ANNUAL COMMUNITY AND ENVIRONMENTAL HEALTH REPORT
2015
AnnualSummaryoftheDivisionofCommunityServicesandEnvironmentalHealthattheToledo-LucasCountyHealthDepartmentfor2015
Toledo-LucasCountyHealthDepartment635NorthErieStreetToledo,Ohio43604Tel419-213-4100Fax419-213-4546www.lucascountyhealth.com
Thispageintentionallyleftblank
PublishedApril,2016
CompiledandPreparedBy:
EricZgodzinski,MPH,RS,CPHDirectorofCommunityandEnvironmentalHealth
DanBaker,MPH,SITCommunityResponsePlanner/MedicalReserveCorpsCoordinator
JerryBingham,RSEnvironmentalHealthSupervisor
DanielleBoyd,MPHPublicHealthAssociate
TerriDalton,MASeniorClerk
KeithDempseyRegionalEbolaCoordinator
SamanthaEitniear,MPH-VPH,CPH,SITBioinformaticsAnalyst
PattiFraker,RD,LDEpidemiologist
JenniferGottschalk,MPH,RS,REHSEnvironmentalHealthSupervisor
AliaKadri,MPHPHABCoordinator/QualityAssurance
ShannonLands,MBAPublicInformationOfficer
LaurenLiebich,MPH,SITEpidemiologist
CherylLocher,MPA,MSDisasterPlanner
GregMoore,MBA,SITRegionalCoordination/BioterrorismCoordinator
JoshuaNiese,RSEnvironmentalHealthSupervisor
BrandonPalinski,MPH-VPH,SITPHABCoordinator/QualityAssurance
BradSherrick,RSEnvironmentalHealthSupervisor
MahjidaSteffinClerkI
ScottStrahlDisasterPlanner
Thisreportisproudlysupportedby:
Dr. David Grossman, MD
HealthCommissioner
TABLE OF CONTENTS
Page1
Contents
InfectiousDiseaseIntroduction ________________________________________________________________________ 1
DemographicProfileofLucasCounty__________________________________________________________________ 1
CountsandRatesofReportableDiseases______________________________________________________________ 2
GeographicDistributionofSelectedDiseases_________________________________________________________ 9
Outbreaks________________________________________________________________________________________________10
TimelinessofDiseaseReports_________________________________________________________________________14
EnvironmentalHealthIntroduction___________________________________________________________________16
FoodProtection_________________________________________________________________________________________17
LeadPrevention_________________________________________________________________________________________17
SepticandWater________________________________________________________________________________________20
RecreationalVehicleParks_____________________________________________________________________________24
RodentProgram_________________________________________________________________________________________25
Schools___________________________________________________________________________________________________28
PublicSwimmingPools_________________________________________________________________________________29
BodyArt_________________________________________________________________________________________________31
BathingBeaches ________________________________________________________________________________________32
Smoke-FreeWorkplace_________________________________________________________________________________33
AnimalBites_____________________________________________________________________________________________34
Nuisance_________________________________________________________________________________________________37
ResponseandPreparedness___________________________________________________________________________38
PublicHealthAccreditation____________________________________________________________________________44
QualityImprovement___________________________________________________________________________________46
ContactInformation____________________________________________________________________________________51
INFECTIOUS DISEASE INTRODUCTION
Page1
InfectiousDiseaseIntroduction
INFECTIOUS DISEASES
Infectiousdiseases,alsocommonlycalledcommunicablediseases,areillnessescausedbymicroorganisms,(bacteria,viruses,andparasites)andcanbetransmittedfromaninfectedpersonoranimaltoanotherpersonoranimal.Therouteoftransmissionvariesbydiseaseandmayincludedirectcontactwithcontaminatedbodyfluids(e.g.,blood)orrespiratorysecretions,contactwithcontaminatedobjects,inhalationofcontaminatedairborneparticles,ingestionofcontaminatedfoodorwater,orthebiteofananimalorvector(e.g.,insect)carryingthemicroorganism.
KEY FINDINGS
2015sawanincreaseofdiarrhealillnesses:o Campylobacterosisincreasedfrom47in2014to72in2015o Giardiasisincreasedfrom9in2014to17in2015o Cryptosporidiosisincreasedfrom17in2014to19in2015o Salmonellosisincreasedfrom37in2014to43in2015
For2015,therewasadecreaseinthenumberofreportedcasesofHIV/AIDS,with54beingreportedin2014and33beingreportedin2015.Additionally,therewasadecreaseinthenumberofcasesofSyphilis,with59beingreportedin2014and40casesreportedin2015.
LOOKING AHEAD
TheToledo-LucasCountyHealthDepartmentiscontinuallystrivingtodecreasethenumberofinfectiousdiseasesacquiredbyresidentsofourcounty,aswellasthosevisitingourjurisdiction.Increasingcommunityawarenessandeducationarecontinuedgoalsforourupcomingcalendaryear.
DEMOGRAPHIC PROFILE OF LUCAS COUNTY
Page1
DemographicProfileofLucasCounty
Table1:LucasCountyPopulationbyGenderandAgeGroup,2010CensusData
Age NumberofFemale Percent NumberofMale PercentUnder5years 14,680 3.3 15,052 3.45to9years 13,984 3.2 14,772 3.310to14years 14,004 3.2 14,625 3.315to19years 16,510 3.7 17,137 3.920to24years 17,029 3.9 16,792 3.825to29years 14,875 3.4 14,536 3.330to34years 13,500 3.1 13,032 2.935to39years 14,112 3.2 13,492 3.140to44years 13,837 3.1 13,209 3.045to49years 16,132 3.7 15,064 3.450to54years 17,088 3.9 16,157 3.755to59years 15,338 3.5 14,411 3.360to64years 12,720 2.9 11,918 2.765to69years 9,020 2.0 7,676 1.770to74years 7,105 1.6 5,622 1.375to79years 6,212 1.4 4,244 1.080to84years 5,761 1.3 3,572 0.885+years 5,942 1.3 2,655 0.6Total 227,849 51.6 213,966 48.4
Table2:LucasCountyPopulationbyRace(aloneorincombinationwithoneormoreotherraces*),2010CensusData
Race Number ofPersons PercentWhite 339,206 76.8BlackorAfricanAmerican 92,260 20.9AmericanIndianandAlaskaNative 4,246 1.0Asian 8,801 2.0NativeHawaiianandOtherPacificIslander 382 0.1SomeOtherRace 11,904 2.7
*Incombinationwithoneormoreoftheotherraceslisted.Thesixnumbersmayaddtomorethanthetotalpopulation,andthesixpercentagesmayaddtomorethan100percentbecauseindividualsmayreportmorethanonerace.
Table3:LucasCountyPopulationbyEthnicity,2010CensusData
Ethnicity NumberofPersons PercentHispanicorLatino(ofanyrace) 26,974 6.1Mexican 22,028 5.0PuertoRican 1,482 0.3Cuban 388 0.1OtherHispanicorLatino** 3,076 0.7NotHispanicorLatino 414,841 93.9Totalpopulation 441,815 100.0Thiscategoryiscomposedofpeoplewhoseoriginsarefromthe DominicanRepublic,Spain,andSpanish‐speakingCentralorSouthAmerican
countries.Italsoincludesgeneraloriginresponsessuchas"Latino"or"Hispanic."
COUNTS AND RATES OF REPORTABLE DISEASES
Page2
CountsandRatesofReportableDiseases
OVERVIEW
AccordingtotheOhioAdministrativeCode3701-3-02,casesandsuspectedcasesofselectedinfectiousdiseasesarerequiredtobereportedtotheOhioDepartmentofHealthandlocalpublichealthagencies.ThesereportablediseasesweredeterminedtobeofpublichealthsignificanceinOhio.ManyofthesediseasesmustalsobereportedbystatehealthdepartmentstotheCentersforDiseaseControlandPrevention(CDC)aspartofnationalpublichealthsurveillanceofinfectiousdiseases.
The2015AnnualSummaryincludescasesofreportablediseasethatwerediagnosedamongresidentsofLucasCounty,reportedtopublichealth,andfoundtomeetthepublichealthsurveillancedefinitionofasuspectedorconfirmedcase.Thesedatadonotrepresentallcasesofreportableinfectiousdiseasethatoccurredinthecommunity,asindividualsmaynotseekmedicalcareformildorasymptomaticinfections.Additionally,areportedcaseofdiseasemaynotmeetthesurveillancedefinitionofaconfirmedorsuspectedcase.Surveillancedefinitionsaredesignedtostandardizedatacollectionandreportingacrosspublichealthjurisdictionsandmaydifferslightlyfromclinicaldefinitionsusedinpatientmanagement.Outbreaksormediacoverageofaparticulardiseasecanalsoinfluencetestingandreportingrates.Datainthissummaryareconsideredprovisional.Pleasenotethatdatainthefollowingpagesaregroupedbytypeofdisease.Discrepenciesinnumbersofreportedcasesmayexistfromlocaltostatelevelandnationallevelbasedonanynumberofcriteriatoincludeorexcludecases.Foranyquestions,pleasecontacttheepidemiologystaffatTLCHD.
ThissummaryisintendedtobearesourceforindividualsandpublichealthpartnersconcernedaboutinfectiousdiseasesinLucasCounty.FurtherinformationoncommunicablediseasemaybeobtainedbycontactingtheToledo-LucasCountyHealthDepartment.
REPORTABLE DISEASES
Acomprehensivelistingandguidanceforreportablediseasesandnon-reportablediseasesintheStateofOhiocanbefoundintheInfectiousDiseaseControlManual(IDCM)(http://www.odh.ohio.gov/pdf/idcm/intro1.pdf).ThisdocumentalsoincludesrulescontainedwithintheOhioAdministrativeCode(OAC)thatpertaintoinfectiousdiseasereporting.ServicesprovidedattheOhioDepartmentofHealthLaboratoryandprocessestosubmitspecimenscanbefoundwithinthisdocument.
CHANGES FROM 2014
OnMay1,2015,Rule3701-3-02intheOhioAdministrativeCodechanged.Thechangesinclude:
AdditionofMiddleEastRespiratorySyndrome(MERS)asaClassAdisease
AdditionofChikungunyavirusinfectionunderarboviraldiseases(ClassB)
EnumerationofthefourViralHemorrhagicFeversinClassA(Ebolavirusdisease,Lassafever,Marburghemorrhagicfever,andCrimean-Congohemorrhagicfever)
COUNTS AND RATES OF REPORTABLE DISEASES
Page3
2015 2014 2013 2012 2011
ReportableCondition Cl
ass
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
ENTERIC
Amebiasis B 1 0.23 1 0.23 1 0.23 1 0.23 1 0.23 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0Campylobacteriosis B 73 16.52 73 16.52 47 10.64 61 13.81 49 11.09 76 17.20 57 12.90 70 15.84 31 7.02 183 41.42Cholera A 0 0.00 0 0.00 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Cryptosporidiosis B 20 4.53 20 4.53 17 3.85 17 3.85 14 3.17 14 3.17 19 4.3 19 4.30 18 4.07 18 4.07Cyclosporiasis B 0 0.00 0 0.00 1 0.23 1 0.23 3 0.68 3 0.68 0 0.0 0 0.0 0 0.0 0 0.0E.coli-NotO157:H7
B 0 0.00 0 0.00 1 0.23 1 0.23 3 0.68 3 0.68 7 1.58 7 1.58 1 0.23 1 0.23
E.coli-O157:H7 B 0 0.00 0 0.00 4 0.91 4 0.91 1 0.23 1 0.23 3 0.68 3 0.68 1 0.23 1 0.23E.coli-Unknownserotype
B 0 0.00 0 0.00 0 0.0 1 0.23 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0
Giardiasis B 18 4.07 19 4.30 9 2.04 9 2.04 13 2.94 13 2.94 7 1.58 7 1.58 15 3.4 15 3.40Hemolyticuremicsyndrome(HUS)
B 0 0.00 0 0.00 1 0.23 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Listeriosis B 0 0.00 0 0.00 1 0.23 1 0.23 3 0.68 3 0.68 2 0.45 2 0.45 0 0.0 0 0.0Salmonellosis B 43 9.73 43 9.73 37 8.37 37 8.37 53 12.00 53 12.00 52 11.77 52 11.77 81 18.33 81 18.33Shigellosis B 13 2.94 13 2.94 19 4.3 19 4.3 7 1.58 7 1.58 11 2.49 11 2.49 31 7.02 31 7.02Trichinosis B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Typhoidfever B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Vibrioparahaemolyticusinfection
B 0 0.0 0 0.0 0 0.0 0 0.0 2 0.45 2 0.45 1 0.23 1 0.23 0 0.0 0 0.0
Yersiniosis B 2 0.45 2 0.45 1 0.23 1 0.23 1 0.23 1 0.23 2 0.45 2 0.45 1 0.23 1 0.23
Table4:RatesandCountsofEntericDiseasesinLucasCountyOhio2011-2015
COUNTS AND RATES OF REPORTABLE DISEASES
Page4
2015 2014 2013 2012 2011
ReportableCondition Cl
ass
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
HEPATITIS
HepatitisA B 0 0.00 0 0.00 0 0.0 0 0.0 1 0.23 9 2.04 2 0.45 7 1.58 2 0.45 5 1.13HepatitisB-PerinatalInfection
B 0 0.0 1 0.23 0 0.0 7 1.58 0 0.0 2 0.45 0 0.0 1 0.23 0 0 18 4.07
HepatitisB-acute
B 4 0.91 6 1.36 1 0.23 6 1.36 0 0.0 10 2.26 4 0.91 17 3.85 2 0.45 7 1.58
HepatitisB-chronic B 130 29.42 280 63.37 57 12.90 253 57.26 52 11.77 111 25.12 38 8.60 66 14.94 87 19.69 134 30.33
HepatitisC-acute
B 2 0.45 2 0.45 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 0.45 0 0.0 0 0.0
HepatitisC–chronic
B 466 100.95 466 100.95 237 53.64 756 171.11 292 66.09 631 142.82 242 54.77 478 108.19 443 108.19 794 179.71
HepatitisE B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Table5:RatesandCountsofHepatitisinLucasCountyOhio2011-2015(Note:duetochangesincaseclassificationovertime,duplicatesmayexistwithinhepatitisreporting)
2015 2014 2013 2012 2011
ReportableCondition Cl
ass
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
STI
Chancroid B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Chlamydiainfection
B 2641 597.76 2641 597.7
6 3231 731.30 3231 731.3
0 2267 513.11 2267 513.1
1 3210 726.55 3210 726.5
5 2359 533.93 2359 533.93
Gonococcalinfection
B 693 156.85 693 156.8
5 995 225.21 995 225.2
1 819 185.37 819 185.3
7 1349 305.33 1349 305.3
3 805 182.20 805 182.20
Herpes-congenital
B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
HIV/AIDS - - 33* 7.47 - - 54* 12.22 - - 39* 8.83 - - 64* 14.49 - - 56* 12.67
Syphilis B - - 40* 9.05 - - 59* 13.35 - - 26* 5.88 - - - - - - - -
Table6:RatesandCountsofSexuallyTransmittedInfectionsinLucasCountyOhio2011-2015*OnlyConfirmedCounts
COUNTS AND RATES OF REPORTABLE DISEASES
Page5
Table7:RatesandCountsofVaccinePreventableIllnessesinLucasCountyOhio2011-2015
2015 2014 2013 2012 2011
ReportableCondition Cl
ass
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
VACCINEPREVENTABLE
Diphtheria A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Haemophilusinfluenzae(invasive)
B 5 1.13 5 1.13 8 1.81 8 1.81 9 2.04 9 2.04 5 1.13 5 1.13 14 3.17 14 3.17
InfluenzaA-novelvirusinfection
A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Influenza-associatedhospitalization
B 117 26.48 117 26.48 322 72.88 322 72.88 161 36.44 161 36.44 59 13.35 59 13.35 121 27.39 122 27.61
Measles A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Meningococcaldisease-Neisseriameningitidis
A 0 0.0 0 0.0 1 0.23 1 0.23 0 0.0 0 0.0 1 0.23 1 0.23 3 0.68 3 0.68
Mumps B 0 0.0 0 0.0 1 0.23 1 0.23 0 0.0 0 0.0 1 0.23 1 0.23 1 0.23 2 0.45Pertussis B 9 2.04 13 2.94 26 5.88 34 7.70 36 8.15 40 9.05 6 1.36 10 2.26 14 3.17 18 4.07Poliomyelitis B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Rubella B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 0 0.0Tetanus B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0Varicella B 0 0.0 0 0.0 13 2.94 16 3.62 12 2.72 13 2.94 13 2.94 14 3.17 17 3.85 17 3.85
COUNTS AND RATES OF REPORTABLE DISEASES
Page6
2015 2014 2013 2012 2011
ReportableCondition
Class
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
ZOONOTICORVECTOR‐BORNE
Anaplasmosis/Erlichiosis 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0Brucellosis B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Chikungunyavirus B 0 0.0 0 0.0 Notreportablepriorto2015Dengue B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Encephalitis B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0LaCrossevirusdisease B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0LymeDisease B 2 0.45 8 1.81 2 0.45 13 2.94 3 0.68 12 2.72 1 0.23 17 3.85 6 1.36 10 2.26Malaria B 2 0.45 2 0.45 1 0.23 2 0.45 2 0.45 2 0.45 0 0.0 0 0.0 1 0.23 2 0.45Otherarthropod-bornedisease
B 1 0.23 1 0.23 1 0.23 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Psittacosis B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0QFever B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Rabies-Human A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0SpottedFeverRickettsiosis B 1 0.23 1 0.23 0 0.0 1 0.23 1 0.23 2 0.45 0 0.0 1 0.23 2 0.45 2 0.45Tularemia A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Typhusfever B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0ViralHemorrhagicFever(VHF)
A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
WestNileVirus B 5 1.13 6 1.36 0 0.0 1 0.23 8 1.81 9 2.04 4 0.91 4 0.91 6 1.36 6 1.36YellowFever A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Table8:RatesandCountsofZoonoticorVector-BorneIllnessesinLucasCountyOhio2011-2015
COUNTS AND RATES OF REPORTABLE DISEASES
Page7
2015 2014 2013 2012 2011
ReportableCondition Cl
ass
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
OTHERREPORTABLE
Anthrax A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Botulism-foodborne A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Coccidioidomycosis B 3 0.68 3 0.68 1 0.23 1 0.23 1 0.23 1 0.23 0 0.0 1 0.23 1 0.23 1 0.23Creutzfeldt-JakobDisease B 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Cytomegalovirus-congenital(CMV)
B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.23 1 0.23 1 0.23 1 0.23
Ehrlichiosis-Ehrlichiachaffeensis
B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0
Legionellosis B 10 2.26 13 2.94 6 1.36 6 1.36 18 4.07 18 4.07 4 0.91 5 1.13 7 1.58 7 1.58Meningitis-aseptic/viral
B 55 12.45 56 12.67 38 8.60 41 9.28 55 12.45 55 12.45 46 10.41 46 10.41 73 16.52 73 16.52
Meningitis-bacterial(NotN.meningitidis)
B 6 1.36 6 1.36 7 1.58 7 1.58 6 1.36 6 1.36 7 1.58 7 1.58 2 0.45 2 0.45
MiddleEastRespiratoryVirus(MERS)
A 0 0.0 0 0.0 Notreportablepriorto2015
Mycobacterialdisease-otherthantuberculosis B 35 7.92 35 7.92 39 8.89 39 8.83 32 7.24 32 7.24 27 6.11 27 6.11 28 6.34 28 6.34
Plague A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0SevereAcuteRespiratorySyndrome(SARS)
A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Smallpox A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Staphylococcalaureus-intermediateresistancetovancomycin(VISA)
B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Streptococcal-GroupA–invasive B 10 2.26 13 2.94 15 3.40 15 3.40 13 2.94 13 2.94 12 2.72 12 2.72 19 4.30 19 4.30
Streptococcal-GroupB-innewborn
B 3 0.68 3 0.68 0 0.0 0 0.0 4 0.91 4 0.91 3 0.68 3 0.68 3 0.91 3 0.91
Streptococcaltoxicshocksyndrome(STSS)
B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 5 1.13 5 1.13 4 0.91 4 0.91
COUNTS AND RATES OF REPORTABLE DISEASES
Page8
2015 2014 2013 2012 2011
ReportableCondition Cl
ass
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
Confirmed+
Probable
Rate
AllStatuses
Rate
OTHERREPORTABLE
Streptococcuspneumoniae-invasiveantibioticresistanceunknownornon-resistant
B 26 5.88 26 5.88 19 4.3 19 4.30 32 7.24 32 7.24 33 7.47 33 7.47 36 8.15 36 8.15
Streptococcuspneumoniae-invasiveantibioticresistant/intermediate
B 11 2.49 11 2.49 9 2.04 9 2.04 14 3.17 14 3.17 10 2.26 10 2.26 12 2.72 12 2.72
Toxicshocksyndrome(TSS)
B 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 0 0.0
Tuberculosis B 8 1.81 8 1.81 2 0.45 3 0.68 7 1.58 7 1.58 4 0.91 4 0.91 4 0.91 4 0.91
Table9:RatesandCountsofOtherReportableDiseasesinLucasCountyOhio2011-2015
GEOGRAPHIC DISTRIBUTION OF SELECTED DISEASES
Page9
GeographicDistributionofSelectedDiseases
OVERVIEW
HighlightedbelowisageographicdistributionofselecteddiseaseswithinLucasCounty.
AspecialthankyoutotheToledoAreaSanitaryDistrictinpartneringandsharingdataregardingmosquitotrappingandtesting.
OUTBREAKS
Page10
Outbreaks
OVERVIEW
Forthe2015calendaryear,therewere25suspect,probableorconfirmedoutbreaksthatwereinvestigatedinLucasCountybytheepidemiologystaff.
OutbreaksareClassCreportableconditions,unlessotherwisespecified.OhioDepartmentofHealthclassifiesoutbreaksintoanumberofcategoriesincludingCommunity,Foodborne,Healthcare-Associated,Institutional,Waterborne,andZoonotic.DefinitionsforeachtypeofoutbreakcanbefoundintheInfectiousDiseaseControlManual(IDCM)(http://www.odh.ohio.gov/pdf/idcm/intro1.pdf).
Table11:OutbreaksInvestigatedbyEpidemiologistsatToledo-LucasCountyHealthDepartment,2015
Status OutbreakType Agent Count NumberofIll
Confirm
ed Foodborne Norovirus 1 4
Healthcare-associated MOTT 1 4Norovirus 2 83
Institutional Norovirus 1 73Shigella 1 7
Total 6 171
Probable Foodborne Norovirus 1 2
Institutional Parainfluenza 1 7Sarcoptesscabiei 1 11
Total 3 20
Suspected
Foodborne UnknownAgent 8 18Healthcare-associated Sarcoptesscabiei 1 15Institutional Hand,Foot,andMouth
Disease3 7
Influenza 1 14Norovirus 1 71Sarcoptesscabiei 1 5
Waterborne Legionellaspp 1 20Total 16 150
GrandTotal 25 341
OUTBREAKS
Page11
02468101214161820
Community
Foodborne
Healthcare-Associated
Institutional
Zoonotic
Other
Community
Foodborne
Healthcare-Associated
Institutional
Zoonotic
Other
Community
Foodborne
Healthcare-Associated
Institutional
Zoonotic
Other
Confirmed Probable Suspected
OutbreaksinLucasCountyfrom2009-2015
2015(n=25) 2014(n=28) 2013(n=19) 2012(n=21) 2011(n=16) 2010(n=16) 2009(n=11)
DISEASE HIGHLIGHTS
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Mycobacteriumchelonae
OVERVIEW
InFebruaryof2015,anInfectionControlPreventionist(ICP)attheUniversityofMichiganMedicalSystemnotifiedtheToledo-LucasCountyHealthDepartmentthattwoindividualshadcontractedMycobacteriumchelonaeafterundergoingLASIKeyesurgeryataLucasCountyfacilityinJanuaryof2015.ItwasnotedthattheToledo-LucasCountyHealthDepartmentlaunchedanimmediateinvestigationintothematter.TLCHDnotifiedmultipledepartmentsincluding:WoodCountyHealthDistrict(duetothefactthatthetwoindividualsinfectedresidedinWoodCounty),theOhioDepartmentofHealth(ODH),theOutbreakResponseandBioterrismInvestigationTeam(ORBIT),andtheBureauofInfectiousDiseases(BID).Basedonepidemiologicalandtracebackinvestigations,4case-patientswereidentifiedinLucasCountyandtheTLCHDrecommendedthefacilityceaseallproceduresuntiltheinfectionsitewasdetermined.
Duringthecourseofthisinvestigation,itwasdeterminedthatasmallhumidifier,intheroomduringsurgery,wasthereservoirofinfection.DuetothefactthatMycobacteriumchelonaecanbepresentinwater,itislikelythatthemistcreatedbythehumidifiercausedtheinfectionintheeyeofthefourpatients.TheTLCHD,alongwiththeODHandCDC,recommendedthattheLucasCountyfacilitydiscontinuetheuseofthesmallhumidifierinthesurgicalsetting.Themistingofwaterfromthehumidifierincreasestheopportunityformicroorganismstobeintroducedintotheenvironment.TheTLCHDalsorecommendedthatthefacilityimplementaregularcleaningscheduleofhumidifiersandthewaterusedinthathumidifier.Itwasalsorecommendedthatanenvironmentalsamplebetakenafterimplementingtheseprocedurestoensurethattheissuehasbeenresolved.
EpidemiologyoverviewofMycobacteriumchelonaeInfectiousagents:AgroupofbacteriumnamedMycobacteriumchelonae
Modeoftransmission:Mycobacteriumchelonaeiscommonlyfoundinwater,soil,anddustandisknowntocontaminatemedicalproducts.Thereisverylittleriskoftransmissionfrompersontoperson.
Symptoms:Lightsensitivity,pain,blurryvision,abilitytoseeinfectionwithnakedeye
Prevention:Implementationofinfectioncontrolpoliciesatsurgicalandmedicalfacilities,including:protocolsforcleaning,disinfecting,andsterilizingmedicalequipmentshouldmitigatefutureinfections.Theuseofhealthcare-approvedhumidifiersinasurgicalsettingshouldalsohelptopreventfurtherinfection.
Formoreinformation:http://www.odh.ohio.gov/
DISEASE HIGHLIGHTS
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Legionnaires’Disease
OVERVIEW
In2015,theToledo-LucasCountyHealthDepartment(TLCHD)wasnotifiedofapotentionalrespiratoryoutbreakassociatedwithaninstitutioninToledo,Ohio.TheEnvironmentalHealthDirectorwasinformedofanumberofindividualsthatwerediagnosedwithpneumoniaandotherswhohadpneumonia-likesymptoms,allofwhomworkedinthesamebuilding(FacilityA).
Aninvestigationwaslaunchedimmediatelyandaquestionnairewasdevelopedtobegincallingtheindividualsforaninterview.TheOhioDepartmentofHealth(ODH)wascalledtodiscusstheoutbreakandtheyalsocoordinatedaspecimenshipmentfortestingattheCenterforDiseaseControlandPrevention(CDC).ThelocalhospitalswereputonheightenedalertforpossiblepneumoniaandLegionnaires’diseasecases.
Followingthelaunchoftheinvestigation,HazcorpEnvServicescompletedairtestingofFacilityAandportableHEPAfilterswereinstalledovertheweekend.TimKeane,anengineeringconsultantspecializinginwaterbornepathogenoutbreakinvestigationandremediaion,wasbroughtforguidanceonapotentialwaterbornediseaseatFacilityA.WiththehelpoftheODHandtheCDC,threeindiviualsthatwereconfirmedintheoutbreakwereaskedtovisitTLCHDforadditionaltesting.AhotlinewasestablishedwiththeTLCHDonSeptember3,2015forcommunitymemberswhowereclientsofFacilityA,whohadbeeninthebuildingbetweenJune13-August4,2015andwereexperiencingpneumonia-likesymptoms.Afterextensivetestingandvalidations,thesummaryshowedLegionellalevelshavebeenwellbelowOccupationalSafetyandHealthAdministration(OSHA)upperlimits.
Ultimately,therewere31casesofillemployeesreportedtoTLCHDfromFacilityA.Afterapplyingthecasedefinition,20individualswereindentifiedasmatchingthecasedefinitionas‘confirmed’or‘suspect’.FacilityAworkedwiththeTLCHDtofindthesourceofillnessandelmininateitimmediately.Anewcompanywashiredtoimplementnecessaryimprovementsandperformroutinepreventativemaintencance.
EPIDEMIOLOGY OVERVIEW OF LEGIONELLA
Infectiousagents:Legionellaspp.,averyserioustypeofpneumonia(lunginfection)Modeoftransmission:Spreadthroughwaterdropletsthatifbreathedin,cancauseLegionnaires’disease.Legionnaires’diseaseisnotspreadfromperson-to-person.IncubationPeriod:2-10daysSymptoms:Cough,muscleaches,highfever,shortnessofbreath,headacheTreatment:Legionnaires’diseaseistreatedwithantibioticsPrevention:CertainfactorscanputapersonathigherriskforcontractingLegionnaires’disease.Theseinclude:beingacurrentorformersmoker,havingchroniclungdiseasesuchasemphysema,orchronicobstructivepulmonarydisease(COPD),orhavingaweakenedimmunesystem.Formoreinformation:http://www.odh.ohio.gov/
TIMELINESS OF DISEASE REPORTS
Page14
TimelinessofDiseaseReports
OVERVIEW
Examiningthetimelinessofdiseasereportingisakeypartofgoodpublichealthpractice.Timelinessrequirementsforeachreportablediseasevarybasedonthecommunicabilityandseverityofthedisease.
IntheOhioDiseaseReportingSystems(ODRS)application,itispossibletoquerythedatewhenahealthcareproviderdiagnosedanillnessandthedatewhenthelocalhealthdepartmentreceivednotificationoftheillness(i.e.,thedatethecasewasenteredintoODRS).Whenthedateofdiagnosiswasunavailable(forsomecases),thedatelaboratoryresultswereavailablewasused.Ifbothoftheaforementioneddateswereabsentfromcasefiles,thedatespecimen(s)werecollectedserveasthedatethehealthcareproviderwassuspectingillness.Thisabsenceofdataisanareathatthedepartmentofepidemiologywillbefocusingontoimprovein2015.
Thetablebelowlistsselecteddiseasesandthecorrespondingmedianandmeannumberofdaysbetweenhealthcareproviderdiagnosisandreportingtothelocalhealthdepartmentin2015.Thisincludesanycasereportedtothehealthdepartment,regardlessoffinaldiseaseclassification.In2009,E.coli,hepatitisA,listeriosis,mumps,pertussis,andsalmonellosisbecameClassB(1)reportableconditions,whicharerequiredtobereportedbytheendofthenextbusinessdayaftertheexistenceofacaseisknown.Measles,meningococcaldisease,andrubellaareClassAreportableconditions(designatedinredinthefollowingtable)duetotheirseverityandpotentialforepidemicspread;ClassAreportableconditionsarerequiredtobereportedimmediatelyviatelephoneuponrecognitionofacase,suspectedcase,orpositivelaboratoryresult.
Reportinglagisdefinedasthedifferencebetweenthediagnosisdateandwhenthecasewasreportedtothelocalhealthdepartment.Itistobenotedthatanincreaseinthelagtimeofsomediseasesthatrequireminimalhealthdepartmentfollow-up(e.g.chlamydia,hepatitisB,hepatitisC,gonococcalinfection)isinflated,duetomanagementofhighvolumeofcasesreceivedbyTLCHD.
TLCHDwillperiodicallymonitorthereportinglagtimesforselecteddiseases.Regularmonitoringwillhelpaddresstwokeyissues:latereportersandmissingdata.Ifspecificreportersarefoundtobecontributingtolongerlagtimes,thisinformationwillbesharedwiththem,challengestotimelyreportingwillbeidentifiedandaddressed,andclosermonitoringofreportswillfollow.Additionally,fillinginmissingorincorrectdateswillaidinbetter,timelierinterventionsandpreventionefforts.
TIMELINESS OF DISEASE REPORTS
Page15
ReportableCondition LagTime (indays)2014
LagTime(indays)2015
Amebiasis 1.00 2.00Anaplasmosis-Anaplasmaphagocytophilum 8.00 0.00Botulism,foodborne 4.00 0.00Campylobacteriosis 3.84 2.54Chlamydiainfection 32.71* 2.27Coccidioidomycosis 1.00 2.67Cyclosporiasis 1.00 0.00Diphtheria 1.00 0.00E.coli 1.57 0.80Giardiasis 6.82 1.65Gonococcalinfection 79.15* 2.12Haemophilusinfluenzae(invasivedisease) 6.63 2.00HepatitisA 7.00 0.50HepatitisB(includingdelta)-acute 1.83 1.00HepatitisB(includingdelta)-chronic 178.11* 2.94HepatitisC–chronic 105.14* 51.65Influenza-associatedhospitalization 2.46 2.02Legionellosis-Legionnaires'Disease 67.00 3.73Listeriosis 0.00 0.00LymeDisease 10.41 0.78Malaria 35.67 3.00Measles 5.00 0.00Meningitis-aseptic/viral 3.68 2.21Meningitis-bacterial(NotN.meningitidis) 5.14 2.43Meningococcaldisease-Neisseriameningitidis 0.00 0.00Mumps 3.75 0.00Mycobacterialdisease-otherthantuberculosis 6.00 0.03Otherarthropod-bornedisease 8.00 1.00Pertussis 4.55 0.95Salmonellosis 20.26 2.35Shigellosis 7.65 0.64SpottedFeverRickettsiosis,includingRockyMountainspottedfever(RMSF)
4.00 3.00
Streptococcal-GroupA-invasive 4.38 2.92Streptococcuspneumoniae-invasive 3.79 3.41Toxicshocksyndrome(TSS) 4.00 0.00Tuberculosis 0.00 0.00WestNilevirusdisease(alsocurrentinfection) 2.83 1.00Yersiniosis 1.00 0.00
DiseasesdesignatedinRedareClassAReportableDiseases*Itistobenotedthatanincreaseinthelagtimeofsomediseasesthatrequireminimalhealthdepartmentfollow-up(e.g.chlamydia,
hepatitisB,hepatitisC,gonococcalinfection)isinflated,duetomanagementofhighvolumeofcasesreceivedbyTLCHD.In2015,TLCHDwasabletohavefull-timeclericalsupportenteringmanydiseasereports,thusreducingtimefromreceipttoinputintodatabase.
ENVIRONMENTAL HEALTH INTRODUCTION
Page16
EnvironmentalHealthIntroduction
OVERVIEW
TheToledo-LucasCountyHealthDepartment’sDivisionofEnvironmentalHealthisresponsibleforinspections,permits,andlicenses.TheDivisioncoversover50differentprograms,including,butnotlimitedto:food,wells,septicsystems,andpublicswimmingpools.Inadditiontoregulatoryresponsibilities,theDivisionconductseducationalsessionsintheaforementionedprograms.
FOOD PROTECTION
Page17
FoodProtection
OVERVIEW
TheFoodSafetyProgramisresponsiblefortheinspectionsoffoodserviceoperations,temporaryfoodserviceoperations,foodvendingmachines,micro-markets,mobilefoodoperations,andretailfoodestablishments.Theseinspectionsareconductedwithconsumersafetyinmind.LocalhealthdepartmentshavetheauthoritytoenforcestatestandardsforsafetyandsanitationinFoodServiceOperationsandRetailFoodEstablishments.
WHY IT IS A PUBLIC HEALTH CONCERN
Foodborneillnessisaseriouspublichealththreat.AccordingtotheCentersforDiseaseControlandPrevention,eachyearintheUnitedStates,76millionpersonssuffersymptoms(e.g.vomiting,diarrhea)causedbymishandled,tainted,orspoiledfood.ItisthegoaloftheFoodProtectionDivisionofEnvironmentalHealthtoreducetheriskoffoodborneillnessesthroughinspection,education,andenforcement.
PROGRAMMATIC UPDATE
FoodfacilityinspectionsthathavebeenconductedasofJuly9,2015areavailableon-linethroughtheToledo-LucasCountyHealthDepartment.ThisadvancementillustratesourcontinuedcommitmenttoincreasedcommunicationandimprovingthehealthofLucasCountyresidents.
2015 SNAPSHOT THE TOP SPOT AWARD
FoodServiceOperations Licensed 1,769 InspectionsCompleted 5,298FoodServiceMobile Licensed 101 InspectionsCompleted 120FoodService‐TemporaryLicense Licensed 321 InspectionsCompleted 321FoodService‐VendingMachines Licensed 282 InspectionsCompleted 234RetailFoodEstablishment Licensed 733 InspectionsCompleted 1,262
Inanefforttoincentivizefoodestablishmentsforoverallcleanlinessandtominimizeviolations,theToledo-LucasCountyHealthDepartmentcreatedtheTopSpotAward.ThisisacompletelyvoluntaryprogramwherefoodestablishmentswhomeetguidelinessetforthbytheTLCHDcanbeawardedTheTopSportAward.Criteriaforthisprograminclude:havingnoconfirmedfoodborneillnesseswithin2years,havingthesamelicenseeforatleast1fulllicensingyear,havingnoviolationsfromtheliquorcontrolorsmokingprogram,amongothercriteria.Theawardrecognizesfoodestablishmentsforapplyingandmeetingtheserequirements.For2015,74foodestablishmentswererecognizedfortheTopSpotAward.
LEAD PREVENTION
Page18
LeadPrevention
OVERVIEW
“LeadPoisoning”isdefinedasaconfirmedlevelofleadinhumanbloodoftenmicrogramsperdeciliter(10µ/dL)orgreater.TheStateofOhiomandatesbloodleadscreeningforallhighriskchildren72months(6years)ofageandbelow.Highriskchildrenaredefinedasachildthatmeetsoneormoreofthefollowingcriteria: Livesinorregularlyvisitsahousebuiltbefore1950.(Thisincludesadaycarecenter,preschool,or
homeofababysitterorrelative.) Livesinorvisitsahousethathaspeeling,chipping,dustingorchalkingpaint. Livesinorvisitsahousebuiltbefore1978withrecent,ongoing,orplannedrenovation/remodeling. Hasasiblingorplaymatewhohasordidhaveleadpoisoning. Frequentlycomesincontactwithanadultwhohasahobbyorworkswithlead.Examplesare
construction,welding,pottery,painting,andcastingammunition. Oranychildresidinginoneofthefollowingzipcodes:
43402 43460 43551 43602 43604 43605
43606 43607 43608 43609 43610 43611
43612 43613 43614 43615 43620 43624
Forthe2015calendaryear,973childrenwerescreenedbytheToledo-LucasCountyHealthDepartmentand70ofthoseresultedinleadcasesthatthehealthdepartmentmanaged.Overall,39RiskAssessments(Inspections)wereconductedfromJanuarytoDecemberof2015.
LEAD PREVENTION
Page19
WHY IT IS A PUBLIC HEALTH CONCERN
Leadcandamagenearlyeverysysteminthehumanbody,andhasharmfuleffectsonbothadultsandchildren.LeadpoisoningisthegreatestenvironmentalthreattochildreninOhio.
Signsofleadpoisoningarenotalwayseasytosee.Childrencanbepoisonedbyleadandmaynotlookoractsick.Sometimesthenon-specificsymptomsmaybemistakenforsimilarillnesses(e.g.upsetstomach,influenza).Somepossiblesignsandsymptomsofleadpoisoningarelistedbelow.
CHILDREN ADULTS
Tirednessorlossofenergy TirednessorweaknessHyperactivity IrritabilityIrritabilityorcrankiness TroublesleepingReducedattentionspan HeadachePoorappetite DifficultyconcentratingWeightloss AchesorpainsinstomachTroublesleeping LossofappetiteAchesorpainsinstomach Constipation Nausea Weightloss
Leadpoisoningcanaffecteveryorganandsysteminthebody.Veryhighlevelsofleadexposurecancausecoma,seizures,andevendeath.Evenalittleleadcanmakechildrenslowlearners.Otherhealtheffectsinclude:
CHILDREN ADULTS
Behaviorandlearningproblems ImpotencyHyperactivity BrainandnervoussystemdamageImpairedspeechandlanguage HighbloodpressureSlowedgrowth DigestiveproblemsKidneyandliverdamage KidneyproblemsHearingdamage Anemia Reproductivesystemproblems Hearing,vision,andmusclecoordination
problemsChildrenandadultscangetleadintheirbodiesbyswallowingorbreathingindustthatcontainslead.Someindividualsalsohaveoccupationalexposurestoleadthatputthemathigherrisksofelevatedbloodleadlevels.Yourhealthcareprovidercanaskyousomequestionstoseeifyouoryourchildisatriskforleadpoisoningandthencanrequestbloodtobetested.Thebloodtestingisusedtofindouthowmuchleadisinaperson’sblood.
SEPTIC AND WATER
Page20
SepticandWater
OVERVIEW
TheprimarypurposeoftheSepticandWellProgramistopreventdiseaseresultingfromhumanconsumptionofcontaminatedwater.Thisisaccomplished,inpart,byassuringthatwaste-waterhandlingsystemsdonotcontaminatetheaquifersandsurfacewatersourcesofdrinkingwater.
Animportantcomponentofthehouseholdsewagetreatmentsystemprogramistoensurethatallsewagesystemsareinstalledproperlyforeffectivetreatmentofsewageeffluenttopreventcontaminationofdrinkingwater.TheToledo-Lucashealthdepartmentoverseessewagesystemdesignsandinstallationincludingconductingsitereviewspriortosewagesystemapprovaltofinalinspectionstoensureproperinstallation.Thehealthdepartmentalsoassistshomeownerswitheducationonpropermaintenanceofsewagesystemtoprolongthelifeofthesewagesystemandtopreventsystemfailures.
Inadditiontothehouseholdsewagetreatmentsystemprogram,theTLCHDoverseesproperinstallationsandmaintenanceofprivatewatersystemsincludingwellsandhauledwaterstoragetanks.Properinstallationofprivatewatersystemsisverycrucialinprovidingsafedrinkingwaterforthehomeowners.Aspartofmonitoringthesafetyoftheprivatewatersystem,theTLCHDconductswatersamplesandtransportthewatertoalabtobetested.
HouseholdSewageTreatment Permits 67 Inspections 94PotableWaterSystems Permits 47 Inspections 34 WaterSamples 229
SEWAGE TREATMENT SYSTEM PROGRAM
Thereareover12,000householdsewagetreatmentsysteminLucasCountythatifproperlymaintained,canbeasafeandeffectivemeanofwastewaterdisposal.However,failedorimproperlydischargingsewagesystemcancausesewagetocontaminateoursurfaceandgroundwater,thesamewaterthatweallswimanddrink.ThemissionoftheTLCHDistominimizethethreatofsurfacewaterandgroundwatercontaminationfrommalfunctionedorimproperlydesigned,installedormaintainedhouseholdsewagetreatmentsystemsinordertopreventdiseasetransmissionandtoprotectthequalityofsurfaceandgroundwater.TLCHDperformsinspections,regulatecontractors,educatehomeowners,andenforcesewageregulations.
SEPTIC AND WATER
Page21
SEWAGE TREATMENT SYSTEM ASSESSMENT PROGRAM
EffectiveJanuary1,2016,thesewageregulationrequiresallhealthdepartmentstodevelopaprogramfortheadministrationofoperationandmaintenance(O&M)managementforsewagetreatmentsystemsandsystemownereducation.TodeveloptheO&Mprogram,TLCHDisconductinganassessmentofallHSTSinLucasCountytodeterminethetype,age,condition,andcomplexityoftheHSTS.Thecomplexityofthesystemreferstowhetherthesystemusesmechanicalcomponentstotreatthesewageeffluentortodosethesewageeffluentintothepipesfordispersal.SurfacewatersamplingisalsobeingconductedaspartoftheassessmenttotestforfecalcoliformandE.coli.Theassessmentisonlybeingconductedfordatacollectionandmonitoringpurposesbutnofeeisbeingassessedtothehomeowners.CurrentlytheassessmentisconductedbytwostaffsanitariansandtheimplementationoftheprogramstartedinAugust,2015.
Assessmentscompletedin2015 324SurfaceWatersamplescollectedin2015 93
PRIVATE WATER PROGRAM
Aprivatewatersystemisanywatersystemotherthanapublicwatersupplysystemthatprovideswaterforhumanconsumption.Themostcommonexamplesofprivatewaterssystemsincludewells,hauledwatersystems,cisternsanddrinkingwaterponds.Theconstruction,alterationorsealingofaprivatewatersystemwillrequireapermitfromthehealthdepartment.Onlyregisteredwatersystemcontractorsmayconstruct,alterorsealprivatewatersystems,drillwaterwells,andinstallpit-lessadapters.
HOUSEHOLD SEWAGE TREATMENT SYSTEM REPLACEMENT AND REPAIR SYSTEM
TheOhioEnvironmentalProtectionAgencyandtheOhioDepartmentofHealthawardedtheToledo-LucasCountyHealthDepartment$300,000toassistOhiohouseholdswithnoorlittlefinancialmeanstorepairorreplacefailinghouseholdsewagetreatmentsystems(HSTS)withanemphasisintheSwanCreekWatershed.TheprogramrequiresthathouseholdsthatarelocatedintheSwanCreekWatershedandwhoseincomeisatorbelow100%,200%,or300%oftheU.S.DepartmentofHealthandHumanServicespovertyguidelinesbeprioritizedforthereplacementorrepairprogram.Thefundingcoverssuchexpensessuchsoilevaluation,designs,applicablepermits,andinstallationincludingmaterials.ThereplacementorrepairsofHSTSisbefullyreimbursableforhomeownerswhoseincomesareatorbelow100%ofthepovertylevel.TheprogramwillalsoassistLucasCountyhouseholdswhosepovertylevelisatorbelow200%andisatorbelow300%withlesseramountofreimbursementsofcost.Ifmoneyisstillavailable,theprogramwillopenuptotherestofLucasCountyoutsideoftheSwanCreekWatershed.
WOLF CREEK WATERSHED SEPTIC SYSTEM EDUCATION PROGRAM
InconjunctionwiththeToledometropolitanareaofcouncilofgovernment(TMACOG),theCityofOregon,andtheLucasCountySoil&WaterConservationDistrict,theTLCHDbegantheWolfCreekWatershedSepticSystemEducationProgram.TheprogramisaimedateducatinghomeownersintheWolfCreek
SEPTIC AND WATER
Page22
watershedonhowtoproperlymaintaintheirhouseholdsewagetreatmentsystem.ThehomeownersareassessedregardingtheirknowledgeofHSTSandthenprovidedwitheducationalmaterialonpropermaintenanceofHSTS.AvideowhichcanbeseenontheTLCHDwebsitehasalsobeencreatedtoprovideinformationonHSTSandhowtomaintainthem.
CHAMBERS INSTALLATION FIELD DAY—TRAINING OPPORTUNITY FOR SEWAGE CONTRACTORS
May5,2015,atrainingwasprovidedforsewagecontractorsusingalivedemonstrationofasewagetreatmentsystembeinginstalledusing“chambers”.PriortotheadoptionofthenewsewageregulationsinJanuary1,2015,manyofthelocalsewagecontractorsinstalledtraditionalstoneandpipesforleachfields.TheChambersinstallationfielddaywhichwassponsoredbyInfiltratorSystemsInc.andJohnHelminiak&SonsExcavating,alocalsewagecontractor,wasusedtodemonstrateanothermethodfortheinstallationofleachfields.Chambersaregravel-lesssystemsandcanbeinstalledusingasmallerinfiltrativeareathantraditionalleachfields.OvertwentyfivepeoplewereinattendanceandcontractorswereabletoobtainCEU’swhicharerequiredtobecomeregisteredtoconductsewageworkinLucasCounty.
WHY IT IS A PUBLIC HEALTH CONCERN
Safesepticandsewagetreatmentisanimportantcomponenttopublichealth.Sewagehasthepotentialtopollutewatersystemswithpathogens,excessnutrients,heavymetals,andothertoxins.Improperlymanagedsewagesystemscannegativelyimpactaquaticlifeandcontributetobacterialgrowthinbodiesofwater.Pathogenscarriedinsewagecanalsoendupindrinkingwatersuppliesandswimmingareas,ifsystemsarenotproperlymaintained.TheEnvironmentalProtectionAgencyestimatesthatupto3.5millionindividualsfallillfromswimminginwaterscontaminatedbysanitaryseweroverflowsaloneevery
SEPTIC AND WATER
Page23
year.Listedbelowareanumberofpathogens,parasitesandvirusesthatcanbeimplicatedincontaminatedwatersystems:
AGENT ACUTE EFFECTS
BACTERIA
E.coliO157:H7 DiarrheaLegionellapneumonia Fever,pneumoniaHelicobacterpylori GastritisVibriocholera DiarrheaVibriovulnificus SkinandtissuedamageCampylobacter DiarrheaSalmonella DiarrheaYersinia DiarrheaShigella DiarrheaCyanobacteria DiarrheaLeptospirosis Fever,headache,chills,muscleaches,vomitingAeromonashydrophila DiarrheaPseudomonasaeruginosa Fever,lethargy
PARASITE
Giardialamblia DiarrheaCryptosporidium DiarrheaToxoplasmagondii Newbornsyndrome,hearingandvisualloss,mentalissuesMicrosporidia DiarrheaEntamoebacayetanensis Amebiasis,amoebicdysentery,abscessesinliverorotherorgans
VIRUS
Hepatitisvirus LiverinfectionAdenoviruses Eyeinfections,diarrhea,respiratorydiseaseCaliciviruses DiarrheaCoxsackieviruses Encephalitis,asepticmeningitisEchoviruses AsepticmeningitisPolyomaviruses GastroenteritisNorovirus Nausea,vomiting,abdominalpainorcramps,wateryorloose
diarrhea,malaise,low-gradefever,musclepainListingisnotcomprehensivetocoverallwaterborneillnesspathogens/bacteria/viruses.Alsonotincludedare
chemicalsthathavebeenimplicatedinpreviouswaterborneillnesses.
RECREATIONAL VEHICLE PARKS
Page24
RecreationalVehicleParks
OVERVIEW
TheToledo-LucasCountyHealthDepartmentismandatedbytheOhioDepartmentofHealthtoenforcerulesrelatingtorecreationalvehicleparks;theserulescanbefoundintheOhioAdministrativeCode(OAC)inChapter3701-25.Minimumstandardshavebeenestablishedandaretobeenforcedforthedesign,installation,operation,andmaintenanceoftheseparkstoprotectthepublicfrominjury,minimizethepotentialfordiseasetransmission,andprovideasafeandhealthyrecreationalenvironment.
2015 SNAPSHOT
For2015,14facilitieshavebeenlicensedand17inspectionshavebeenconductedduringthecalendaryear.
RODENT PROGRAM
Page25
RodentProgram
OVERVIEW
Therodentcontrolprogramisdesignedtomanageoneoftheoldestpublichealthproblemsknowntohumans.Rodentsdestroyproperty,havethepotentialtocontaminatefoodsupplies,andalsocarrydiseases.Ourgoalistocontrolthespreadofdiseasebylimitingthegrowthofrodentpopulationsandtocorrectconditionsthatcontributetorodentbreeding.Toaccomplishthisgoal,therodentcontrolprogramconductsfieldinspections,issuesorderstoabateconditionsthatareconducivetoproliferationofrodents,baitpublicareas,andmeetwithneighborhoodgroupstoprovideeducationonmethodsofrodentcontrolandapplicationofpesticides.
2015 SNAPSHOT
Forthe2015calendaryear,therodentprogramconducted1,404inspectionsandapplied233poundsofbaitwithinLucasCounty.
COMMUNITYDEVOLOPMENTBLOCKGRANT(CDBG)41stYEARUPDATE
TherodentprogramalsoworksundertheCommunityDevelopmentBlockGrant(CDBG)whenconductingrodentcomplaintanddemoinspectionswithintheCityofToledo.TheareaforthisgrantincludesallareasintheCityofToledowithanemphasisinareaswithlowtomoderatelevelsofincome.Whencompilingdataforthisgrant,onlytheinitialcomplaintanddemoinspectionarereported.Inthepast18months,theToledo-LucasCountyHealthDepartmentcompletedatotalof1,080rodentabatementinspectionsatdemolitionsitesintheCityofToledo.Ofthe1,080inspections,81%or875inspectionswereconductedinthelowandmoderatehouseholdincomeareasaccordingtothe2013MedianHouseholdIncomeMap.Demolitioninspectionsinthelowincomelevelscompletedtotaled48.33%or522inspectionsandareasofmoderateincomehadatotalof32.6%or353demolitioninspections.Thedatashowsthatwewereabletomeettheneedsofourtargetedarea.
TotalNumberofDemolitionInspectionsConducted
LowHouseholdIncomeper2013CensusTract
522DemolitionInspectionsCompleted48.33%
ModerateHouseholdIncomeper2013CensusTract
353DemolitionInspectionsCompleted32.69%
OtherCensusTractAreas 205DemolitionInspectionsCompleted 18.98%
TotalNumber:1,080DemolitionInspectionsCompletedintheCityofToledo 100%
RODENT PROGRAM
Page26
Inthepast18monthstheToledo-LucasCountyHealthDepartmentreceivedatotalof1,190rodentcomplaintsintheCityofToledo.Ofthe1,190complaintsreceived,70.25%or836complaintswerereceivedinthelowandmoderatehouseholdincomeareasaccordingtothe2013MedianHouseholdIncomeMap.Complaintsreceivedinthelowincomelevelareastotaled38.66%or460totalcomplaintsandareasofmoderateincomehadatotalof31.60%or376totalcomplaintsreceived.Thenumberofcomplaintsreceivedarecountedbyaddressandnotthenumberoftimesaninspectorwillvisitthehometoconductaninspection.
WHY IT IS A PUBLIC HEALTH CONCERN
Asidefromtheobviousconcernsrelatingtothepresenceofrodents,manydiseasescanbedirectlytransmittedbyrodents.Listedbelowarejustafewofthesediseases:
Hantaviruspulmonarysyndrome Hemorrhagicfeverwithrenalsyndrome Lassafever Leptospirosis LymphaticChorio-meningitis(lcm)
Omskhemorrhagicfever Plague Rat-bitefever Salmonellosis SouthAmericanarenaviruses Tularemia
Rodentsalsocanindirectlytransmitmanydiseasestohumans.Thesediseasesinclude,butarenotlimitedto:
Babesiosis Coloradotickfever Cutaneousleishmaniasis Humangranulocyticanaplasmosis Lacrosseencephalitis Lymedisease Murinetyphus
Omskhemorrhagicfever Powassanvirus Scrubtyphus Rickettsialpox Relapsingfever Rockymountainspottedfever Sylvatictyphus WestNilevirus
TotalNumberComplaintsReceivedJuly1,2014‐December31,2015LowHouseholdIncomeper2013CensusTractArea
460RodentComplaintsReceivedfortheseareas 38.66%
ModerateHouseholdIncomeper2013CensusTract
376RodentComplaintsReceivedfortheseareas 31.60%
OtherCensusTractAreas 354RodentComplaintsReceivedfortheseareas 29.75%
TotalNumber: 1,190RodentComplaintsReceived 100%
RODENT PROGRAM
Page27
SCHOOLS
Page28
Schools
Overview:Forthe2015calendaryear,theToledo-LucasCountyHealthDepartmentinspectedallpublicandprivateschoolsforenvironmentalhealthandsafetyrisksfactors.InaccordancetotheU.S.DepartmentofEducation,officeoftheunderSecretary,“Inadequateindoorenvironmentinschoolsmaydecreaseperformancebycausinghealtheffectsthateitherdirectlyimpairconcentrationsormemoryorindirectlyaffectlearning.”Ourgoalistoinspectschoolstwiceaschoolyearandinformtheschoolofficialsoftheenvironmentalhealthandsafetyrisksfoundduringourinspectionsandprovideguidanceoncorrectinganydeficiencies.Whilethisprogramisunfundedandtherearenoregulatoryrequirementsforschoolstocorrectanydeficiencies,webelievethatthisprogramhashelpedprovidedasafeschoolenvironmentforthechildrenofLucasCounty.
2015 SNAPSHOT
In2015,180facilitieswerelicensedandatotalof299inspectionswerecompleted.
WHY IT IS A PUBLIC HEALTH CONCERN
In2010,PresidentObama’sEducationBlueprintstatessafetyandhealthconditionsofschoolenvironmentasanessentialelementtoimprovestudentlearning.Thereisagrowingnumberofliteraturewhichdocumentsthesupportofasafeandhealthyschoolenvironmentforlearning.Decayingenvironmentalconditionspresentinaschoolbuildingcanaffectlearningaswellasthehealthandmoraleofstaffandstudents.Accordingtoa2004reporttotheUnderSecretaryoftheU.S.DepartmentofEducation,“Theoverallevidencestronglysuggeststhatpoorenvironmentsinschools,dueprimarilytoeffectsofindoorpollutants,adverselyinfluencethehealth,performanceandattendanceofstudents.”Oneoftheeasiestwaystocreateahealthyschoolenvironmentistoimproveeverydaymaintenancetokeeptheschoolbuildingsclean,runningsmoothlyandsafely.Unsanitaryconditionsandpoorcleaningpracticescanattractunwantedpests,allowdustsandotherirritantstoaccumulatewhichcontributetoincreasedrespiratoryandasthmasymptomsamongthechildrenandadults.*
*U.S.EPA:AnOverviewofRoutineCleaningandMaintenanceforaHealthySchoolEnvironment*U.S.DepartmentofEducation,OfficeofPlanning,EvaluationandPolicyDevelopment,ESEABlueprintforReform,Washington,D.C.2010*TheAmericanClearinghouseonEducationalFacilities,MaintainingaSafeandHealthySchoolEnvironmentforLearning.Vol.1,No.1,2011.*InformationtakenfromODHSchoolInspectionGuidance,10-29-10
PUBLIC SWIMMING POOLS
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PublicSwimmingPools
OVERVIEW
Publicswimmingpools,spas,andspecialusepoolsareregulatedundertheauthorityofChapter2749oftheOhioRevisedCode(ORC)andChapter3701-31oftheOhioAdministrativeCode(OAC)andtheenforcementoftheseregulationswithinLucasCounty,OhiofallstotheresponsibilityoftheToledo-LucasCountyHealthDepartment.
Theseruleswerecreatedtoestablishminimumstandardsforthedesign,installation,operation,andmaintenanceofthesefacilitiesinordertoprotectthepublicfrominjury,minimizethepotentialfordiseasetransmission,andprovideasafeandhealthyaquaticrecreationalenvironmental.Publicswimmingpoolcollectivelyreferencespublicswimmingpools,publicspas,specialusepools,wadingpools,andspraygrounds.
Mostswimmingpoolsareinspectedbyourstaffpriortothepoolsopeningduringtheearlysummermonthsandareinspectedonaperiodicbasisthroughoutthesummer.Therearealsoseveralindoorswimmingpoolsandspasthatarelocatedinhotelsandhealthclubsthatinspectedyearround.Inadditiontoconductingregularinspectionsofswimmingpools,theToledo-LucasCountyHealthDepartmentconductsinspectionsiftherearecomplaintsfromacitizenorifinvestigatingconcernsassociatedwithpossiblewaterborneillnesses.
2015 SNAPSHOT
ThestaffattheToledo-LucasCountyHealthDepartmenthavelicensed254publicswimmingpoolsandconducted620inspectionsfor2015.
WHY IT IS A PUBLIC HEALTH CONCERN
Chlorine,acommonpoolcleaningchemical,doesnotkillallgermsinstantly.Somebacteriaandparasiteshavebecomeverytoleranttochlorineand,untilrecently,havenotbeenknowntocausehumanillness.Theseresistantbacteriaandparasitescantakeminutestodaystobekilledbychlorine,soswallowingjustalittlewaterthatcontainsthesegermscanmakeyousick.
Recreationalwaterillnesses(RWIs)arecausedbygermsspreadbyswallowing,breathinginmistsoraerosolsof,orhavingcontactwithcontaminatedwaterinswimmingpools,hottubs,waterparks,waterplayareas,interactivefountains,lakes,rivers,oroceans.RWIscanalsobecausedbychemicalsinthewaterorchemicalsthatevaporatefromthewaterandcauseindoorairqualityproblems.
RWIsincludeawidevarietyofinfections,suchasgastrointestinal,skin,ear,respiratory,eye,neurologic,andwoundinfections.ThemostcommonlyreportedRWIisdiarrhea.DiarrhealillnessesarecausedbygermssuchasCrypto(shortforCryptosporidium),Giardia,Shigella,NorovirusandE.coliO157:H7.WithRWIoutbreaksontherise,swimmersneedtotakeanactiveroleinhelpingtoprotectthemselvesand
PUBLIC SWIMMING POOLS
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preventthespreadofgerms.ItisimportantforswimmerstolearnthebasicfactsaboutRWIssotheycankeepthemselvesandtheirfamilyhealthyeverytimetheyswim.
Inthepasttwodecades,therehasbeenasubstantialincreaseinthenumberofRWIoutbreaksassociatedwithswimming.Crypto,whichcanstayalivefordayseveninwell-maintainedpools,hasbecometheleadingcauseofswimmingpool-relatedoutbreaksofdiarrhealillness.AsindicatedintheCentersforDiseaseControlandPrevention’sMorbidityandMortalityWeeklyReportfrom2012,2004to2008,reportedCryptocasesincreasedover200%(from3,411casesin2004to10,500casesin2008).
AlthoughCryptoistoleranttochlorine,mostgermsarenot.Keepingchlorineatrecommendedlevelsisessentialtomaintainahealthypool.However,a2010studypostedintheCentersforDiseaseControlandPrevention’sMorbidityandMortalityWeeklyReportin2010foundthat1in8publicpoolinspectionsresultedinpoolsbeingclosedimmediatelyduetoseriouscodeviolationssuchasimproperchlorinelevels.
Formoreinformationaboutrecreationalwaterillnesses,seewww.cdc.gov/healthywater/swimming/rwi.
BODY ART
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BodyArt
OVERVIEW
BodyartinthestateofOhioisregulatedundertheauthorityofChapter3730.01oftheOhioRevisedCode(ORC)andChapter3701-9oftheOhioAdministrativeCode(OAC)and,forthejurisdictionofLucasCountyOhio,istobeenforcedbytheToledo-LucasCountyHealthDepartment.Theseruleswerecreatedtoestablishminimumstandards,applicableacrosstheentirestateofOhio,fortheoperationandmaintenanceofbodyartfacilitiesinordertoprotectthepublicfrominjury,minimizethepotentialfordiseasetransmission,andprovideasafeandhealthyenvironment.
2015 SNAPSHOT
Forthe2015calendaryear,theprograminLucasCountyhaslicensed25facilitiesandconducted60facilityinspections.
WHY IT IS A PUBLIC HEALTH CONCERN
Popularityanddecreasedtabooassociatedwithtattooingandbodypiercinghasleftmanyindividualsbelievingthattheseproceduresareextremelysafe,especiallywhenconductedinwhatmayappeartobeawell-respectedtattooartistinaseeminglysterilesetting.Publichealthworkstoensurethatfacilitiesareoperatingwithinlicensingguidelinesandthattheriskofinfectiousdiseasesandhazardoussituationsaremitigated.UnsteriletattooingequipmentandneedlescantransmitdiseasessuchasHIV,hepatitis,andskininfectionscausedbymanybacteria,includingsomespeciesofStaphylococcus.
BATHING BEACHES
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BathingBeaches
OVERVIEWTheBathingBeachRegulationadoptedbytheToledo-LucasCountyHealthDepartmentisthesourceofregulationsforbathingbeachespermittedbythisdepartment.TheToledo-LucasCountyHealthDepartmentwillconductannualinspectionsatpermittedbathingbeachesinLucasCounty.Safetyandsanitationofthebathingbeachanddivingareasareevaluatedalongwiththewaterquality.WaterqualitystandardsarebasedonthecurrentU.S.EnvironmentalProtectionAgency(EPA)standards.Currently,thestandardsstatethatE.Colishallnotexceed235E.Colicoloniesper100mlinmorethan10%ofthesamplestakenduringany30-dayperiod.
2015SNAPSHOTIn2015,theToledo-LucasCountyHealthDepartmentissued3bathingbeachpermitsandconducted5inspectionswithwatersampling.AllwatersamplestakenandtesteddidnotexceedtheU.S.EPAstandardof235E.Colicoloniesper100ml.
WHYISITAPUBLICHEALTHCONCERNConductinginspectionsatthepermittedbathingbeachesallowsthisdepartmenttoassureasafeandhealthyaquaticrecreationalenvironmentbyprotectingthebathingpublicfromrisksofcontractingwaterbornediseasesfromexposuretocontaminatedwaters.Gastroenteritiswiththesymptomsofnausea,vomiting,headache,stomachache,feveranddiarrheaarethemostcommonassociatedillnesswhenswimmingincontaminatedwater.Otherillnessesassociatedwithswimmingincontaminatedwaterinclude,eye,ear,noseandthroatinfections.
SMOKE‐FREE WORKPLACE
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Smoke-FreeWorkplace
OVERVIEW
PublichealthinLucasCountyhasbeenalong-standingadvocateforsmoke-freeenvironments.In2003,manyuniversitiesacrossOhio,includingsomewithinLucasCounty,bannedsmokingoncampus.TheToledo-LucasCountyHealthDepartmenthasbeenresponsibleforenforcingOhio’sSmoke-FreeWorkplaceActandhasbeeninstrumentalintighteningsmokinglegislationwithinthestate.Ohio’sSmoke-FreeWorkplaceActwasvoteduponinNovemberof2006asIssue5inthestateofOhio;Issue5wasastatutewhichsetintolawarequirementthatallpublicplacesandplacesofemploymentinthestateofOhioprohibitsmoking.
ThenewlawwentintoeffectDecember7,2006,thirtydaysaftervoterspassedthelaw.AdministrativerulefortheOhioRevisedCode3794furtherdefinedthelawandenforcementbyoutliningresponsibilitiesofproprietorsandindividuals.Theyclarifythepostingrequirementsforsigns,outlinedueprocessforproprietorsandindividualsandstatefinesandpenaltiesforviolations.
2015 SNAPSHOT
Forthecalendaryearof2015,theToledo-LucasCountyHealthDepartmentconducted130smoke-freeworkplaceinspections.
WHY IT IS A PUBLIC HEALTH CONCERN
SmokingistheleadingpreventablecauseofdeathintheUnitedStates.TheCentersforDiseaseControlandPreventionestimatesthatcigarettesmokingcausesmorethan480,000deathsintheUnitedStatesannually.Smokersarealsomorelikelythannonsmokerstodevelopheartdisease,stroke,andlungcancer.Quittingsmokinglowersyourriskforsmoking-relateddiseasesandcanaddyearstoyourlife.
Secondhandsmokeisthecombinationofsmokefromtheburningendofacigaretteandthesmokebreathedoutbysmokers.Exposuretosecondhandsmokehasimmediateadverseeffectsonthecardiovascularsystemandcancausecoronaryheartdiseaseandstroke.Breathingsecondhandsmokecanhaveimmediateadverseeffectsonyourbloodandbloodvessels,increasingtheriskofhavingaheartattack.Secondhandsmokeharmsnotonlyadults,butchildrenbyincreasingtheirlikelinesstodevelopotherillnesses(e.g.bronchitis,pneumonia,earinfections,asthma).
Foradditionalinformation,seehttp://www.cdc.gov/tobacco/index.htm
ANIMAL BITES
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AnimalBites
OVERVIEW
OhioStatelawrequiresthatownersofanyanimalthatmayhavebeeninvolvedinabitefollowspecificrules.Peoplecanbeexposedtodiseases,suchasrabies,whentheyarebittenbyaninfectedanimal,orlesscommonly,whensalivafrominfectedanimalsgetintoanopenwoundorontoamucousmembrane.TheToledo-LucasCountyHealthDepartmentworkswiththeOhioDepartmentofHealthZoonoticDiseaseProgramtoconductactivitiestoprotectOhioresidentsfromthespreadofdiseasescarriedbyanimalsbyprovidingeducation,providingtestingofspecimens,andcollectingandmaintainingdataonrabiesandanimalbiteswithinLucasCounty,Ohio.
2015 SNAPSHOT
Forthe2015calendaryear,701bitereportswerecompleted.81samplesweresenttotheOhioDepartmentofHealthLaboratoriesand0testedpositiveforrabiesvirus.
2015AnimalBiteReportbySpeciesinLucasCountySpecies NumberofBite
ReportsDog 586Cat 89Bat 16Raccoon 3Squirrel 3DomesticRodent 2Monkey 1Opossum 1
WHY IT IS A PUBLIC HEALTH CONCERN
Animalbitescanresultinseriousinjuriesandpotentialexposurestodiseasessuchasrabies.Itisestimatedthatnearly5millionpeopleintheUnitedStatesarebittenbydogseachyear,andabout1in4ofthosepeoplerequiremedicalattention.Mammalsarecarriersforrabiesand,thoughthepresumedfearisprimarilyaroundcontractingrabiesfromdogs,themorelikelyexposuretorabiesisthroughthebiteorcontactwithbats.
ANIMAL BITES
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Formoreinformation,visithttp://www.odh.ohio.gov/animalrabies
ANIMAL BITES
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NUISANCE
Page37
Nuisance
OVERVIEW
Apublichealthnuisanceiswhenabuildingorpropertyisinaconditionthatthreatensorpotentiallythreatensthehealthofanypersonorcommunity.TheToledo-LucasCountyHealthDepartmentwilloftenworkwithcities,townshipsandvillagestoabatepublichealthnuisanceconditionsbyinspectionsandenforcementactions.Examplesofpublichealthnuisancesareunsanitaryhousingorlivingconditions,accumulationoftrash,garbage,andotherdebrisonpropertiesandotherconditionsthatattractroachesandrodentswhichmayharbordiseases.
2015 SNAPSHOT
Forthe2015calendaryear,theTLCHDinspected408nuisancecomplaints.
TypeofNuisanceComplaintInvestigated NumberofComplaintsReceived
Pest/Vermin 99Housing/UnsanitaryConditions 95Other 49Rawsewageatadwelling 46Nowateratadwelling 30Mosquito-StagnantWater/Pool 26AnimalIssues 24CityofToledoComplaintsregardingKeepingofChickens 9FeralCats 7Ticks 7SolidWaste 6ScrapTires 4OpenDumping 4Composting 2TotalComplaintsInvestigated 408
RESPONSE AND PREPAREDNESS
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ResponseandPreparedness
GROUPOVERVIEW CommunityServices,ResponseandPreparedness(CSRP)wasestablishedin2008tolooktothefuture
andassurecuttingedgeepidemiologicalcapabilities,infectiousdiseasesurveillance,emergencyresponseservices,emergencypreparednesseducationandawarenesstothecommunity.
ThegroupdirectstheHealthDepartment'ssupportandresponseforanypublichealthemergencyorlocaldisasterrelatedeventforLucasCounty
Inaddition,thegrouphousestheRegionalPublicHealthCoordinatorforNorthwestOhio.ThroughtheofficeofCommunityServices,ResponseandPreparedness,Toledo-LucasCountyHealth+DepartmentprovidesemergencypreparednesscoordinationandsupporttotheeighteencountyNorthwestOhioPublicHealthRegion.
EMERGENCY PREPAREDNESS
TheCommunityServices,ResponseandPreparednessgroupisprimarilyfundedthroughthePublicHealthEmergencyPreparedness(PHEP)Grant.Thisgrantisannuallyusedtosupport,sustainandbuildemergencypreparednesscapabilitieswithinLucasCounty,OhioandtheNorthwestOhioRegion.Resourcesobtainedandprojectsaccomplishedwiththeseresourcesbene itthegeneralpopulationwithinToledo-LucasCountyHealthDepartment’sjurisdictions.The11speci iedcommunitysectorswithinLucasCounty(business,communityleadership,culturalandfaith-basedgroupsandorganizations,emergencymanagement,healthcare,socialservices,housingandsheltering,media,mental/behavioralhealth,stateof iceofagingoritsequivalent,educationandchildcaresettings)alsogreatlybene itfromtheseplanningefforts.
RESPONSE AND PREPAREDNESS
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TLCHDstrivestoannuallymeettheoutlinedPHEPgrantdeliverablesthatcorrespondtothe15CentersforDiseaseControlandPrevention(CDC)emergencypreparednesscapabilities.SomeoftheseactivitiesincludeupdatingtheStrategicNationalStockpile(SNS)self-assessmentandimprovementplan,conductingtrainingandconductingexercisestoaddressgaps/inefficiencies.
DISASTERRESPONSETEAMTheTLCHDdisasterresponseteamwascreatedin2015.ThepurposeofthisgroupistohavetrainedstaffavailabletoprovideassistancewhenadisasteroccurswithinLucasCountyandthecityofToledo.ThegroupfeaturesstaffmembersfromalldivisionsandprofessionsacrosstheTLCHD.
Theteammeetsmonthlytohearfromdifferentspeakers,visitlocalcommunitypartners,orperformin-houseplanninginitiatives.Teamactivitiesincludethefollowing:
SiteVisits ToledoFireDepartment ProMedicaToledoHospitalEmergencyDepartment LucasCountyEmergencyManagementAgency,
EMA,EmergencyOperationsCenterTraining IncidentCommandStructureTraining PersonalProtectiveEquipmentOverview
EXERCISEPLANNINGANDTRAINING RegionalFitTestingTraintheTrainer
o TLCHD,inconjunctionwithToledoFireSpecialOperationsprovidedfittestingtoalllocalfirstrespondersandpublichealthofficesintheNorthwestOhioregion.
ContinuityofOperationsPlanning(COOP)o TheNorthwestOhioregionalfunctionalexerciseinApril2015focusedonCOOP.o Insuchexercisesanorganizationmustshowitsabilitytorelocateandsustainessential
serviceswhenadisasterstrikesitspermanentestablishment. Davis-BesseGradedExercise
o TheLucasCountyEMAconductedafunctionalexerciseandafull-scaleexercisefortheDavis-BesseNuclearPowerPlaninthespringof2015.
o TheLucasCountyEMAisrequiredtoperformanactivationoftheirEmergencyOperationsCenterindowntownToledo,aswellasanactivationoftheircommunityreceptioncenterinOregon,OhiointheeventadisasteroccursatDavis-BesseNuclearPowerPlantinOttawaCounty.
ResponseteamvisittoToledoFireStationNo.5
RESPONSE AND PREPAREDNESS
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o TheexercisewasgradedbytheFederalEmergencyManagementAgency(FEMA)forcomplianceofcurrentnuclearregulations,stakeholderresponse,andcommunityresiliency.
o LucasCountyleadsthenationinemergencypreparednessbyprovidingapetreunificationcenterforresidentsutilizingthecommunityreceptioncenter.ThismeasureisnotrequiredbyFEMAandisonlydonebyaselectfewagenciesacrossthenation.
Multi-AgencyCoordinationPlanTabletopExerciseo TheLucasCountyIntegratedHealthcareCoordinationTeam(localhealthcarecoalition)
conductedatabletopexercisewithallmemberstoreviewtheactivationandresponsibilitiesoftheLucasCountyMulti-AgencyCoordinationPlan.
St.Luke’sHospitalFluClinico Theemergencypreparednessteampartneredwithhealthservicestoprovideacommunityflu
clinicinNovember2015.o Thefluclinicprovidedbothpediatricandadultfluimmunizations.o ThisfluclinicfulfilledaPHEPgrantrequirementforapointofdispensingactivationsite.
EMERGENCY RESPONSE PLAN REVISIONS
TheTLCHDemergencyresponseplansareintheprocessofbeingcompletelyrewrittenandreformatted.AllplanswillnowbeinlineandreflecttheCentersforDiseaseControlandPrevention’sPublicHealthPreparednessCapabilities.Thefollowingplanshavebeenupdatedduringthe2015calendaryear:
o All-HazardsEmergencyResponsePlano ContinuityofOperationso DemobilizationandRecoveryo QuarantineandNon-PharmaceuticalInterventionso VolunteerManagemento EpidemiologyandSurveillanceo HazardVulnerabilityAnalysiso TrainingandExercise(LocalandRegional)o EmergencyPublicInformationandWarningo BloodBornePathogens
EBOLAVIRUSDISEASESUPPLEMENTALGRANTInApril2015,thedivisionofCommunityServices,ResponseandPreparednesswasawardedasupplementtoitsPHEPgrant.ThissupplementaimstoincreaselocalandstatepreparednessplanningandcoordinationwithregardtotheconcernsaroundtheEbolaVirusDisease(EVD)andotherspecialpathogens.TheseeffortswillresultinthecreationoftheNorthwestOhioEbolaandOtherSpecialPathogensConceptofOperationsPlan.
ThedivisioniscurrentlycollaboratingwiththeseventeencountiesintheregiontocreateregionalandlocalEbolaVirusDiseaseplans.ThisgrantenabledthedivisiontohireaRegionalEbolaCoordinatortohelpcoordinatethepreparednessplanningintheregionandpartiallyfundanotherteammembertowritethelocalplanforLucasCounty.
RESPONSE AND PREPAREDNESS
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NorthwestOhioEbolaandOtherSpecialPathogensConceptofOperationsPlanconsiderations:
LocalHealthDepartmentRoles FirstResponderPPETraining PatientTransportationGuidelines HospitalGuidelines
Isolation&Quarantine ManagementofHumanRemains WasteMangement InformationSharingGuidelines
CreatingtheNorthwestOhioEbolaandOtherSpecialPathogensConceptofOperationsPlanhasbeenverytimely,sincemanyNorthwestOhioepidemiologistshavemonitored“travelers”(personswhohavetraveledthroughregionsunderCDCrestrictions)intheirrespectivecountiesforEboladisease.
Regionalplanchallenges:
IdentifyingEMSprovidersthroughoutNorthwestOhiowhoareproperlytrainedandequippedtotransportsuspectedorknownEbolapatientstotheappropriatehospital.
Waitingforhospitalclassifications.Currently,OhiohasOneEbolaTreatmentHospital(MetroHealthMedicalCenter)inCleveland,OhioandeightEbolaAssessmentHospitals.TheonlyassessmenthospitalinNorthwestOhiois,St.Rita’sMedicalCenter(Lima,Ohio).Allotherhospitalsareconsideredfront-linehospitals.
HospitalDefinitions:Frontlinehospitalswillidentify,evaluate,andisolatesuspectedEbolaViruspatientsandarrangefortransporttoahigherlevelofcare.AssessmenthospitalsacceptsuspectedEbolaViruspatientsupto96hourstoperformtestingtoconfirmorexcludeinfection.TreatmentCentersserveasastateresourcetoacceptandtreatpatientswiththeEbolaVirus.
PlanningforthecareofpediatricEVDpatients.NorthwestOhio’sonlyEbolaassessmenthospital,St.Rita’sMedicalCenter,doesnothavethecapacitytocareforpediatricEbolapatientssothesepatientsmayrequiretransporttoachildren’sassessmenthospitalinCleveland,OhioorColumbus,Ohio.Securingtransportationinthiscasehasbeendifficult.
AdditionalActivitiesAssociatedwiththeGrant:
InOctober,2015Toledo-LucasCountyHealthDepartment,ToledoFire&Rescue,LucasCountyEMS,TheHospitalCouncilofNorthwestOhio,andtheLucasCountyProsecutorsOfficesponsoredtheNorthwestOhioEbolaUpdateProgram.TheprogramwasheldattheUniversityofFindlayandwasdirectedtoallfirstresponders(Fire,EMS,LawEnforcement,EMA,Hospitals,andPublicHealth)throughoutNorthwestOhiotoprovidethemwithupdatesandthelatestinformationonresponsetoEbolarelatedincidents.
InDecember,2015theLucasCountyEbolaPlanCoordinatorandtheRegionalEbolaCoordinatorwereinvitedtoattendanEbolaexerciseatProMedicaToledohospital,toseehowthatfacilitywouldtorespondifsomeonewithEbolaweretowalkinunannouncedintheiremergencydepartmentfortreatment.Theirresponsefollowedtheirfacility’sEbolaPlan.TheexerciseconcludedwhenProMedicaTransportationNetworktransferredthepatienttoanEbolaassessmenthospital.
CSRPhaspurchasedadditionalpersonalprotectiveequipment(PPE)tobetterprepareforanemergencyevent.
RESPONSE AND PREPAREDNESS
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POINTOFDISPENSING(POD)SITES
IntheeventthattheentirepopulationofLucascountyneedstoobtainmedicalcountermeasures(MCM),thehealthdepartmentlackstheresourcestosingle-handedlyrespondtosuchanincident.Suchaneventmaybecausedbyanactofbioterrorism,epidemicorpandemicdisease,ornovelandhighlyinfectiousagentposesaseriousrisktothepublic.
Toprepareforthiskindofpublichealthemergency,TLCHDhasaPointofDispensing(POD)plan.Inthisplan,wehaveestablishingMemorandumsofUnderstandingswithpartnerstousetheirfacilitiesand/orstafftodistributemedicalcountermeasuresinapublichealthemergency.ThesePODpartnerscurrentlyinclude,faithbasedorganizations,schools,businesses,andotherlocalorganizations.
TypesofPODSOpen TLCHDhas19openPODpartnersofferingtheuseoftheirfacilityuseand/orvolunteers
Closed ClosedPODsareestablishedataprivatebusinessesororganizations.TheytypesofPODsarespecificallymeanttoserveaspecificpopulation,usuallythebusinessororganization’semployeesandtheirfamilies.
Thehealthdepartmenthasmemorandumofunderstandingswith34closedPODpartnersconsistingofbusinessesandorganizations
BothclosedandopenPODpartnerswouldserveasthesitewherepharmaceuticalsfromtheStrategicNationalStockpilecouldbedelivered,andmedicalpersonnelatthesesiteswoulddispensethesemedicationsduringapublichealthemergency.AgreementswithtruckingcompaniestoassistinthetransferofsuppliestoourPODpartnersarealsoinplace.
ThePODagreementsensurethatwecanofferantibiotics,vaccines,orothermedicalcountermeasurestoasmanypeopleasexpeditiouslyandefficientlyaspossibletominimizemorbidityandmortalityamongstthepopulation.
RESPONSE AND PREPAREDNESS
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MEDICALRESERVECORPS
TheMedicalReserveCorps(MRC)isavoluntaryorganizationcomprisedofphysicians,nurses,dentists,andothermedical/non-medicalprofessionalstoassistpublichealthduringanemergency.
Asofthebeginningof2016,theLucasCountyMRChas128registeredvolunteers.
NewlearningplansforemergencytraininghavebeencreatedtohaveallMRCvolunteerstrainedforavarietyofdisasters.
In2015,aclimatesurveywasgiventoallvolunteerstogaugewhatinterestsvolunteerswouldlikeincorporateinthecomingyear.Inresponse,differenttrainingandoutreachopportunitieswillbeconductedfor2016.
Improvementshavebeenmaderegardingbadging,credentialing,anddeploymentlogisticswiththeUnitedWayofGreaterToledo.
REGIONALCOORDINATIONBYTLCHDTheDivisionofCommunityServices,ResponseandPreparednesshousestheRegionalPublicHealthCoordinationTeamforNorthwestOhio.ThisteamprovidesthefollowingservicesfortheNWOhioRegion:
Facilitatorformeetings/trainingsfortheNWOhioPublicInformationOfficers,DisasterPlanners,EpidemiologistsandHealthCommissioners
LiaisonforHospitalPlannersinNWOhio 24/7liaisonwithOhioDepartmentofHealth,LocalHealthDepartments
andtheRegionalHealthcareCoalitiontoassistwithinformationsharingduringaresponse
INTRA-AGENCYCOORDINATIONThePHEPgranthasaffordedTLCHDtheopportunitytoworkwiththeHospitalCouncilofNorthwestOhio(HCNO)tolocallydeveloptheLucasCountyIntegratedHealthcarePlanningCoalition,andtoregionallydeveloptheNWOhioHealthcareEmergencyManagementCoalition(NWO-HEMC).BothofthesegroupsareagreatsuccessinhowpartnershipswithEMA,hospitals,andotherstakeholderscanworktogetherinhealthcareplanning.Bothgroupsmeetregularly;TLCHDandtheHospitalCouncilofNWOhiositonthesteeringcommitteesforbothcoaltions.Fortheupcomingyear,publichealth’smembershiponthesteeringcommitteewillbere-evaluatedduetothelanguageinthecurrentRFPthatregionally,PHEPandHPParetoco-leadhealthcarecoalitionactivities.NWOHEMCmission:
Topromoteregionalcooperationandthesharingofhealthcaresystemandregionalhealthcareresources,theNWO-HEMCwillcontinuetopreparethroughcooperativeplanning,training,andexercisingtojointlyrespondtoman-madeornaturalemergencies.
PUBLIC HEALTH ACCREDITATION
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PublicHealthAccreditation
OVERVIEW
PublicHealthAccreditationisavoluntaryprogramdevelopedtomeasurehealthdepartmentperformanceagainstanestablishedsetofnationallyrecognized,practice-focused,andevidenced-basedstandards.Itprovidesasystematicapproachforperformanceassessmentandimprovementacrosstwelvedomainsofpublichealthpractice.ThePublicHealthAccreditationBoard(PHAB)modeledtheseaccreditationrequirementsontheTenEssentialPublicHealthServicestoensureallapplicantsmeetorexceedanestablishedbaselineofcareandservicetotheirconstituents.TheunderlyinggoalforthisprogramistoadvancethequalityandperformanceofpublichealthdepartmentsinanefforttoimproveandprotectthehealthoftheentireU.S.population.
ThestateofOhiohasmandatedthatallpublichealthdepartmentsreachanaccreditedstatusbytheyear2020.ThefollowingisaperformancesnapshotoftheToledo-LucasCountyHealthDepartment'sprogresstowardsaccreditationreadinessinthe2015calendaryear.
2015 SNAPSHOT
TheToledo-LucasCountyHealthDepartment(TLCHD)continuedtomakesignificantprogresstowardstheirapplicationforPublicHealthAccreditation.AsofJanuary1st,2015,TLCHDhadcollectedandverified35.11%oftherequireddocumentationinPHAB'sstandardsandmeasures.Throughouttheyear,theTLCHDAccreditationTeamcollectedandpreparedanadditional35%oftherequireddocumentationnecessarytodemonstrateourcommitmenttowardsimprovingourpublichealthstandardsandservices.
Inadditiontodocumentationpreparation,agencyadministratorsandsupervisorscompletedbothPerformanceManagementandWorkforceDevelopmentself-assessmentsinpreparationforwiderstaffengagementin2016.
TheQualityAssuranceCoordinatorsalsofacilitatedanall-staffMoraleSurveyonbehalfoftheHumanResourcesdepartment.Theresultsofthissurveyhighlightedareasforimprovedcommunicationandprovidedabaselineforsubsequentstaffmoralesurveys.Asummaryoftheseresultswerepresentedatthe2015all-staffWinterRetreat.ApresentationonthefundamentalsofPHABAccreditationwasalsodeliveredtoallstaffattheWinterRetreatbytheQACoordinators.
Theagency'saccreditationreadinesshasmovedclosertotherealizationofbecominganationallyaccreditedbody.Applyingforaccreditationisourpromisetothecommunitythatourhealthcarestandardsarehigh,ourvisionforahealthierLucasCountyisclear,andourcommitmenttothepublic'swellbeingremainsourhighestpriority.
PUBLIC HEALTH ACCREDITATION
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1 2 3 4 5 6 7 8 9 10 11 12
Dec2014 38.8 29.7 44.4 33.3 44.0 63.6 20.0 13.3 6.67 16.6 24.2 45.4
Nov2013 5.41 23.6 8.33 0.00 22.0 5.00 0.00 0.00 0.00 0.00 15.6 30.0
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Domain Percentages
PHAB Domain Completion Progress
Dec2014
Nov2013
QUALITY IMPROVEMENT
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QualityImprovement
OVERVIEW
QualityImprovement(QI)inPublicHealthisaformalizedprocessdesignedtoexamineandimprovethedeliveryandefficacyofpublichealthservices.QIinvolvestheuseofadeliberateanddefinedimprovementprocess,suchasPlan-Do-Study-Act(PDSA),todissectaproblem,discoveritsrootcause,implementasolution,andmeasurethesuccessorfailureofthechangeinitiative.QIisacontinuousprocessthatempowersemployeesatalllevelsofanorganizationtosupportandparticipateintheimprovementofprocesses,programs,andservicestheydelivertothepublic.
QualityImprovementismostsuccessfulwhenembeddedwithinthecultureoftheorganization.Organizationalcultureistheveryessenceofhowworkisaccomplished;itmaturesoverseveralyears,duringwhichnormsarepassedonfromonegenerationofstafftothenext.Becauseitisingrainedwithinanorganization,transformingculturetoembraceQIrequiresstrongcommitmentandsupportfromagencyleadershiptodrivethechangeovertime.
2015 SNAPSHOT
In2015,theToledo-LucasCountyHealthDepartment'sQualityImprovementCouncilmeteighttimestoexamineQIprojectsuggestionsandassociateddata.ThreeQIprojectswereselectedtomoveforwardbasedontheevidencepresentedtotheCouncil.
NewEmployeeOrientationProject(NEO)
TheaimofthisprojectwastoimprovetheNewEmployeeOrientationprocessthroughbetterstaffcommunicationandpreparationpriortonewemployee’sarrivalandconductingamorepersonalorientationdayforeachnewemployee.Theprocessstartsthedayofhireandendswhentheemployeeorientationevaluationiscomplete.Successwillbemeasuredbyimprovingtheoverallsatisfactionscoreonthenewemployeeorientationsurveyby20%.Toachievethesemeasures,theNEOProjectteamsurveyednewemployeeshiredwithin14monthspriortothestartoftheproject.Additionally,directorsandsupervisorsweresurveyedtoassesstheirreadinessfororientingnewemployees,iftheyareproperlynotifiedinadvance,andtheiroverallsatisfactionwiththeexistingprocess.Theteamidentifiedpotentialimprovements,includingtheprovisionofguidancetodirectorsandsupervisorsonthenewemployeeorientationprocess;sendingwelcomeletterstonewemployeespriortotheirstartdate;arrangingawelcomepacketwithimportantinformationandhealthdepartmentbranded"swag;"assigningabuddytoguidethenewemployeethroughtheirorientationprocess;redesigningtheorientationprocesstotakeplacethecourseofamonthratherthanasingleday;andstandardizingasingleorientationdayonceamonthforallnewemployeeshiredsincethelastorientationday.TheNEOProjectteamdevelopedmaterialforawelcomepacket,anemployeehandbook,andworkedwiththeHumanResourcesdepartmenttodeterminethebestmethodstochangethecurrentprocess.Thisprojectiscurrentlyon-holdpendingadministrativeapprovals.(SeeFishboneDiagramon48)
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TheDailyQIProject
Theaimofthisprojectwastodevelopastandardizedprocedureforcodingthedailylogstoallowproperreportingofinformationtobothourinternalandexternalstakeholders.TheDailyQIProjectteamhelditsfirstmeetinginlateNovember,andsetascheduletomeetonceperweekthereafter.Theteamidentifiedpotentialimprovementsincludingthedevelopmentofastandardpolicyandproceduresforcompletingthedailylogs;developmentofatrainingprogramandexamplematerials/referencebook;arevisedversionofthedailycodelist;andapossiblerevisionofthedailyformitself.Bytheendof2015,theteamhadalreadybegunanopendialoguetoexamineandreclassifythecodesusedfordailylogreporting.TheteamexpectstohaveallmaterialsreadyforreviewbytheenvironmentalsupervisorsandstaffbylateFebruaryorearlyMarch.(SeeFishboneDiagramon49)
TheAfter‐HoursQIProject
Theaimofthisprojectistostandardizetheresponsetodisastersafterbusinesshourscounty-wide.
TheAfter-HoursQIProjectteamfirstmetinDecembertoexaminethecurrentprocessofthe24/7C.L.I.C.line.Thislineservedasthemeansforthegeneralpublicandcommunitypartnerstocontactthehealthdepartmentintheeventofanemergency.ThecurrentprocessoftenresultedinthewrongadministratororsupervisorbeingcontactedasthePublicUtilitiesstaffmanningthelineafternormalbusinesshoursfollowedastaticcall-downlistthatdidnotproperlyaccountforareaofexpertiseorjobfunction.
Theteamisultimatelylookingtodecreaseresponsetime,developaprocesstoensureallstakeholderneedsaremet,andtoreducecosttothehealthdepartmentbyavoidingunnecessarycall-outsandovertimecharged.(SeeFishboneDiagramon50)
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New Employee Orientation Project Fishbone Diagram
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Daily QI Project Fishbone Diagram
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After-Hours QI Project Fishbone Diagram
CONTACT INFORMATION
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ContactInformation
Toledo-LucasCountyHealthDepartment
635NorthErieStreetToledo,Ohio43604
Tel419-213-4100
Fax419-213-4546
www.lucascountyhealth.com
EricZgodzinski,MPH,RS,CPHDirectorofCommunityandEnvironmentalHealthZGODZINE@CO.LUCAS.OH.US
AliaKadri,MPHPHABCoordinator/[email protected]
DanBaker,MPHCommunityResponsePlanner/[email protected]
ShannonLands,[email protected]
JerryBingham,[email protected]
LaurenLiebich,[email protected]
DanielleBoyd,[email protected]
GregMoore,MBARegionalCoordination/[email protected]
SamanthaEitniear,MPH‐VPH,CPH,[email protected]
JoshuaNiese,[email protected]
PattiFraker,RD,[email protected]
BrandonPalinski,MPH‐VPHPHABCoordinator/[email protected]
JenniferGottschalkEnvironmentalHealthSupervisorGOTTSCHJ@CO.LUCAS.OH.US
BradSherrick,[email protected]
