012 2013 TOTAL TOTAL TOTAL TOTAL INSPECTIONS: Retail Food 115 115 87 99 Restaurants 369 307 284 295 Hotels & Motels 56 60 52 66 Campgrounds 37 34 39 37 Swimming Pools 44 31 27 21 Mobile Home Parks 16 18 13 17 Rec. & Educational Camps 7 5 7 5 Tattoo & Piercing Establishments 5 8 11 8 Well - SDWA 32 60 48 40 DPI-School Kitchens 26 29 26 29 INSPECTION TOTAL: 707 667 594 617 INVESTIGATIONS: Food or Waterborne Illness 13 11 5 19 West Nile 0 0 1 1 Animal Bites/Rabies Protection 23 21 19 28 Air Quality Issues 29 23 42 58 Housing Issues 29 30 30 43 Animal/Insect 15 27 29 29 Consumer Complaints 15 22 21 45 Water Quality Issues 29 31 10 88 INVESTIGATION TOTAL: 153 165 157 311 LEAD HAZARDS: Elevated Blood Lead 1 1 5 0 Lead Risk Assessments 7 2 6 0 Lead Inspections - other 2 2 2 0 Clearance Inspections 5 0 0 2 LEAD INSPECTION TOTAL: 14 4 8 SAMPLE COLLECTION: 4 ---PAGE BREAK--- City Water 45 48 48 48 SDWA 315 344 299 209 Retail Food Swabs 30 30 0 40 SAMPLE COLLECTION TOTAL: 390 452 347 297 TRAINING PROGRAMS: Presentations 1 8 7 6 Participants 11 87 1000 750 HOME RADON TESTS: 9 62 63 63 LABORATORY 2010 2011 2012 2013 ACTIVITY TOTAL TOTAL TOTAL TOTAL Water Analysis Biological: Coliforms 3300-51 Public TNC 418 315 [PHONE REDACTED]-217 Private 498 471 441 309 Municipal 227 225 237 227 Chemical: Chlorine Residual 227 225 237 227 Total Coliform Tests 1153 1033 1010 804 Total Chemical Tests 227 225 237 227 Total Biological & Chemical Tests 1380 1258 1247 1031 Pasteurized Milk Analysis Total Milk Tests 599 595 616 633 Medical Waste: Loads 5 7 4 2 Autoclave Spore Tests 0 0 0 0 Discussion: • Air Quality Issues; Air quality numbers have seen a slight increase from previous years. This can be attributed to the number of complaints received from residents involving a local landfill. It was determined that the rain event of 2012 accelerated the decomposition of the landfill materials. We corroborated with the City of Superior Fire Dept., landfill owner, residents, WI DNR, a private consulting company and local government entities to bring resolution to this issue. Resources available to us included knowledgeable State personnel, and the availability of testing equipment. Direct involvement and investigation by this agency led to an agreeable solution in the end. • Well Inspections – SDWA (Safe Drinking Water Act): The Environmental Health unit of the Douglas County Dept. of Health is an agent for the Wisconsin Department of Natural Resources. This involves obtaining and testing well water samples under the Safe Drinking Water Act (SDWA). Since 2012 staff has received more advanced training in detecting, issuing, and follow-up correction of non-compliant issues involving water sources used by the public. Staff have also taken a proactive role in observing water source systems in their daily inspections, and have made recommendations to ensure a safe water supply. This approach may have resulted in the lowest number of unsafe water samples on record at two, resulting in fewer follow- up samples taken. The WIDNR has made note of this at the recent SWDA Training. • West Nile Virus: In September Douglas County had a crow that tested positive for West Nile Virus (WNV). An alert citizen notified us of a crow acting disoriented and sickly near his home. The dead bird was collected and sent to the Wisconsin State Lab of Hygiene for testing. The test confirmed what has been suspected, that WNV is widespread throughout the State of Wisconsin. A press release was issued and follow-up interviews with local news media took place, focusing on preventative measures. • Water Quality/Water Testing: The Douglas County laboratory provides water testing for private well owners as well as municipal water supplies. Advantages of having the testing done locally include timely testing and sharing of results. Once water samples are collected they need to be tested within a very specific amount of time. By having a local lab residents and businesses incur less shipping cost and issues related to sample holding times. 5 ---PAGE BREAK--- SECTION C: COMMUNITY HEALTH EDUCATION, TRAINING and PROGRAM DEVELOPMENT (Infrastructure Focus) Maternal Child Health/Early Childhood System Intervention: With several new employees in Public Health this year staff had to complete training about early childhood system interventions. They also met with leadership from the two local/regional hospital and clinic systems and Head Start to discuss and plan for ways to work collaboratively. The goal is to identify child development delays early by utilizing the Ages and Stages Development Screening tools. Since the focus of interventions has shifted from individual activities to systems-based strategies the work looks quite different. Community Health Improvement Plan: During 2013 the Steering Committee did not meet, but two sub-committees continued working on the health focus areas: Alcohol and Other Drug Use Physical Activity and Adequate, Appropriate, and Safe Food and Nutrition. The Community Health Assessment data presentation and current CHIP are posted to the Douglas County website at http://www.douglascountywi.org/index.aspx?NID=605 Community Education and Outreach: Public Health staff attends several different types of health fairs during the course of the year where they do education about a variety of topics. Events are held at local schools, the University, Wisconsin Indianhead Technical College, and other sites in the community. Public Health Nurses utilize the Life Course Board Game and get their audience involved in active learning. Pamphlets and brochures on a variety of topical areas are available for the general public to take home with them for future reference. Individual and group education also occurs in house. Adult and youth leadership groups visit public health and learn about programs, services, and job opportunities. During 2013 these events were popular and participants learned about public health and laboratory services. Workforce Development Staff in public health completes trainings that are necessary to assure competency in specific skill areas. Some training is mandated by the state while others are optional, but important to complete to assure that quality is at the forefront of our service delivery. With several new employees in public health this year training about public health preparedness was a critical piece to complete. Other program areas where training occurs routinely are Communicable Disease, Immunization, Maternal Child Health, and Prenatal Care Coordination. Staff continues to build depth in each program/service as they gain hands on experience and continue to learn new content. Earned Media Coverage Sharing information with the media and the general public remains an important aspect of the work done in public health. During 2013 several requests about health related topics were made from media sources in the Twin Port area. Reporters sought out information about back to school vaccinations as well as information about influenza practices. During the spring wildfire information about well safety and the importance of testing well water was highlighted. Tick-borne diseases continue to be an area that media seek out information as they attempt to educate the public. 6 ---PAGE BREAK--- Public Health Preparedness Douglas County Public Health is a member of the Western Wisconsin Public Health Readiness Consortium which consists of eleven local public health agencies and one tribal health agency. Established in 2003 with funds from the Center for Disease Control and Prevention (CDC), the purpose of the is to help local public health agencies and the public health workforce prepare to respond to all types of health emergencies, from large scale disease outbreaks to acts of bioterrorism. The does this through networking, coordinating, standardizing and centralizing resources and planning efforts among twelve local public health agencies in Western Wisconsin. Our Partners Barron County Health and Human Services Department, Burnett County Department of Health and Human Services, Chippewa County Department of Public Health, Clark County Health Department, Douglas County Department of Health and Human Services, Eau Claire City-County Health Department, Pepin County Health Department, Pierce County Health Department, Polk County Health Department, Rusk County Department of Health and Human Services, St. Croix Tribal Health Department, and Washburn County Health and Human Services Department. 2013 Key Achievements 1. maintained a strong presence in the arena of preparedness. is one of only two remaining consortia, pertaining to public health emergency preparedness, in the State of Wisconsin. 2. member agencies achieved measurable gains in target capabilities. Highlights include: a. Fatality Management: members reduced the number of identified gaps by 48. b. Community Preparedness: members responded to new criteria in this capability and accurately identified eight new gaps to be addressed. c. Responder Safety and Health: members averaged 11% fewer gaps than non-members in the region. 3. members participated in a two-day fatality management training, instructed by a nationally-recognized presenter. 71 people, including local staff and partners, attended. 4. sponsored ICS 300 and 400 trainings in the region as well as Preparedness 101 trainings. Staff in public health attended ICS 300 and 400 training as well fatality management training. A presentation about general preparedness was offered to all Douglas County employees. 5. Douglas County increased public awareness of emergency response by releasing information to the public through press releases and on our website during the spring fire and other times throughout the year. 6. Douglas County successfully met all the Public Health Cooperative Grant Agreement contract objectives and deliverables Future Preparedness Challenges 1. Federal funding for preparedness has been reduced in past grant years. Public health preparedness funding is expected to remain level in Wisconsin; hospital preparedness funding is being reduced. 2. Wisconsin is likely transitioning to a model of regional preparedness coalitions consisting of hospitals, public health agencies, emergency management and other allied agencies called “Healthcare coalitions.” The goal of these coalitions is to increase emergency response capacity in local communities. 3. Governmental public health departments are facing significant workforce shortages that will likely be exacerbated through retirements, tax levy constraints and grant funding shortages. The loss of workforce, in terms of knowledge and skills, will challenge the readiness of the public health system to respond to health emergencies. Submitted by Katherine German-Olson Health Officer, Health and Human Services Department 7