State trainings to
improve outbreak
response using the
CIFOR Guidelines for
Foodborne Disease
Outbreak Response
CSTE Annual Conference
June 5, 2012
Lauren Rosenberg, MPA
CSTE
Council to Improve Foodborne Outbreak
Response (CIFOR)
AFDO
USDA/
FSIS
ASTHO
APHL
NEHA
NASPHV
CDC
CSTE
NASDA
NACCHO
FDA
CIFOR Guidelines Development
• Comprehensive, consensus-based
guidelines
• Developed by a workgroup with
representatives from state, local,
and federal level as well as all
disciplines
• Based on existing guidelines and
practices
• Released in 2009
CIFOR Guidelines Product
• Description of major functions in outbreak
response
• Specific practices to improve outbreak response
• Performance indicators to determine effectiveness
of activities
• Comprehensive but not stand-alone
• Does not provide instructions for implementing any
particular recommendation
CIFOR Guidelines Toolkit
A process and supporting materials
to help agencies and jurisdictions:
• Better understand their current
outbreak response activities
• Become more familiar with the
CIFOR Guidelines and
recommended practices
• Identify appropriate activities to
improve performance
• Make plans to implement those
activities
CIFOR Toolkit Goals
•
•
•
•
To identify CIFOR recommendations most
appropriate for your agency or jurisdiction
To prioritize those recommendations to not
overwhelm resources
To designate a lead person to take responsibility
for implementing each recommendation
To agree on an action plan and timeline to
increase the likelihood that changes will occur
Toolkit Tracks and Focus Areas
Planning and Preparation
Control Measures
 Control of
source at
implicated
facility
 Food recall
 Control of
secondary spread
 Relationships
 Necessary
resources
 Communications
Surveillance and
Outbreak Detection
Investigation of
Clusters and Outbreaks
 Initial steps
 Epidemiology investigation
 Environmental health
investigation
 Laboratory investigation
 Notification/
complaint
systems
 Pathogenspecific
surveillance
CIFOR Toolkit Steps
Preparation: select participants, assemble
supporting documents, prioritize Focus Areas
Then:
1. Describe current activities/procedures in
each Focus Area and identify areas for
improvement
2. Prioritize CIFOR recommendations that
address these targets
3. Outline steps to implement high priority
CIFOR recommendations
Worksheets
Implementation: State-based
trainings
• CSTE funded trainings in
22 sites
• 17 states:
AK, AR, CT, DE, FL, IA, ID, IL,
KS, KY, ME, MI, NV, ND, PA,
WA, WV
• 2 county-based areas:
Knox County (TN), Cuyahoga
County (OH)
• 3 urban areas:
Los Angeles, Philadelphia,
Milwaukee
Implementation: State-based
trainings
• Each site conducted a multidisciplinary
training using the Toolkit to identify
recommendations from the Guidelines to
implement
• Evaluation form and summary report required
upon completion of training
• Trainings took place starting Spring 2011
State-based trainings: 1,052 Participants
Implementation of the CIFOR Guidelines:
State-based trainings participants
5%
Environmental health specialist (361)
5%
6%
Epidemiologist (229)
34%
Public health nurse (157)
13%
Other (131)
Public health laboratorian (62)
Director of health (54)
15%
Regulator (57)
22%
State-based trainings:
Type of training
• All trainings:
o
o
o
o
•
Used the Guidelines & Toolkit
Introduced participants to Guidelines & Toolkit
Had a dedicated facilitator & recorder
Evaluated the Toolkit
Types of trainings varied:
o 1-day training (AK, CT, ID, IL, KS, KY, Knox County, Los
Angeles County, ME, Milwaukee, ND, Philadelphia)
o Multiple-day training (FL, IA, MI, NV)
o Regional trainings (AR, Cuyahoga County, DE, PA, WA,
WV)
State-based trainings:
Focus areas completed
• Sites completed between 3 and 12 focus areas
• Most commonly completed focus areas:
o
o
o
o
o
1 – Relationships
2 – Communications
7 – Epidemiology investigations
3 – Necessary resources
6 – Initial steps
State-based trainings:
Common themes
• Many sites reported similar improvements to
be made:
o
o
o
o
o
Better communication
Better coordination
More training
More post-outbreak debriefs/ after-action reports
Use standardized investigation/interview/other
forms
o Utilize written protocols (create if necessary)
State-based trainings:
Common themes
•
Many sites reported similar Guidelines
recommendations to be implemented:
o Chapter 3 – Planning & Preparation




3.1 – Agency roles
3.2.3.3 – Agency-specific response protocol & other resources
3.2.3.4 – Training for the team
3.6.2.2 – Communication among the agencies & units of the
outbreak control team
o Chapter 5 – Investigation of Clusters & Outbreaks


5.1.2.5 – Standardized data collection forms
5.2.5 – Coordinate investigation activities
o Chapter 6 – Control Measures

6.6 – Debriefing
State-based trainings:
What was learned
• “We consider ourselves to be ahead of the curve, but
staff roles need to be better defined in an outbreak
investigation.”
• “Utilizing the Toolkit to guide a review of current
practices was very valuable. We learned that we are
doing a lot of things right but also learned that
standardization of foodborne outbreak detection &
response practices statewide would be helpful & could
be improved.”
State-based trainings:
What was learned (continued)
• “Enabling all of the jurisdictions to send
representatives from multiple disciplines allowed for
excellent networking opportunities & face-to-face
discussions. All participants learned a lot… local
health jurisdictions have developed various strategies
to enhance outbreak response.”
• “Having the opportunity to get together & talk about
current practices & needed improvements was very
helpful.”
State-based trainings:
Next steps
• Follow-up with sites that conducted trainings
o Progress on identified action items
o Impact of training on outbreak response
The CIFOR Toolkit is now available at:
www.cifor.us
www.cste.org
CSTE Exhibit Hall booth
Thank you!