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WC CWF Health District Board Minutes - 04/24/2015WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES April 24, 2015 Wichita Falls- Wichita County Public Health District 1700 Third Street - Parker Conference Room Wichita Falls, Texas MEMBERS PRESENT: Board Members Diane Stewart, R.N., Secretary David Carlston, Ph.D. Robin Moreno, MHA -HAS, ACHE Keith Williamson, M.D. MEMBERS ABSENCE EXCUSED: Scott Plowman, Chair Julie Gibson, D.V.M, Vice -Chair MEMBERS ABSENCE UNEXCUSED: Larry Rains, D.D.S. Lou Kreidler, R.N., B.S.N. Amy Fagan, M.P.A. Ray Gonzalez Director of Health Assistant Director of Health County Commissioner I. CALL TO ORDER Diane Stewart called the Health Board meeting to order at 12:00 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES Diane Stewart called for the review and approval of minutes from the meeting held on Friday February 20, 2015. Dr. David Carlston introduced a motion to approve the minutes as presented and Robin Moreno seconded the motion. The motion passed unanimously. At this time it was noted the excused absence of Scott Plowman and Dr. Julie Gibson and the unexcused absence of Dr. Larry Rains. III. COUNTY HEALTH RANKINGS Amy Fagan, Assistant Director of Health informed the Board of the release of the updated County Health Rankings. The rankings had been compiled by the University of Wisconsin for the last six years and provide a method for the Health District to look at the overall picture of health in Wichita County as compared to other counties across the nation. Wichita County "Health Outcomes" ranking went from 151 (2014) in the state to 135 (2015), based on a composite of length of life (176 -2014 to 161 -2015) and quality of life (87 -2014 to 1062015). A significant improvement was seen in the premature death rate, which is measured by the number of deaths converted to years of potential life lost rate (9,438 -2014 to 8,822 - 2015) "Health Factors" (70 -2014 to 73 -2015) was comprised of Health Behaviors (191 -2014 to 178 - 2015), Clinical Care (same 19 -2014 and 2015), Social & Economic factors (88 -2014 to 106 -2015) and Physical Environment (87 -2014 and 69- 2015). Improvements are seen in the ratio of primary care physicians to patients, as well as the preventable hospital stays, which decreased from 67 to 56 (this was a lag data from 2012). There had been no change in the Wichita County reported Adult Smoking rate of 21% because the same exact data set was used from 2014 (which is lag data from 2006 - 2012); the Adult Obesity rate decreased this year from 33% to 32% (this is also lag data from 2011). One of the most notable improvements was in the "access to exercise opportunities" section, where it went from 64% having access to 84 %. The challenge is that our physical inactivity rate remained stagnant at 29% reporting no leisure -time physical activity. 1V. DSHS SILVER RECOGNITION PROGRAM Lou Kreidler, Director of Health announced that out of 19 counties Wichita County received the second highest recognition, Silver Level, from the Texas Council on Cardiovascular Disease and Stroke. The Wichita Falls- Wichita County Public Health District compiled information related to various health indicators to submit to the agency. The Health District made strides in recent years in programs to help prevent and control chronic diseases such as cardiovascular disease, stroke, and other chronic illnesses. The county was awarded The Texas Healthy Communities grant in order to support and improve the health quality of Wichita County. The communities had been assessed based upon environmental and policy indicators including having a comprehensive smoke free ordinance, healthy eating options, mother - friendly worksites, and child health /nutrition curriculum in school, among others. The Health District will continue to work with the Health Coalition of Wichita County to specifically focus on six goals for improvement in the county; 1) creating an Active Living Plan, 2) increasing the number of mother - friendly worksites in the county, 3) implementing a childhood nutrition /obesity prevention program, 4) healthy vending options, 5) access to physical activity in the workplace, and 6) increasing smoke free environments in the surrounding communities. V. HEALTH COALITION REPRESENTATIVE APPOINTMENT Lou Kreidler, Director of Health advised that Scott Plowman as a Health Board representative on the Health Coalition requested that he be replaced now that the smoking ordinance passed. Board member Robin Moreno voiced interest in the representation but a member would need to make the nomination for a vote. Dr. Carlston introduced a motion to nominate Robin Moreno as the Health Board representative on the Health Coalition. Dr. Williamson seconded the motion. The motion passed unanimously. VI. EPIDEMIOLOGY Nursing Administrator Lynette Williams made the PowerPoint presentation due to the Epidemiology Charge Nurse Deborah Booher was out ill. Purpose of Epidemiology • Obtain, interpret, and use health information to promote health and reduce disease. • Conduct disease surveillance. • Investigate unusual occurrences of disease. • Assess environmental exposures. Epidemiology Triad of Causal Factors • Agent (virulence; infectivity; addictive qualities, etc.) • Environment (public health sanitation; social context; availability of health care, etc.) • Host (genetic susceptibility; resiliency; nutritional status; motivation, etc.) K Epidemiology Surveillance Cycle Public and Health Care Providers (Clinicians- Laboratories - Hospitals) REPORTING to Health Department FEEDBACK to Public and Health Care Providers (Clinicians- Laboratories- Hospitals) How does Epidemiology help? It allows the distribution of health and illness in a population to be described in terms of: • WHO is affected? • WHAT is the problem and its frequency? • WHEN and WHERE does this problem occur in the population? • WHY does it occur in this particular population? Epidemiology information is used to: o PREVENT illness and PROMOTE health o AIDE in treating people with existing disease o EVALUATE existing health services Who do we work with? • Other Divisions and Public Health Emergency Preparedness (PHEP) in the Health District • Health and Medical Community • Sheppard AFB Public Health • Department of State Health Services Region 213 Epidemiology Unit • Department of State Health Services in Austin • Centers for Disease Control and Prevention (CDC) In Wichita Falls and Wichita County we are monitoring trends with the National Electronic Disease Surveillance System (NEDSS) for any reports of reportable diseases. Deborah Booher monitors NEDSS, contacts physicians and patients, dings in the system as a case, investigates, follow -ups, and closes. Notifiable Diseases exceeding 5 year monthly median for March 2015 Decreased • Varcella (Chickenpox) • Streptococcus Invasive Group B • ShigellosisSalmonellosis Increased • Streptococcus Invasive Group A • Streptococcus pneumonia invasive • Shia toxin - producing Escherichia coli (STEC) • Pertussls • Campylobacteriosis The GI Reportables spreadsheet from December 2014 to April 2015 indicates quite a few cases of Campylobactor. The six month period of 2015 in comparison to the six month period of 2014 there was one more case of Campy. Lou Kreidler indicated that Deborah Booher created the GI Reportables spreadsheet because of a Water Quality Task Force monthly meeting since the Direct Potable Reuse Program it became important to know the levels of waterborne diseases and no increases have been seen since DPR was initiated. Dr. Williamson asked, where do these cases get reported from? In his office when a client comes in with diarrhea illness it could be campylobacter but unless a fever present or bloody stool it is not worked up. 3 Lou Kreidler replied we face that issue on the surveillance from the hospital a spike of diarrhea illness could be shown but not necessarily know what it could be. The cases reported are -individuals that have gone to the physician or the ER been admitted had stool cultures or lab work done that show campy present. It is known for everyone seen there are two to three gone unreported. Lynette Williams stated a Health Advisory was sent out on the multistate Listeria Outbreak linked to Blue Bell ice cream. Lou Kreidler added the Public gets a different press release from the Physicians press release. The physicians are notified when a spike or the unusual seen to watch for in patients. Lynette Williams continued that there was a GI outbreak in January 2015 that involved a junior hockey team that consisted of 30 individuals; coach, assistant coach, trainer, equipment manager, and players with complaints of nausea, vomiting, and diarrhea. The Incident Timeline January 14 -18, 2015 sheet on the outbreak was provided for review of the investigation. Lou Kreidler said a Health District employee that works at the IMPEC was approached by an individual that said the hockey team was sick. They explained the team arrived in town ate at Restaurant A all had the same meal, the next day ate at the same restaurant and the food had made them sick. Saturday evening upon notification Public Health Inspectors had been called to go to Restaurant A take samples of what the team had and do a health inspection in which they received a great score of 90. On Monday the Inspectors went back to Restaurant A the restaurant recooked the meal just as they had to take more samples. On both occasions all the samples taken there was no sign of bacteria to cause a foodborne illness. All the individuals that had gotten sick had been called then after further investigation discovered two of the players got on the bus sick with a long bus ride only one restroom to use they all got sick. Lynette Williams concluded. Lessons Learned Investigation Process o Context a Hypothesis must be supported by data o Guard against presumptions before all info /data is gathered Safeguard Information • Email • Correspondence Notification Process Investigation Information Sharing In the conclusion Lou Kreidler stated a Health District Epi Team was organized that consists of staff in Nursing, Emergency Preparedness, Environmental Health and the Lab for these occurrences. The team meets to review any observations each then do their part to come back together for a conclusion. A report system within the group was established that works well, when Deborah the Epi Charge Nurse receives any reports she enters the data that is emailed out to everyone. As example an email was received that an individual got a milk shake shared with the spouse at Restaurant A the other day and both got sick but did not go to the doctor battled through the illness at home it was 5 days later but we did proceed through the Epi process. As with the hockey team one individual went to the doctor but was not tested. Epidemiology is interesting because it is such a puzzle piece we are generally working behind the curve because by the time they have gotten sick gone to the doctor and got to us there has been a lag time. Assistant Director Amy Fagan discussed the Salmonella outbreak that involved a restaurant during MSU graduation weekend plus two wedding parties. The process was started to piece it together worked with the restaurant took food samples. Centers for Diseases Control and Prevention (CDC) called to ask if 4 we could use their expertise and help we committed that day the next day a team from Atlanta flew in then another person from the New York City Health Department. Everyone gathered together the CDC team came up with a fourteen page survey version which was extensive due to the restaurants menu. At the time what they figured out from the survey was not to buy tomatoes with the exception of vine tomatoes but it turned out to be the jalapenos once they validated the hypothesis. It was the type of salsa served the hot versus the cold and makeup of that salsa. The process worked and CDC wrote an article on the case it was a great experience for the Health District. The CDC team was incredibly surprised of the cooperative response when the individuals affected had been contacted but the Health District works daily to build the trust and relationship of the community. Diane Stewart adjourned the meeting. VII. NEXT MEETING June 26, 2015 Vlll. ADJOURN The meeting adjourned at 1:45 pm. Signature Print Name Scott Plowman Chair. Julie Gibson D.V.M. Vice -Chair, or Diane Stewart R.N. Secretary Wichita Falls - Wichita County Public Health Board City - County Board J