Public Health Department Policy & Procedure Manual Example

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RESPIRATOR SELECTION

See Appendix C: N-95 Respirators—1860, 9211, and Powered Air Purifying Respirator

Respirator are selected and approved for use by the Administrator. Proper respiratory protection selection is made only after a determination has been made as to the real and/or potential exposure of employees to harmful concentrations of contaminants in the workplace atmosphere. This evaluation will be performed prior to the start of any routine or non-routine tasks requiring respirators. The following items will be considered in the selection of respirators:



      • Effectiveness of the device against the substance of concern

      • Estimated maximum concentration of the substance in the work area

      • General environment

      • Known limitations of the respiratory protective device

      • Comfort, fit, and worker acceptance

      • The task to be performed

      • Other contaminants in the environment

      • Potential for oxygen deficiency

      • A verification of the respirator’s NIOSH certification for its intended use
  1. Particulate Respirators (N-95 Masks)

This NIOSH-certified respirator can help reduce inhalation exposures to certain airborne biological particles (e.g. viruses, mold, Bacillus anthracis, Mycobacterium tuberculosis, etc.) but cannot eliminate the risk of contracting infection, illness or diseases. OSHA and other government agencies have not established safe exposure limits for these contaminants. This respirator is a negative-pressure device using the suction produced by inhalation to draw air through the filter. Do not use in atmospheres containing less than 19.5% oxygen. Do not use when concentrations of contaminants are immediately dangerous to life and health or are unknown. Do not use for gases and vapors. See Section 11.0 Appendix C – Respirators for user instructions regarding the 1860 Series N95 particulate respirator.

  1. Powered Air-Purifying Respirator


Powered air-purifying respirators (PAPR), which operate on the same principle as air-purifying respirators, but rely on a blower unit to move air through filters and deliver it to the user. These respirators remove air contaminants by filtering, absorbing, adsorbing, or chemical reaction with the contaminants as they pass through the respirator canister or cartridge. This type of respirator is to be used only where adequate oxygen is available and the atmosphere is not oxygen enriched (19.5 to 23.5 percent by volume). Do not use for gases and vapors See Appendix C – Fit testing for user instructions regarding the Air-Mate High Efficiency Powered Air Flower/Filtration Unit.

No respirator may be used for any purpose if it has not been NIOSH certified for that purpose.
Respirators are purchased from the following contact or a private vendor of these products:

Ron Mosca, Senior Account Representative

3M Occupational Health and Environmental Safety

3M Center, Bldg 0235-02-W-07

St Paul, MN 55144-1000

(800) 537-8461

rjmosca1@mmm.com
Respirators selected for use by the Buffalo County Health Department staff for responding to the agents identified in Section 11.0 Appendix B, Coulee Region Public Health Consortium Hazard Assessment are:

Particulate Respirators (N95 3M 1860 and 9211 Series)

Powered Air Purifying Respirator (3M HEPA Series)

  1. RESPIRATOR USE

Respiratory protection is authorized and issued for the following employees:


      • Workers in areas known to have contaminant levels requiring the use of respiratory protection or in which contaminant levels requiring the use of respiratory protection may be created without warning (e.g., act of bioterrorism or an infectious disease outbreak).

      • Workers performing operations documented to be health hazardous and those unavoidably required to be in the immediate vicinity where similar levels of contaminants are generated (e.g. Infectious Disease Outbreaks / Isolation Rooms)

      • Workers in suspect areas or performing operations suspected of being health hazardous but for which adequate sampling data has not been obtained. (e.g. bioterrorism Hazards including mass vaccination clinic)

Employees may not wear respiratory protective equipment if he or she has any condition (i.e., facial hair, clothing, or hairstyle, etc.), which may interfere with the proper fit and operation of the respirator. If an employee requires corrective lenses, these lenses must be worn during operations involving respiratory protective equipment, and must be worn in such a way as to not interfere with the respirator’s seal or operation.




  1. RESPIRATOR FIT TESTING

Employees of the Buffalo County Health Department shall be fit tested at least every 12 months. In order to ensure that respiratory protective equipment provides a good fit, and therefore good protection without excessive leaks, employees must successfully complete a fit test. Employees shall also be fit tested whenever:

      • A different size, style, or model of respirator is to be used
      • Whenever there are changes in the employees physical condition that could affect the respirator seal (such as an obvious change in weight, facial scarring, dental changes, or surgeries involving the face and head)


      • Whenever the employee reports a change in the fit of his or her respirator

      • Fit testing shall be performed using one of the following OSHA approved qualitative or quantitative fit test methods:

        • Saccharin Solution Aerosol*

        • Denatonium Benzoate (Bitrex) Solution Aerosol

These methods are qualitative methods, which rely on the employee’s response to the challenge agent (taste, smell, cough, etc.) to determine an adequate fit. Denatonium Benzoate (Bitrex) will be the preferred method of fit testing.


Fit testing will not be done on employees with facial hair that passes between the respirator seal and the face or interferes with valve function. Such facial hair includes stubble, bears, and long sideburns.
Respirator fit testing shall be documented and shall include the type of respirator, brand name and model, method of test and test results, test date and the name of the instructor/tester.

  1. TRAINING

See Appendix D: Respirator Training
In order to provide adequate protection, employees must be trained on the proper use and care of respiratory protective equipment. This training shall be given annually and shall include the following points:

      • Why the respirator is necessary and how improper fit, usage, or maintenance can compromise the protective effect of the respirator;

      • What the limitations and capabilities of the respirator are;

      • How to use the respirator effectively in emergency situations, including situations in which the respirator malfunctions;

      • How to inspect, put on and remove, use, and check the seals of the respirator;
      • What the procedures are for maintenance and storage of the respirator;


      • How to recognize medical signs and symptoms that may limit or prevent the effective use of respirators; and

      • The general requirements of this section.



Employees shall be retrained at least annually, and whenever there are changes in the workplace or task that make previous training obsolete, it becomes apparent that the employee’s knowledge of respiratory protection is inadequate, and when any other situation arises that indicates a need for retraining.

  1. RESPIRATOR INSPECTION, MAINTENANCE AND STORAGE

See Appendix C for user instructions regarding inspections, cleaning and storage.



  1. PROGRAM EVALUATION


See Appendix E: Fit Testing Record Form and Procedure for Fit Testing and Appendix F: Respirator Training Program Attendance Roster
Program Manager shall retain written information regarding medical evaluations and fit testing of the Buffalo County Health Department’s Respiratory Protection Program for a period not to exceed 5 years.. Records of medical evaluations are retained and made available in accordance with 29 CFR 1910.1020.
The Respiratory Protection Program shall be reviewed and evaluated at least every 12 months by the Program Administrator and the Program Manager(s). The Checklist for Respiratory Protection Programs will be used as a program evaluation tool.
REFERENCES/LEGAL AUTHORITY:

POLICY TITLE: Blood Lead Level (BLL) Results and Follow-Up



EFFECTIVE DATE: 07/05/2006

DATE REVIEWED/REVISED: 11/30/2006, 07/06/2012

AUTHORIZED BY: Jen Rombalski, Health Officer

PURPOSE STATEMENT:
To assure blood lead screening follow-up to Buffalo County children at ages one (1) and two (2) years, as well as children six (6) years of age or younger who have not been screened in the past. To maintain a central case registry (hereinafter referred to as Elevated Lead Log), in accordance with the quality criteria of the WCLPPP, for all children with elevated blood lead levels.
RESPONSIBLE STAFF:
Public Health Nurse

WIC Technician

Environmental Health Specialist
PROCEDURE:
Receive BLLs for lead screenings done through the Public Health Unit-WIC Program as well as those performed at private providers and review results.

For all BLLs < 4 µg/dL: This is considered a normal BLL. Initial and date lead test results and file in current years’ Lead Results Binder under appropriate section (private provider or WIC). No follow-up to guardians is required for normal BLL results.

For all BLLs 5-10 µg/dL, this is considered a reference value, a letter is sent to the family (found in G/ Public Health Unit/ Lead/ Lead Results Over 5mcg) include the Look Out for Lead Brochure.

For all BLLs over 10µg/dL (Lead Exposure)


  1. Enter data into Elevated Lead Log (PHN0057) for current year

  2. Send form letter Elevated Blood Lead Level (PHN0072) to the parent/guardian within 48 hours of receipt of results. (only if first level obtained is a capillary sample and venous draw is necessary)
  3. Send informational packet to include lead informational materials, such as appropriate ones listed in Section 3.0 Scope/Supporting Facts


  4. Continue to follow-up on all subsequent BLLs done while case is open and provide reminders to parents/guardians if re-screening is not completed.

  5. For EBLL (see definition above) Complete Case Report and Environmental investigation (per procedure #PHN009).

For all BLLs 45-69 µg/dL: This is an EBLL.

  1. Call child’s parent/guardian immediately upon receipt of the BLL results and inform them that they must make an appointment with the child’s primary care provider for a venous BLL within 24-48 hours.

  2. If parent/guardian is not home, make every effort to locate them as soon as possible.

  3. Contact primary health care provider to advise him/her of situation

  4. Follow procedure as above.


REFERENCES/LEGAL AUTHORITY:
http://dhfs.wisconsin.gov/lead/doc/Chap7Screen.pdf

POLICY TITLE: Environmental Health Complaint Investigation



EFFECTIVE DATE: 8/1/03

DATE REVIEWED/REVISED: 6/28/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
PURPOSE STATEMENT:
To assure uniform follow-up of all human health hazard complaints/events according to Wisconsin Statutes as well as the Pepin County Nuisance Ordinance that prohibits human health hazards.
POLICY:
Pepin County Health Department Staff will respond to citizen complaints in a timely manner, and will resolve the issue through consultation or legal action as needed.
Objectives:
  1. Investigate human health hazard ordinance complaints within 10 working days.


  2. Investigate 100% of complaints received.



PROCEDURE:

Complaint receipt and documentation:

  1. Phone, walk-in or written complaints will be forwarded by public health support staff to the Health Officer or designee. If health officers are unavailable, callers will be forwarded to voice mail. Walk-ins will be told when the health officer will return and be instructed to call or leave contact information for a return call.

  2. The HO will contact the complainant as soon as possible to gather additional information regarding the complaint. The complaint will be referred to public health staff or assigned to the health officer.

  3. Staff handling the complaint will fill out the Environmental Health and Human Hazard Report found here: S:\PUBLIC HEALTH\Human Health Hazards\Forms-Letters\Environmental Health and Human Health Hazard REPORT.doc with information gathered from the complainant.

  4. Complaints will be prioritized using the following criteria:

  • Imminent health hazards will be acted upon as soon as possible, on the day the complaint is received.

  • Health hazards will be acted upon as soon as possible, but within 10 working days.

5. An anonymous complaint will be accepted and handled as any other complaint.

6. The names of those filing a complaint are generally kept confidential. However, in cases where the complainant name must be used, the complainant will be informed that his/her name will be divulged.

7. Initial documentation regarding the complaint will be kept on the Environmental Health and Human Hazard Report in the case of a reported illness. Complaint investigations may include communication by telephone, letter, or on-site field inspections.

8. The complaint will be entered into the Nightengale Notes database. All fields will be

completed in the database unless unavailable. The date the complaint was received,

investigation began, and date resolved will be documented.


  1. Those requesting complaint investigation information must request the records in writing

as an open records request.
Complaint Investigation:

  1. A complaint that is immediately resolved through consultation, education, or referral is entered into the Nightengale Notes database. No further action is required.

  2. Field inspections shall be in accordance with accepted environmental health practice. Proper documentation may include photographs and video/audio tape recordings. Written detailed information will include, for example; dates, times, persons contacted and phone numbers, and any other information relevant to the investigation.

  3. Staff will make appropriate referrals to county agencies, state agencies, or local jurisdictions for corrective action. Staff contacts the complainant, if necessary. Staff will contact the non-compliant party, if necessary.

  4. Follow-up information and/or photographs will be attached to the complaint form or placed in a file marked with the name of the complaint. Complains are filed by year. The current year is in the health officer file cabinet. The form or the file must clearly indicate the disposition of the complaint. All forms are located on the S Drive under Public Health/Human Health Hazard and can be found by the following link: S:\PUBLIC HEALTH\Human Health Hazards

5. When an order to correct a health hazard must be issued, the procedure outlined in the Pepin County Human Health Ordinance shall be followed. Written orders will be sent certified mail with compliance due within 30 days of receipt of the order as indicated on the US Postal Service return form. A copy of the written order and verification of receipt of the order will be attached to the Environmental Health and Human Hazard Report when filed. Compliance dates may be extended, if it appears that a good faith effort has been made to comply, and more time is necessary to achieve compliance. A hard copy of the abatement order will be placed in the file.

6. Failure to comply may result in legal action as determined by the health officer and the

corporation counsel staff. If court actions are needed, the corporation counsel staff will make arrangement for court dates and will request necessary paperwork from the health officer.

7. Complaints shall be filed by year of complaint, in the health officer office and must be kept for 7 years.

8. A Complaint follow-up will either consist of a visit to the site, or a phone call or other contact. The handling of the of the complaint is determined by the nature of the complaint. If violations are noted upon investigation of the complaint, orders to abate the problem will be issued. Depending upon the seriousness of the complaint, either immediate corrections, or corrections within no greater than 30 days may be ordered. If the complaint is resolved via phone call or other contact, this will be noted in the record.

EVALUATION:


  1. All complaints will receive follow-up within 10 working days as indicated in the complaint database.

  2. All complaints will have proper documentation of situation and resolution as documented on the complaint investigation form and supporting materials.


REFERENCES/LEGAL AUTHORITY:


  • FoodBorne and Waterborne Outbreak Investigation Policy

  • Access Complaint Database

  • DHS or DATCP Fact Sheets

  • Ch 250,251,252,254 823 Statutes

  • Sections 59.70, 59.54, 66.0119 and 66.0417 Statutes

  • Ch HFS 140

  • WI Administrative Code

  • Pepin County Ordinance Ch 10

POLICY TITLE: Environmental Health Fee Exempt Testing

EFFECTIVE DATE: 7/16/12

DATE REVIEWED/REVISED: 7/16/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
PURPOSE STATEMENT:
The PCHD will provide existing fee exempt testing for Pepin County residents to protect public health while eliminating the barrier of cost.
POLICY:
The use of free exempt testing will help to assure safe drinking water for infants, identify lead poisoned children early, determine the cause of outbreaks, and provide environmental testing for those with health problems or potential health problems.
PROCEDURE:

Fee Exempt Water Testing:

Low income families with pregnant women or newborns will be offered fee exempt water testing if they have a private well for their drinking water supply. PHN will provide water sampling instructions and the fee exempt test kit to families meeting these criteria. Families will be instructed to read the sampling instructions, collect the water sample, and mail it to the WSLH using the mailer and postage paid sticker included with the kit. If staff members believe the family may be unable to understand the directions for sampling, the PHN may collect the sample at the time of a home visit. When the water test results are received by the PCHD, the family will be contacted if the water is unsafe in any way.

If a sampling error occurred and the bacteria sample must be repeated, a second sample bottle for bacteria only will be provided to the family for the re-test.
Lead Screening or Lead Hazard Assessment:

Families will receive a free lead screening or lead hazard investigation if a child in the home has an elevated blood lead level. If a child in the home has a documented blood lead level of 20 ug/dL, or if the child has two BLL’s of 15 ug/dL taken 90 days apart, a lead hazard investigation will begin. The investigation is mandatory and is intended to locate all lead sources in and around the home. All environmental lead sampling is done free of charge. Lead sampling is conducted in the child’s home and any residence where the child spends a significant amount of time, such as a daycare or the home of a relative or friend. Lead paint chips, dust wipe samples, and potentially soil samples will be collected and analyzed. The PCHD contracts with Cedar Cooperation for inspection and testing services.



Foodborne or Waterborne Illness Investigation Sampling:

There is no cost to individuals for a foodborne or waterborne illness investigation. Individuals involved in foodborne or waterborne outbreaks will be offered free stool sample kits and analysis to determine the illness or source of illness. Kits are distributed to ill and well individuals, as well as food handlers. Completed samples can be either dropped off at the Health Department, or Health Department staff will pick up the completed kits and ship them to the State Lab of Hygiene for analysis. Food or water involved in the outbreak will also be analyzed without cost to the individuals. Food Samples are analyzed either at the Wisconsin State Lab of Hygiene, or will be forwarded to the DATCP Bureau of Lab Services.

Indoor or Outdoor Air Quality Investigations:

Pepin County families or individuals with documented health conditions relating to indoor or outdoor air quality will receive a free air assessment with the use of either the 4 gas air monitor owned by the Health Department, or the loaned equipment from the Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health. An Indoor Air Quality questionnaire will be given to the family to complete. This questionnaire will be used to determine potential areas of concern in the home. BEOH staff will consult with PCHD staff to determine the type of air testing appropriate for the air conditions and health conditions noted. If outdoor air is an issue, the Department of Natural Resources may be involved in the investigation as well.

West Nile Virus:

West Nile Virus surveillance takes place annually from May through October. During this time period, the PCHD will accept calls regarding sick or dying birds. The information will be entered into the West Nile database in PHIN. EH staff will collect dead ravens, crows or blue jays from residents. Analysis of birds to detect the presence of West Nile Virus in the county will be done free of charge to residents. Dead bird testing will cease as soon as a county has one positive bird submitted for the year.


1. See current year “Arbovirus Management Protocol” as provided by the State of Wisconsin

Department of Health and Family Services found at:



http://www.dhs.wisconsin.gov/communicable/ArboviralDiseases/PDFfiles/2012ArbovirusManagementProtocol.pdf

2. For further questions, please contact Diep (Zip) Hoang Johnson at 608-267-0249 or email at



diep.hoangjohnson@wi.gov

EVALUATION:
Residents will be offered all appropriate and available fee exempt testing. They will be made aware of the cost of any other testing offered by the PCHD before they utilize or participate in the testing.

REFERENCES/LEGAL AUTHORITY:


  • Division of Public Health Guidelines for Fee Exempt Environmental Sample Analysis

  • Fee Exempt Well Water Sampling Instructions

  • West Nile Virus Guidelines

  • Foodborne and Waterborne Outbreak Investigation Manual

  • Ch 250,252,254, 823 Statutes

  • Ch HFS 140, WI Administrative Code

  • Wisconsin Administrative Codes, Dept. of Natural Resources

POLICY TITLE: Foodborne and Waterborne Outbreak Investigation


EFFECTIVE DATE: 7/2/12

DATE REVIEWED/REVISED: 7/2/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
PURPOSE STATEMENT:


  1. To assure early detection of, and rapid, effective response to a foodborne or waterborne disease outbreak.

  2. To reduce incidence of foodborne, and waterborne diseases.

  3. To provide epidemiological follow-up on all reportable foodborne or waterborne disease outbreaks.

  4. To provide education on foodborne or waterborne disease prevention to individuals and the community.

  5. To stress risk factor reduction to food establishment employees and managers as a means of preventing future outbreaks. These risk factors include inadequate cooking temperatures, improper holding temperatures, poor personal hygiene, unsafe food sources, and contaminated equipment.


POLICY:

The Pepin County Health Department will work in collaboration with the Department of Health Services or the Department of Agriculture, Trade and Consumer Protection, Department of Natural Resources, Division of Food Safety to determine the source of a reported foodborne or waterborne disease or illness outbreak, and will take steps to prevent further illness. A foodborne outbreak is the occurrence of more cases of disease than expected in a given area or among a specific group of people during a particular period of time. A waterborne outbreak is when two or more people experience a similar illness after the ingestion of drinking water or after exposure to water used for recreational purposes, and epidemiologic evidence must implicate water as the probable source of the illness. (One illness is considered a waterborne outbreak for a single case of lab confirmed primary amebic meningoencephalitis and for single cases of chemical poisoning if the water-quality data indicate contamination by the chemical.)

PROCEDURE:
Notification:

The outbreak investigation will begin within one working day of notification of an outbreak. At the onset of a food or waterborne disease investigation, the DHS Communicable Disease Epidemiology Section, Food Safety and Recreational Licensing Section, and the Western Regional DHS office will be notified. Depending upon the circumstances and source of illness, the DATCP Division of Food Safety, or the Department of Natural Resources may be notified as well. If the event overwhelms the capacity of the Pepin County Health Department, DHS or DATCP will be asked to assist in the investigation. Notify local health care providers to inform them of the outbreak situation.


Consult with the management team to determine whether the Public Health Emergency Plan should be activated. Consider the following triggers:


  • The event is urgent in nature and/or potentially severe in consequences

  • Staff’s day-to-day work will need to be redirected

  • An interdisciplinary response is required (within the agency and/or with the Department of Health Services or the DATCP Division of Food Safety)

  • Other agencies are part of the response team

  • The response is expected to last greater than one day.


Investigation:

Pepin County Health Department will investigate reports of food-borne or water-borne disease following the procedure outlined in the Foodborne Illness Investigation Manual. Public Health Nurses will conduct interviews with ill and non-ill individuals that shared a common source of food or water at an event or common location. Employees of the facility in question will be interviewed as well. The health officer will collaborate with the DHS to assure inspection of the food service facility or the collection of environmental health samples. The outbreak may originate at a public establishment, private home, temporary food stand, at a Farmers Market, Bake Sale, County Fair, farm event, or other food service operation.

In the event the outbreak becomes cross-jurisdictional, DHS or DATCP will coordinate the activities of governmental agencies in order to most quickly and efficiently end the outbreak.
Steps taken in the investigation include the following:


  • Obtain initial information from the complainant regarding a reported food or waterborne illness report.

  • Contact the food service establishment to inform them of the complaint, and to determine if the establishment has received other reports of illness.

  • Develop a list of individuals to contact regarding the outbreak.

  • Contact the State Epidemiologist to obtain direction for the epidemiologic investigation, food sampling, and lab sample submission. Forward an intake log sheet with basic information regarding the outbreak to the State Epidemiology section.

At this point, the Public Health Emergency Plan should be activated considering the following triggers:




  • The event is urgent in nature and/or potentially severe in consequences

  • Staff’s day to day work will need to be redirected

  • An interdisciplinary response is required (within the agency and/or with the Department of Health Services)

  • Other agencies are part of the response team

  • The response is expected to last greater than one day

The investigation continues with the following steps:




  • Interview the ill individuals and well individuals who shared the common food, water, or event. Interview food service workers and determine health status.

  • Prepare a line list of ill persons listing signs, symptoms, onset times, duration of illness.

  • Gather appropriate community and environmental information; investigate potential sources of the responsible agent and factors that may have contributed to the outbreak.

  • Inspect the food service facility and collect samples, data, or reports as necessary. Interview the establishment owner or operator, and key employees.


  • Analyze and interpret data.

  • Receive, evaluate, and transmit completed reports to the state epidemiologist.

  • Implement control measures for specific diseases consistent with measures recommended by the state epidemiologist.

During the course of the investigation, a food establishment may need to be closed while the source of the outbreak is determined and to allow time for elimination of the hazards within the operation. If the establishment does not close voluntarily, the Pepin County Health Officer can order the establishment closed as part of the communicable disease containment and prevention.


Final Report:

Following the investigation of the waterborne or foodborne illness, a final report will be completed. The final report will detail the number ill and not ill, the identified illness agent, source of illness, and investigation methods and findings. If the scope of the event required the utilization of the Public Health Emergency Plan, an After Action Report will be completed. The report and documentation will be maintained for seven years. The patient and health reports are confidential. The investigation report is public record.

The foodborne illness complaint form can be found here: S:\PUBLIC HEALTH\Updated Policies and Procedures 2012\Environmental Health\Foodborne Illness Forms\Foodborn_Illness_Complaint_Form.pdf.

EVALUATION:
100% of foodborne or waterborne outbreak complaints will be investigated.

100% of all establishments involved in an outbreak will receive a debriefing following the investigation

REFERENCES/LEGAL AUTHORITY:


  • Wisconsin Administrative Code Chapter 145

  • Chapter 252 Wisconsin Statutes

  • Chapter 254 Wisconsin Statutes

  • Pepin County Public Health Ordinance 301

  • DHS 196 and Addendum A, Wisconsin Food Code

  • ATCP 75 and Addendum A, Wisconsin Food Code


POLICY TITLE: Home Visitation: Elimination of Second Hand Smoke Exposure

EFFECTIVE DATE: 9/5/08

DATE REVIEWED/REVISED: 6/28/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer /Director
PURPOSE STATEMENT:
To provide a safe work environment for home visiting employees by reducing exposure to second-hand smoke.
POLICY:

Pepin County Health Department strives to provide employees, including home visiting employees with a safe work environment as they provide services for the residents of Pepin County. A home visiting employee is defined as a person who provides services in private homes or other environments, as arranged by the Pepin County Health Department. The health department is committed to maintaining employee safety and preventing second-hand smoke exposure.


PROCEDURE:
Home visiting employees have the right to ask a client, or other household occupant, not to smoke in their presence while they are providing services. If anyone refuses the request, the employee can leave without providing further services – unless doing so would present an immediate, serious danger to any person involved.

The home visiting employee must follow any guidelines provided by the employer that are aimed at ensuring the client receives a reasonable level of care, in a safe manner.

Responsibility of the home visiting employee who leaves a home due to second hand smoke exposure:


  1. within 30 minutes, or as soon as possible, the employee must phone their employer and provide the following information:

  1. to advise that they have made a request to provide services in a smoke-free environment, the client or other individual have refused the request and the employee has left.

  2. To provide information about the circumstances and care requirements of the client over the next 24 hours, including

    • In what situation the client was in when the employee left.

    • Whether an appropriate person is present and available to care for the client, if needed,

    • If the client would require additional care in the next 24 hours,

    • Any other unusual circumstances that may be present.

2. Written documentation of event will be provided within 24 hours.
Employer Obligations:

The director or Program Supervisor will support the rights and responsibilities of an employee who chooses to leave a client’s home because of second-hand smoke exposure risk.


Enforcement:

The Director or Program Supervisor will enforce this policy. Clients will be notified of this policy prior to enforcement and individual circumstances will be reviewed. Services will be terminated should the policy be violated. All events will be documented in the clients chart.




EVALUATION:
REFERENCES/LEGAL AUTHORITY: N/A

POLICY TITLE: Human Health Hazards


EFFECTIVE DATE: 05/25/2006


DATE REVIEWED/REVISED: 10/06/2006, 07/06/2012

AUTHORIZED BY: Jen Rombalski, Health Officer
PURPOSE STATEMENT:
To assure a systematic follow-up of all human health hazard complaints in accordance with Wisconsin State Statute 254.59 as well as local ordinance #01-08-02, which was established to protect the public’s health, safety and general welfare.
POLICY:
Buffalo County Department of Health and Human Services shall employ a full-time Health Officer, who will also function as health services supervisor for the public health unit. This individual shall have at least a bachelor’s degree from a nursing program accredited by the national professional nursing education accrediting organization or from a nursing program accredited by the board of nursing [s. 251.06(1)(a) Stats.]. In accordance with s. 251.06(3) (a-i), the local health officer shall:


  • Administer the local health department in accordance with state statutes and rules.

  • Enforce state public health statutes and rules.

  • Enforce any regulations that the local board of health adopts and any ordinances that the relevant governing body enacts, if those regulations and ordinances are consistent with state public health statutes and rules.

  • Administer all funds received by the local health department for public health programs.

  • Appoint all necessary subordinate personnel, assure that they meet appropriate qualifications and have supervisory power over all subordinate personnel. Any public health nurses and sanitarians hired for the local health department shall meet any qualification requirements established in rules promulgated by the department.
  • Investigate and supervise the sanitary conditions of all premises within the jurisdiction area of the local health department.


  • Have access to vital records and vital statistics from the register of deeds.

  • Have charge of the local health department and perform the duties prescribed by the local board of health. The local health officer shall submit an annual report of the administration of the local health department to the local board of health.

  • Promote the spread of information as to the causes, nature and prevention of prevalent diseases, and the preservation and improvement of health.


RESPONSIBLE STAFF:
Health Officer

Any employee within BCDHHS

Social Worker

PROCEDURE:


  1. Receive referral and complete the top section of the HHH Progress Notes. Note: If the person giving the referral refuses to leave his or her name, they will be notified that the person maintaining the health hazard may refuse investigation. The referral source will always remain anonymous. However, if the individual refuses to allow the EHS to enter, and an inspection warrant is obtained through the court, the caller’s name will be listed on the warrant, in which the person maintaining the health hazard will receive a copy.

  2. A detailed description of the complaint/potential health hazard shall be documented in the progress notes.

  3. Enter information into Human Health Hazard Case Log (PHN0020).

  4. In the absence of the EHS, any human health hazard complaint will be given to a public health worker, then to the social worker on intake.

  5. Determine if the complaint can be addressed when the EHS is due to return or if it needs more immediate attention. If the complaint needs immediate attention, direct another individual within the agency to begin the follow-up procedure.
  6. Determine if problem falls under the jurisdiction of the BCDHHS or if it should be referred to another agency because of the nature of the complaint or the geographical area if falls within. Referrals to other agencies should be considered using the following guidelines, which are not meant to be all-inclusive:


Referrals to DNR:

The DNR has statutory authority over several types of pollution, including air pollution (Chapters NR400-499 of the Wisconsin Administrative Code; surface water pollution (Chapters NR102 and NR103 of the Wisconsin Administrative Code; groundwater pollution (NR140 of the Wisconsin Administrative Code); and improper waste disposal (Chapter NR500 of the Wisconsin Administrative Code).

Concerns about air pollution, surface and groundwater pollution and the improper disposal of solid waste should be referred to the West Central District of the DNR. The DNR will advise if there is a more local agency that may have jurisdiction in the specific situation.

Referrals to Local Municipality:

Some municipalities have their own human health ordinance (a/k/a a nuisance ordinance).



Referrals to the Department of Ag/Trade and Consumer Protection:

Landlord/tenant issues.


Referrrals to Buffalo County Zoning Administration:

Complaints about septic systems and zoning violations (such as land use concerns in zoned townships).


Referrals to the Humane Society and/or WI Department of Agriculture:

Animal welfare issues.


If the complaint is referred to another agency for follow-up, request that the agency provide notification of their follow-up to BCDHHS. Once received, document the follow-up.

  1. Things to consider prior to visit:

    1. Seek legal advise from Corporation Counsel

    2. Check with township or village officials to determine if a joint investigation is desired

    3. Check with child, adult, including elderly, and mental health/AODA social workers to determine if they are familiar with case.

    4. Check with law enforcement to determine past responses or known difficulties



  1. If the complaint alleges an imminent threat to health, make an unannounced visit. In other cases, contact owner and obtain permission from the owner of the property to inspect the premises. If admittance is not allowed, obtain a court order to investigate if necessary.

  2. If the EHS is available and follows-up on the case, request that an employee of the Buffalo County Sheriff’s Department, local law enforcement, zoning, or an employee of BCDHHS accompany Health Officer on inspections for safety, as deemed necessary. In some cases this may not be necessary, (e.g.: if a tenant files a complaint about housing that he/she is renting and the tenant will be present for the inspection, the Health Officer may inspect this property independently. If, however, the tenant will be absent, the Health Officer will request accompaniment.)

  3. Proceed with on-site investigation and take photographs of the alleged violation.

  4. Complete a report within 5 working days of completion of the inspection. If a health order is written, send to the owner and the occupant of the property by certified mail with return receipt requested. The Buffalo County Sheriff’s Department may serve the order if the owner refuses or is unable to accept registered mail. Notify the owner that a health hazard exists and that it be removed or abated within 30 days. The written order of abatement must include:

  1. The nature of the hazard and the steps needed to correct it.

  2. The time period in which the violation must be corrected.

  3. Penalties that the owner will be subject to if the hazard(s) is/are not abated.

Send a copy of the written order of abatement to Buffalo County Corporation Counsel.
  1. In accordance with s. 254.59 Statutes, “(1) If a local Health Officer finds a human health hazard, he or she shall order the abatement or removal of the human health hazard on private premises, within a reasonable time period, and if the owner or occupant fails to comply, the local Health Officer may enter upon the premises and abate or remove the human health hazard. (2) If a human health hazard is found on private property, the local Health Officer shall notify the owner and the occupant of the property, registered mail with return receipt requested, of the presence of the human health hazard and order its abatement or removal within 30 days of receipt of the notice. If the human health hazard is not abated or removed by that date, the local Health Officer shall immediately enter upon the property and abate or remove the human health hazard or may contract to have this work performed.”


  2. If an individual maintaining a human health hazard refuses to abate or remove the health hazard in a time period specified by the Health Officer, abate or remove the health hazard for the owner. Such expenditures may be recovered by civil action against the person or by order of the Clerk to extend such sum as a special tax against the property upon which the violation existed.

  3. Consider additional monthly extensions beyond 30 days if the owner is making a good faith effort to abate. Document all extensions and communications regarding the hazard in the case notes. Take additional photographs to document the progress or lack thereof. No extensions will be granted beyond one year without significant progress occurring in the abatement process, as determined by the EHS.

  4. Upon abatement or removal of any human health hazard, document that all areas of the health order have been sufficiently satisfied. Send a letter to the property owner and complainant (if necessary) stating that the hazard has been removed. Complete Human Health Hazard Case Log (PHN0020) and close.


REFERENCES/LEGAL AUTHORITY:
Wisconsin Statutes Chapter 254

Wisconsin Administrative Code HFS 140.04(1)(e)

POLICY TITLE: Medical Waste Disposal

EFFECTIVE DATE: 11/7/03

DATE REVIEWED/REVISED: 6/15/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
PURPOSE STATEMENT:
To assure safe and legal disposal of medical waste generated by the Pepin County Health

Department.


POLICY:

Pepin County Health Department will maintain a contract with a professional, licensed medical waste disposal organization.

PROCEDURE:
1. The Pepin County Health Department maintains a contract with Stericycle Inc. to pick up medical waste/sharps two times annually.

2. Approved sharps containers are to be used for all sharps generated by the health department staff.

3. When containers are 2/3 full, they are to be permanently closed. Full sharps containers are stored in the medical supply room.

4. Full sharps containers are placed in the 32-gallon container provided by Stericyle, Inc. This container is lined with a red biohazard bag prior to placing closed sharps containers inside.

5. When the 32-gallon container is full, the health department secretary will seal it according to the instructions and will contact Stericycle, Inc. to have the waste picked up.

EVALUATION:

REFERENCES/LEGAL AUTHORITY: N/A

POLICY TITLE: Methamphetamine Lab Follow-up



EFFECTIVE DATE: 1/13/04

DATE REVIEWED/REVISED: 7/13/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer /Director

PURPOSE STATEMENT:
1) To inspect the property where a meth lab was detected and orders the property owner to cleanup the property prior to anyone else residing there.
2 ) To conduct a follow-up inspection to assure appropriate clean-up of the meth lab environments to protect the public from negative health effects of chemical exposure.
POLICY:

Pepin County Health Department is notified by law enforcement if a methamphetamine (meth) lab is seized in the county. The Pepin County Health Officer or designee will respond to a law enforcement or Department of Justice report of a meth lab closure in the county. The health department will assure necessary steps are taken to cleanup the area, and will conduct a follow-up inspection of the area after cleaning is complete.

PROCEDURE:


  1. Health Department staff is notified by local law enforcement or the Division of Narcotics Enforcement (DNE), Department of Justice when a met lab is seized in Pepin County.

  2. All efforts will be made for the health officer or designee to arrive on site with law enforcement agents following the removal of all chemicals and residents from the home.

  3. Health Department staff will conduct an inspection of the property to determine if a human or environmental health hazard exists.

  4. If health department staff believes the extent of the contamination of the property presents an immediate health hazard, the property may not be used for human habitations until other appropriate agencies are notified and the human health hazards are abated. Other appropriate agencies may include any of the following:

  • Department of Natural Resources

  • Bureau of Environmental Health

  • Pepin County Human Services Department

  • Department of Agriculture

  1. The Pepin County Health Officer or designee will provide the property owner with information regarding the necessary clean up procedures and will monitor the property until the cleanup is complete. No individual will be allowed to occupy the dwelling until all human health hazards are abated.

  2. In the event the property owner refuses to do the necessary cleanup, the health officer or designee will seek legal action through the Pepin County Corporation Counsel.

For more information, see the document, “Cleaning Up Hazardous Chemicals at Methamphetamine Laboratories” found here: http://www.dhs.wisconsin.gov/eh/chemfs/pdf/MethFS.pdf


Contact Henry Nehls-Lowe at the Wisconsin Division of Public Health for more detailed information: (608) 266-3479.

EVALUATION:

All known Pepin County residences or locations of previous methamphetamine labs will be inspected and cleared for human habitation prior to re-occupation.

REFERENCES/LEGAL AUTHORITY:


  • Cleaning up hazardous Chemicals at Methamphetamine Laboratories, DHS 4/2011

  • Wisconsin Statute 254.59

  • Pepin County Health Ordinances Chapter 10

POLICY TITLE: Radon Outreach and Testing



EFFECTIVE DATE: 7/2/12

DATE REVIEWED/REVISED: 7/2/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director

PURPOSE STATEMENT:


  1. To ensure that Pepin County residents are aware of the risk of radon exposure, have access to radon testing equipment, and are able to obtain mitigation services if elevated radon levels are found in their homes.

  2. Provide radon education and training for home builders and realtors.



POLICY:
Pepin County Health Department offers low cost, short term and long term activated charcoal radon detectors to Pepin County residents in order to assist them in determining the radon level in their homes. In addition, health department staff will provide follow up advice based on the result of the radon test.
PROCEDURE:

Ordering Radon Test Kits: Short and long term Radon measurement kits are ordered through the current radon information center (RIC) for Pepin County. Eau Claire County serves as the Pepin County RIC. The short-term activated charcoal tests are used as a screening tool. The long term kits will give a more accurate and reliable result, which should be used to determine if mitigation is necessary. The EPA recommends fixing your home if your long term test kit result is 4 picocuries per liter (pCi/L) or higher.

Distribution of Test Kits: Public health will provide news releases about the risk of radon exposure. Kits will be distributed as requested. Directions are enclosed in the kit, but instructions will be reviewed to be sure the individual understands the entire procedure. Results will be sent to the Pepin County Health Department. Public Health Staff will review the results and either call the client or send information in writing about what steps, if any, should be taken next.
Measurement Conditions:


  • Measurement should be done under closed-building conditions. All windows, outside vents, and external doors should be closed (except for normal entrance and exit areas) for 12 hours prior to and during the assessment period.

  • Measurement should be done during winter months if possible.

  • Internal-external air exchange systems (other than a furnace) such as high-volume attic and window fans should not be operating during measurements and for at least 12 hours before measurements are initiated. Air conditioning systems that recycle interior air may be operating.


Measurement Device Location:

  • A position should be selected where the detector will not be disturbed during the measurement period.

  • The measurement should not be made near drafts caused by heating, ventilating, and air conditioning vents, doors, fans, and windows. Locations near direct sunlight, excessive heat (such as near fireplaces), and areas of high humidity should also be avoided.

  • Place detector at least 3 feet from windows or doors, and 1 foot from exterior walls.
  • Place detector at least 20 inches off the floor and 4 inches from other objects. An optimal height for the detector is in the general breathing zone, such as 5-7 feet from the floor.


  • Measurements should not be made in kitchens, laundry rooms, closets, or bathrooms.


Directions for Measurement (for home owners to complete themselves):

There are two plastic bags covering your kit. You can open the outside bag to read instructions, but do not open inside plastic bag until ready to test.



  • For 12 hours before and throughout the measurement time:

  • Windows and external doors must be kept closed, except for normal entry/exit, and;

  • Ventilation systems such as stove hoods, bathroom fans, or attic fans are not operated.

  • Record your name, address, phone, number, test kit serial number, test start date and time, and test location on the information card included with the test kit. Important: Analysis cannot be completed without a complete start/stop time and date.

  • When you are ready to begin testing, open the plastic bag and remove the test kit. Place the kit (paper side up) on a flat surface in the breathing zone (2-7ft. off the floor) in the lowest livable level of your home. Be careful not to tear or puncture the Radon Sampler. Do not disturb the sampler during the measurement period.

  • Stop the test after two days (48 hours): Kits are invalid if exposed longer than 96 hours.

  • Record the stop time and date on the information card included with the test kit.

  • Place the charcoal test kit and the completed information card in the return envelope and seal the envelope. For better security, tape the envelope after sealing it.
  • Place necessary postage on the envelope and return the kit immediately to Alpha Energy Laboratories for evaluation to, 2501 Mayes Road, Suite 100, Carrollton, Texas 75006-1378. Normally, you will receive your results within 2-3 weeks from the time you mail the kit to the lab.


  • Radon tests must be received at the lab within 10 days of the stop date! (Please consider sending via Priority Mail to ensure delivery within 10 days)


Test Results:

  • For results less than 4 pCi/L: No follow-up needed.

  • For results between 4 and 10 pCi/L: A year-long follow-up measurement with an alpha-track detector should be done to determine the average radon level. Radon levels change with the seasons and are lower when windows are open. The average radon level in occupied floors of the home determines lung cancer risk from radon exposure.

  • For results above 10 pCi/L: A second short-term test should be done to confirm the results. If this test is < 4 pCi/L, no further testing is required. If the results remain elevated, a long-term test should be done.


Reducing Radon Levels:

The higher the confirmed results are, the more important it is to fix the home. Outdoor air has about 0.4 pCi/L, and this is the lowest achievable level in a house.



  • Contractors who are certified in a Radon Proficiency Program should be used. There are a couple such contractors in the Pepin County area:

  • For a list of Certified Radon Mitigation Contractors go to www.radongas.org.
  • Sealing: Virtually all radon in Wisconsin comes from the soil beneath houses. Gaps and openings to soil through basement floors and walls should be sealed with gas-tight materials. The caulk type with the best adhesion to concrete is polyurethane (not silicone). However, experience by researchers has shown that sealing cracks and openings in basements will result in reductions of radon by more than 50% in only about 20% of the homes. One shouldn’t expect a major effect. Hairline cracks are not worth sealing.


  • Soil Depressurization: This is generally highly effective. Air is withdrawn from beneath the basement floor with a continuously-running fan in a 3 or 4-inch diameter pipe, which exhausts at roof level. The cost for a proficiency-listed contractor to install a system is usually around $1,200 and can range from $800 to $2,000.

  • If results in occupied levels of a home are confirmed to be in the range of 4 to 20 pCi/L, it may reasonably take up to a year to get the work done. For confirmed results above 20 pCi/L, mitigation action should be more prompt.

  • Call 1-888-LOW-RADON for more information.

Radon Education and Training



  1. Radio shows, Public Service messages, newspaper articles, special trainings and promotional events are all used to educate the public on the risks of radon.

  2. The radon specialist attends radon meetings and trainings to keep up to date on newest radon information


EVALUATION:
Public education on radon will be made available through PSA’s radio shows and newspaper article/press release.

Public Health will host trainings for residents, home builders, realtors, loan agencies and home inspectors.



Information available on follow-up testing for radon results over 3.9 pCi/L and mitigation will be compiled in the radon database.
REFERENCES/LEGAL AUTHORITY:


  • US EPA: Citizen’s Guide to Radon

  • US EPA: Home Buyers and Sellers Guide to Radon

  • US EPA: Consumers’ Guide to Radon Reduction

  • WI Statutes s. 254.34
  • Programs of the US EPA regarding measurement, mitigation and risk reduction for radon in homes as reflected in the three EPA documents above, should be recommended. No others have been specified in the state legislation.


  • State of Wisconsin Statutes/Administrative Rules/Guidelines:

  • WI Statutes s. 254.34


POLICY TITLE: Recreational Water: Restricted Use/Closure

EFFECTIVE DATE: 8/1/03

DATE REVIEWED/REVISED: 7/19/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
PURPOSE STATEMENT:
To assure that the health and safety of swimmers is protected when microbiological contamination of recreational waters is detected.
POLICY:
Per Wisconsin State Statute 254.46, “The department or local health department shall close or restrict swimming, diving, and recreational boating if a human health hazard exists in any area used for those purposes or on a body of water and on associated land and shall require the posting of the area.” When recreational waters fail to meet the standards of guidelines, the Health Officer, after taking into consideration the causes for the elevation of microbiological indicators, may close, post warning signs, or otherwise restrict use of the recreational area until corrective action has been taken and standards or guidelines are met.”
PROCEDURE:
Pepin County does not conduct regular sampling of beaches but will perform sampling in the event of a complaint or reported problem.
Public swimming areas shall be constructed, operated, and maintained as specified in chapters ILHR 90 except as follows:

  1. Any beach as defined in s.254.46 Wisconsin Statutes shall comply with the following standards: A beach water sample shall not exceed 200 colonies of fecal coliform per 100 ml of sample and not more than 235 colonies of E. coli per 100 ml of sample.


  2. Exceeding the forgoing standards shall cause the immediate closure of the bathing area by the health officer.

  3. The health officer shall order immediate closure of swimming areas when a cluster of illnesses associated with a public swimming area has been identified until information reveals that the water is safe.

  4. In cases of emergency, whereby the public health and well being of swimmers is jeopardized, the health officer shall order immediate closure of the swimming area.

Per s.254.56 Wisconsin Statutes, “The department or local health department shall close or restrict swimming, diving and recreational bathing if a human health hazard exists in any area used for those purposes on a body of water and on associated land and shall require posting of the area.


Steps:

  1. Any recreational water safety/health complaint will be taken by the health officer. In her absence, a public health nurse will take the complaint. The health officer will investigate the complaint within 3 working days.

  2. If the health officer will be absent for greater than 3 days, a public health nurse in consultation with the Western Regional Officer of the Division of Public Health will investigate the complaint. The health officer/PHN will determine if a human health hazard exists.

  3. Other persons (landowners or agencies) including DNR, law enforcement, town/village/city officials will be informed, if appropriate.

  4. If a human health hazard is found, the public beach will be posted informing the public not to use the beach. The posting will include a brief reason. For Example:

WARNING! BEACH CLOSED TO SWIMMING.

BEACH AREA IS CONTAMINATED AND MAY CAUSE ILLNESS.


  1. Information regarding action will be provided to the public via press releases.

  2. If action is taken, a certified letter outlining appropriate course of action will be sent to the responsible parties.

  3. The beach posting sign will be removed when the human health hazard has been abated.

  4. All follow-up investigations, inspections, samplings and other will be documented.





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