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Douglas County Department of Health and Human Services Health Services Division – 2012 Annual Report Dec. 2008 Dec 2009 Jan 2010 Jan. 2011 Jan 2012 Jan 2013 Deputy Dir Health Svcs. / Health Officer*/ 2011 – Public Health Services Supv 1.0 FTE 1.0 FTE 1.0 FTE 1.0 FTE (Vacant as of May) 1.0 FTE (Vacant) 1.0 FTE (Interim) Environmental Health Mgr 1.0 FTE 1.0 FTE 0.0 FTE (Revised) Eliminated NA NA Public Health Nurses 4.0 FTE 4.0 FTE 4.0 FTE 5.0 FTE (1 FTE-held) 4.0 FTE 5.5 FTE Licensed Practical Nurse 0.8 FTE 0.8 FTE 0.8 FTE 0.0 FTE (Position Elim) NA NA Environmental Health Specialists 2.6 FTE 2.6 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) Total FTE 9.4 FTE 9.4 FTE 7.8 FTE 8.0 FTE 7.0 FTE 11 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 2012: By December 31, 2012, 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 76% 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 engaged a recruitment firm in the Fall of 2012 after unsuccessful attempts in recruitment. Several counties, state-wide have similar challenges in filling vacant Health Officer positions. Line staff nursing positions had turnover during the year for varied reasons. However the Public Health Nursing Service gained an additional PHN position during the year to address work capacity challenges. Outside public health consultant service continues to be engaged for varied administrative tasks. 1 ---PAGE BREAK--- This report has been reformatted 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 2009 Total 2010 Total 2011 Total 2012 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) 2142 [PHONE REDACTED] 2122 [PHONE REDACTED] 3293 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 Referrals Out # of Children Case Mgmt - # of Children # of Encounters 25 75 27 19 54 12 22 52 12 12 25 Birth to 3 Referrals: Month Admissions: YTD Active: 71 51 70 61 41 87 44 49 74 32 39 # Health Check Screenings/cancels # ASQ Actual / Annual Goal # ASQ-SE Actual / Annual Goal 20 129/100 107/100 6/2 87/50 73/50 NA 53 44 NA 52 43 Oral Health: Children Getting Fluoride Varnishes / annual goal 100/158 117/50 NA NA Oral Health: Children Getting Sealants / MCH annual goal Seal-A-Smile sealants/goal 42/50 31/100 0/50 * NA NA Prenatal Care Coord. Client Refs Prenatal Care Coord. Client Admit Prenatal Care Coord. Contacts 125 63 451 98 73 350 117 67 443 116 48 302 EIDP – Early Ident. And Detect. Reproductive Education Clients Pregnancy Tests Express Enrollment Assistance 500 2 0 300/500 7 4 NA 7 1 NA 7 2 High Risk New Born Referrals High Risk New Born Admits High Risk New Born Visits/TCs 114 95 206 149 107 357 132 97 276 180 116 240 Children’s Elevated Blood Lead Levels 8mcg/dL - <10mcg/dL ) Children with Blood Lead Poisoning (>10mcg/dL) YTD Blood Level Draws 5 3 5 2 60 (WNL) 5 1 4 19 6 5 1 18 (WNL) YTD # Court Ordered Urine Drug Tests (for illegal substances) % of test = + this mo. % of test = + YTD 32 100% 31% 22 75 % 44%( 11//25) 47 17%(1/6) 34%(16/47) 61 30% (3/10) 31% (19/61) 2 ---PAGE BREAK--- # WI Well Woman New Enrollees # WI Well Woman Re-Enrollees # Women With Cancer Diagnosis Total Number Women Served 44 129 1 26 109 4 135 31 92 1 123 42 75 8 117 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: Challenges in meeting this year’s project number of women served include reaching women who are eligible for WWWP and assisting them to access preventative care, increasing community and medical provider awareness about WWWP and the services offered, and assisting women in rural areas who have limited transportation to access medical care. 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 79% of the projected number. SECTION B: COMMUNICABLE DISEASES AND INTERVENTIONS 2012 2011/2010 2012 2011/2010 Arborviral Infect 0 0/0 Meningitis 3 3/1 Babesiosis 3 6/0 Blastomycosis 0 2/2 Meningitis 0 0/1 Campylobacteriosis 5 7/9 4 2/2 Mycobacterial, non-TB 1 1/5 Pertussis 26 2/2 Rabies Expos. 0 1/0 E. Coli 0157:H7 & other E.Coli 1 1/2 Pneumoniae- Strep Inv 4 2/5 Ehrlichiosis –(dx. criteria chged in 2010) 21 32/22 Salmonella 4 7/1 Giardiasis 6 3/9 Shigellosis 3 0/0 Hemoph. Influ B 1 0/1 Strep Group A 1 1/0 Hepatitis A 1 0/1 Strep Group B 3 4/4 Hepatitis B 10 3/0 Hepatitis C 50 41/29 Toxoplasmosis 1 1/1 HINI Influenza A 1 0/0 TB – Active 1 0/0 Influ Assoc. Hosp. 14 16/0 Varicella 14 0/0 Legionella 2 1/1 Lice -nuisance 8/10 TB Prophylaxis 1 3/7 Lyme Disease (Prob, Susp, Confirm) 42 71/120 TB Skin Tests 417 513/435 Other Discussion: Babesiosis is a vector-borne illness usually transmitted by Ixodes scapularis ticks. A reported increase in babesiosis diagnoses in the 2000s is thought to be caused by more widespread testing and higher numbers of people with immunodeficiencies coming in contact with ticks, the disease vector. Influenza Associated Hospitalizations – In 2011, the CDC directed hospitals to report influenza associated hospitalizations to local health departments. Prior to this directive the numbers are not available. Reported suspect, probable and confirmed cases declined during 2012. In 2011 the County had 19 confirmed cases. A comparison of cases by county can be accessed at : www.dhs.wisconsin.gov/communicable/Tickborne/Lyme/2011WICoCount.htm PHN’s collaborated with Washburn County to provide follow-up on cases associated with an outbreak of Pertussis occurring in a school located in Washburn County but with students residing in Douglas County. They provided 3 ---PAGE BREAK--- surveillance and education for 4 cases of Pertussis in July, 2012 and sent a Health Alert along with the updated Wisconsin DPH guidelines for Pertussis to local medical providers with recommendation to test and treat patients who present with initial of Pertussis. The Public Health Service continued to see Pertussis cases throughout the summer, including an outbreak at child care setting (August, 2013). Varicella Outbreak - The occurrence of ≥5 Varicella cases that are related in place and epidemiologically linked. In July, PHN’s conducted investigation, surveillance, education, and guidance at a rural youth camp during a Norovirus outbreak that involved 81 campers and staff members and for 2 staff members who tested positive for shigellosis SEXUALLY TRANSMITTED DISEASES 2012 2011/2010 2012 2011/2010 Chlamydia 191 133/124 Chlamydia/ Gonorrhea 4 0/0 Gonorrhea 11 5/3 HIV/AIDS 0 0/0 Genital Herpes * 0 0/1 Pelvic Inflammatory. Disease 0 1/1 * Law changed in 2008 for providers requiring the reporting of “1st Episode Only” Discussion: • All cases are tracked via WEDSS • For discussion and trending of Sexually Transmitted Infections (STI’s) in Wisconsin, see : . Sexually transmitted diseases remain a major public health challenge in Wisconsin and the US. The Centers for Disease Control and Prevention (CDC) estimates that approximately 19 million new infections occur each year, almost half of them among young people ages 15 to 24 years. The two most commonly reported infectious diseases in America, Chlamydia and Gonorrhea, pose a particular risk to the health of women, as both can cause infertility if left untreated. ENVIRONMENTAL HEALTH SERVICES 2007 2008 2009 2010 2011 2012 TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL INSPECTIONS: Retail Food 91 97 79 115 115 87 Restaurants 346 379 260 369 307 284 Hotels & Motels 55 66 53 56 60 52 Campgrounds 33 38 32 37 34 39 Swimming Pools 52 29 14 44 31 27 Mobile Home Parks 16 19 21 16 18 13 Rec. & Educational Camps 7 5 5 7 5 7 Tattoo & Piercing Establishments 20 0 0 5 8 11 Well - SDWA 37 34 27 32 60 48 DPI-School Kitchens 27 26 26 26 29 26 INSPECTION TOTAL: 684 693 517 707 667 574 INVESTIGATIONS: Food or Waterborne Illness 6 10 24 13 11 5 West Nile 3 9 0 0 0 1 Animal Bites/Rabies Protection 28 28 41 23 21 19 Air Quality Issues 27 31 35 29 23 42 Housing Issues 78 98 55 29 30 30 Animal/Insect 12 18 14 15 27 29 Consumer Complaints 11 7 8 15 22 21 Water Quality Issues 7 23 30 29 31 10 INVESTIGATION TOTAL: 177 227 207 153 165 157 4 ---PAGE BREAK--- LEAD HAZARDS: Elevated Blood Lead 4 3 2 1 1 5 Lead Risk Assessments 30 27 11 7 2 6 Lead Inspections - other 13 7 3 2 2 2 Clearance Inspections 8 2 6 5 0 0 LEAD INSPECTION TOTAL: 55 39 22 14 4 8 SAMPLE COLLECTION: City Water 54 42 43 45 48 48 SDWA 252 283 343 315 344 299 Retail Food Swabs 30 30 30 30 30 0 SAMPLE COLLECTION TOTAL: 641 668 424 390 452 347 TRAINING PROGRAMS: Presentations N/A 14 9 1 8 7 Participants N/A 273 406 11 87 1000 HOME RADON TESTS: 55 38 47 9 62 63 LABORATORY 2007 2008 2009 2010 YTD ACTIVITY TOTAL TOTAL TOTAL TOTAL 2011 Water Analysis Biological: Coliforms 3300-51 Public TNC 300 307 360 418 [PHONE REDACTED]-217 Private 616 558 574 498 471 441 Municipal 234 237 229 227 225 237 Chemical: Chlorine Residual 237 233 236 227 225 237 Total Coliform Tests 1466 1426 1175 1153 1033 1010 Total Chemical Tests 237 233 236 227 225 237 Total Biological & Chemical Tests 1703 1659 1411 1380 1258 1247 Pasteurized Milk Analysis Total Milk Tests 670 571 618 599 595 616 Medical Waste: Loads 8 8 6 5 7 4 Autoclave Spore Tests 0 0 0 0 0 0 Discussion: • Air Quality Issues; This past year has seen a noticeable increase in air quality investigations. The 42 air quality investigations exceed the previous year’s investigations by 42 mainly due to a June, 2012 flood impact on much of Douglas County including the City of Superior. The flooding increased calls to the Environmental Health Unit regarding indoor air / mold concerns. The Unit provided education to the public via dissemination of information on local flood recovery resources, via in person contacts and through the County’s website. The Unit also partnered with service agencies to address flood recovery and to investigate human health hazards that occurred during the flood. • Animal and Insect Issues – Complaints regarding animals and insects have increased by 48% from the prior year 15 – 2011; 29 - 2012. Most of the complaints were regarding bed bug infestations. Nationwide there has been an increase in the prevalence of bed bug infestations due to a resistance to pesticides, increased mobility of society, and a lack of owner/operator pest control experience, especially regarding bed bugs. Several investigations of multi-unit dwellings and individual homes were conducted by Environmental Health staff in 2012, along with the City of Superior Building Inspection staff. Clients were assisted through the dissemination information on bed bugs, as well as staff working with property owners to find pest control services that properly treat for bed bug infestations. Follow-up checks are made by staff to ensure problem resolution. • Food and Waterborne Illness – All reported complaints and incidences of food or water borne illness are investigated in collaboration by the Environmental Health and Public Health Nursing staff. Although complaints were down by 55% in 2012, reasons for the decline in reporting are not known. 5 ---PAGE BREAK--- • Presentations – The Environmental Health staff participated in eight community outreach events throughout 2012. Events included the Health and Housing Expos at the Mariner Mall; A Food Safety Presentation to restaurant owners and employees at St Anthony’s Catholic Church in Lake Nebagamon.; the Children’s Festival at Lucius Woods in Solon Springs; health fairs at WITC, North Western High School, Cooper School, and Superior Middle Schools; and a family fun day at SHA (Superior Housing Authority). Several hundred people attended these events with questions and concerns that were addressed by Environmental Health staff. Douglas County continues to be an active participant in community events, disseminating current information, and guidance to residents. • Radon Testing – The Environmental Health staff continued to provide public education on radon and radon testing in 2012. Staff promoted radon testing through press releases, public access television, public outreach, and offering test kits at a reduced fee during Radon Awareness Month (January). The public responded to this effort and purchased 63 radon test kits, the highest amount distributed in over 6 years. Of the 63 kits sold, 41% (26) kits were returned for testing. Of the 26 test results, 23% results were greater than the EPA guidelines, which indicate a radon health hazard. The Environmental Health staff provided guidance and resources to remediate potential for this human health hazard. Staff continues to field inquiries, jurisdiction-wide about radon. Grant funding was not available to offset the expense of providing this service, however, revenues from the sale of the kits helped in part to cover costs. • Retail Food Inspections – (8 months) doubled up last year, not this year) As State Agent for DHS (Department of Health Services) and DATCP (Department of Agriculture, Trade and Consumer Protection) in licensing regulated establishments, staff increased the frequency of inspections for high risk establishments (when the foods are serve or prepared at higher risk for food-borne infections to include complexity of food and food handling processes). Starting September 2010, high risk establishments are inspected every 8 months verses once a year. This increased frequency results in 3 full inspections over a 2 year period. Approximately 30 establishments in the County fall into this category. This may result in two inspections one year and one inspection the following year. In addition, overall complaints were down from previous years. • Water Quality Issues – A major flood took place in Douglas County, June 19/20 of 2012. The flood waters had an immediate effect on living conditions for many residents, and also long term effects with compromised drinking water from wells throughout the county. With assistance from the State Department of Health Services, water test kits were provided free of charge to the Environmental Health staff and County residents. Residents who experienced a compromised well from the flood were given a free test kit to sample their well water. Over 60 kits were distributed, and a minimum of 20% of those tested were unsafe due to contamination. Staff also provided information and guidance on sanitizing unsafe wells to home owners or through service providers. • Well Inspections – SDWA (Safe Drinking Water Act) – Each year, Environmental Health Staff inspect approximately 35 wells for the Safe Drinking Water Act. This is 20% of all drinking water systems the department is responsible for sampling as per a contract with the Wisconsin DNR (Department of Natural Resources). In 2012, staff conducted 37 well inspections. At the request of the Wisconsin Department of Natural Resources, staff also conducted follow up inspections of drinking water systems with deficiencies identified during the original inspection. Twelve fewer well inspections required a follow up inspection to assure that drinking water systems complied with the safe drinking water act in 2012. SECTION C: COMMUNITY HEALTH EDUCATION, TRAINING and PROGRAM DEVELOPMENT (Infrastructure Focus) ECSI Objective: Public Health staff met with leadership from the two local/regional hospital and clinic systems to review results from a prior assessment of health services required by children. A major role of Public Health Nursing is to ensure that community leadership works in coalition with public health to address gaps and other issues that are discovered in such assessments and to develop multi-year plans to address these needs. The MCSI objective has a focus on child development and related health care interventions. CHA and CHIP: The Steering Committee met twice during the year and provided direction to the two sub-committees that are 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 Public Health Preparedness Activities: 1/31/12 -2/1/12 Several staff attended a conference on “Shelter Management” in Duluth, MN 10/11-12 Staff attended Risk Communication training 10/30/12 Lead Preparedness staff met to determine 3 areas the Health Division will address within each of the 3 target capabilities the state has chosen to address this year. The 3 target capabilities chosen by the state are: Emergency Operations Coordination, Emergency Public Information and Warning, and Information 6 ---PAGE BREAK--- 12/17/12 Staff attended the Western WI Public Health Readiness Consortia Board of Directors meeting in Eau Claire, WI. Lead Preparedness staff updated Incident Command positions to account for staffing changes Several new staff members completed the required ICS training certification 9/29/12 Several staff participated in a webinar provided by the regional coalition on “Preparedness” Community Education: 2/7/12 Staff presented the Life Course Game as a teaching method during Youth Leadership Day 2/10/12 Staff presented the Life Course Game as a teaching method during Adult Leadership Day 2/13/12 Nursing staff provided Mantoux testing and education to UWS students who required testing due to their career tract. 2/17/12 Staff participated in the Winter Fest Health Fair at NW (Northwestern) School 6/09/12 Staff participated in the Solon Springs Youth Fair by providing a variety of information regarding public health and environmental health programs and services. 9/4/12 Staff provided lead safety information at Cooper Elementary School fair. 9/17/12 Two staff nurses provided Mantoux skin tests to students at UWS. 9/22/12 PHN provided education on public health services at Superior School District Youth Fair. Workforce Development 2/21/12 One PHN attended training on the WWWP (Wisconsin Well Woman Program) 3/23/12 Several nurses participated in TB educational webcast, by the State 3/27/12 A PHN participated in the WITC Health Fair 4/3/12 Staff participated in a training on Internet Safety 4/18/12 One PHN attended a WWWP training regarding Fax to Quit Program (smoking cessation) 4/18-19/12 Two new PHNs attended the Training for New Public Health Employees, by the State 6/9/12 Staff participated in the Solon Spring’s Children’s Fair 6/26/12 Staff nurses participated in a training webcast on “How to Talk to Vaccine Hesitant Parents” 7/24/12 Several nurses participated in a webcast on “Vaccine Policy Changes”, by the State 7/24/12 Staff participated in a webinar entitled “How to Talk to Vaccine Hesitant Parents”. 7/26/12 Staff participated in a webinar entitled “Vaccine Policy Changes”. 8/2012 Two PHNs attended the Annual PHN Conference 8/07/ 1staff attended Wisconsin Immunization Registration training 8/15/12 Nursing staff participated in a webinar on “the MCH Grant / Life Course Model 8/20-21: 2 nurses attended the PHN Annual Conference in Stevens Point 8/27: All nurses met with contract nurse consultant to review 2012 grant deliverables and develop continued tactics for meeting these deliverables. 9/5/12 All nurses viewed webinar on changes to immunization eligibility guidelines 9/13/12 New PHN attended Breastfeeding Conference in Duluth, MN 9/26/12 PHN attended Western Region PNCC and Healthy Babies Meeting in Eau Claire, WI 9/27/12 Two nurses attended WIR/VFC training in Ashland, WI. 10/2/12 Two nurses attended PNCC 101 training in Eau Claire, WI 10/16/12 Several nurses participated the teleconference “ Pertussis Outbreak in MN” 10/17-18/12 New PHN attended New Public Health Employee Orientation in WI 10/23/12 Staff attended customer service training provided by the County 10/23/12 PHN and Interim Health Officer attended Quality Improvement/Accreditation meeting in Eau Claire, WI 10/23/12 Several staff attended the webinar on “Life Course Theory / Model 10/30/12 PHN attended Regional Infection Control Network meeting in Duluth, MN 11/15/12 One PHN attended a Breast Feeding Conference provided by the State Earned Media Coverage 9/5/12 PHN provided media interview to Duluth News Tribune on “Pertussis in Day Care Environment” 9/5/12 PHN provided media interview to WDIO TV on “Back to School Immunizations” 12/4/12 PHN provided media interview regarding early onset of influenza season and influenza-related deaths in WI, though no influenza-related deaths or outbreaks have been reported in WI at this time. Submitted by Patricia Schanen, Interim Health Officer and Director, Health and Human Services Department Written by Deb Clasen, RN, PHN, MA – Consultant, March, 2013 7