Public Health Department Policy & Procedure Manual Example


Steps for Recreational Water Inspection

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Steps for Recreational Water Inspection




  1. Perform a survey of the area that may identify actual or potential sources of contamination of the recreational waters and beach areas. No sewage, sludge, grease, or other physical evidence of sewage discharge should be visible at any time on any public beach area.

  2. Sampling of waters may be necessary. For crowded beaches at which swimmer-to-swimmer contamination may be a significant route of microbiological exposure, sampling when recreational use is highest may be appropriate. Pepin County Health Department does not provide regular sampling of beaches, but will perform sampling in the event of a complaint/problem.

  3. Samples should be taken from just below the water surface, in ankle- to knee-depth water, approximately 12-24 inches deep. The State Laboratory of Hygiene will be contacted for appropriate sampling containers.

  4. At a minimum, fecal coliform and E. coli will be tested for.

  5. Specimens will be sent iced in styrofoam containers.

  6. The beach area will be closed if the sample exceeds 200 colonies of fecal coliform per 100 ml of sample or 235 colonies of E. coli per 100 ml of sample.

  7. Reopening of closed recreational waters is appropriate when two successive samples taken at least 24 hours apart show concentrations lower than EPA guidelines.



Flow Chart


Complaint Received







Obtain one sample at 12 inches and one sample at 24 inches and submit to Wisconsin State Lab of Hygiene for analysis of E. coli and fecal coliform.

Upon receipt of lab results:





Close Beach If:

Total fecal coliform > 200 colonies/100ml
E. coli > 235 colonies/100ml

Leave Beach Open If:
Total fecal coliform < 200 colonies/100mlE. coli < 235 colonies/100ml




Retest beach water immediately upon receipt of results.



No further testing required.


Keep closed until 2 samples 24 hours apart are WNL.





Beach Reopening:

A beach shall be reopened when the follow up sample result is below the established criteria of 235 colonies per 100 mL. Closure signs will be removed once the beach is reopened.



Sources of Microbiological Contamination of Recreational Water




Sewage

Potential sources of microbiological contamination of recreational waters may be associated with system failures in human sewage treatment facilities (particular point sources), or with rainfall and resulting surface water runoff (non-point surfaces).



  1. Tertiary treatment of sewage in community sewage treatment plants is adequate to protect receiving waters from microbiological contamination. When excessive rainfall occurs and systems are not able to process the volume of water that enters it, flooding and releases of untreated sewage may occur.


  2. Other system failures may occasionally release untreated sewage. When these system failures occur, public health authorities should be notified as soon as possible.



Sewage Sludge

The distribution of treated sludge, provided that treatment adequately destroys any microbiological components that may be present, should not pose a potential for microbiological contamination of recreational waters. Organisms in inadequately treated sewage sludge, which should not be disposed of on land, may be present in runoff associated with rainfall or with landscape or irrigation practices.



Septic Systems

Leachate from septic systems may be a potential source of microbiological contamination of recreational waters, particularly from septic systems that are poorly maintained, or during flooding. Although a single home septic system alone may pose a small risk of environmental contamination, in areas where septic systems predominate, shabby maintenance and flooding may be more significant.



Other Sewage

Other sewage retaining systems that are specific for recreational areas may be a potential source of microbiological contamination of recreational waters if they are poorly maintained or otherwise release their contents. These include facilities associated with recreational vehicles, boats and portable toilets.


Animal Wastes

Animal wastes may also contribute to microbiological contamination of recreational waters, though it is generally assumed that such contamination represents a less substantial human risk than contamination by human sewage. To the extent that animals may be allowed on beaches or other recreational properties, their wastes may add to the microbiological burden of recreational waters. Feedlots, dairy farms, pasture land, forests and other “natural” areas, and urban runoff may be sources of contamination. Animals, both domestic and wild, may also serve as vectors for microbiological parasites of public health concern, such as Giardia and Cryptosporidium.


Surface Water Runoff

Urban water runoff can contribute significantly to the census of microbes in a recreational body of water, particularly in times of heavy rains, in which street gutters and storm drain systems that often contain decaying organic matter are flushed out by large volumes of water.

In addition, sanitary sewer systems and septic systems may be overwhelmed by storm water that may enter them. In situations with common storm drains and sewer drains, or leaking sewer drains, heavy rains are obvious problems.

Other Surface Runoff

In addition to urban runoff, surface runoff from other land surfaces may also contain microbes, and land on which wildlife or domestic animals are in dense populations may contribute to high microbial densities in runoff.


Swimmer-to-Swimmer Contamination

Another source of microbial contamination of recreational waters are the individuals who are using those waters for recreation. Constituents of residual fecal matter may be washed off the body on contact with water, with most of it washed off within a relatively short time after submersion. Hence, swimmers, bathers, waders, surfers, and the fishing population, and others who may come into full- or most-body contact may all contribute to contamination to which they are exposed.

Infants, young children, and other individuals may also contribute significantly to microbial contamination by accidental fecal releases. Others may cause contamination by intentional fecal releases because of proper sanitary facilities at or near the recreational area, or because such facilities, though present, are not used.

Recreational users at beaches with limited wave action will likely be subjected to a greater swimmer-to-swimmer contamination than those at beaches with more wave action, where water circulation would be greater.


EVALUATION:

REFERENCES/LEGAL AUTHORITY:


  • Wisconsin Statute s.254.46

POLICY TITLE: Well Water Testing



EFFECTIVE DATE: 1/13/10

DATE REVIEWED/REVISED: 7/19/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer /Director
PURPOSE STATEMENT:
To encourage annual testing of private wells and to make supplies accessible to Pepin County residents.
POLICY:
Pepin County Health Department encourages all owners of private wells to be tested for bacteria and nitrates annually.
PROCEDURE:
Supplies:

Households with infants under one year present may obtain a fee exempt kit from Pepin County Health Department for testing water for Total Coliform, Nitrate, Fluoride and 14 different metals.


Households interested in fluoride testing only may obtain a fee exempt kit from Pepin County Health Department
Households interested in coliform testing only may obtain a kit for $15 from Pepin County Zoning.
All other households interested in testing should contact Eau Claire City-County Health Department to obtain kits on a fee for service basis.
If individuals in the household are ill and question the safety of the water supply, or if other public health situations arise where the water should be tested for safety, these tests can also be done free of charge using the health department fee exempt number.

Kit Preparation:

When distributing kits to the public, be sure it is complete with instructions, an information form, a fee exempt sticker, if applicable, a plastic bag, the styrofoam mailer, and two rubber bands. Clients are responsible for the cost of mailing the sample in for fluoride tests but not for the infant tests.

Be sure to explain the directions to the client when he/she stops in to pick up a water test kit. Remind clients that the sample needs to be sent in the same day it is collected. Samples should not sit in the post office over a weekend/holiday, so ask clients to collect samples early in the week and mail them immediately.
Collection of a Water Sample:


  1. See instructions on the back side of the Water Test Request Form.

2. The Water Test Request Form can be found here: S:\PUBLIC HEALTH\Updated Policies and Procedures 2012\Environmental Health\Well Water Forms\WSLH Laboratory Report.pdf
Results:

  1. If the well is safe in all areas tested, copy the results and mail them to the client.

  2. If the well is unsafe due to the presence of coliform bacteria, send a copy of the results along with the handout “Possible Sources of Bacterial Contamination/Disinfection of the Well and Water System.” The handout can be found here: This handout will come from the State Lab of Hygiene along with the results. A retest is suggested using a different tap source. Avoiding swivel faucets sometimes helps. Call the client to advise him/her that the current bacteria test is unsafe and they should use bottled water or boil their water until a follow up test comes back safe.

  3. If the well is unsafe due to nitrates, send a copy of the results to the client, along with the DNR brochure regarding nitrate levels. Call the client to advise him/her of the elevated nitrate levels and provide education regarding blue baby syndrome. Advise that pregnant women and children under six months of age should not consume the water and it should not be used for infant formula preparation. Advise the client NOT to boil the water as this increases nitrate levels.
  4. Document the date the results were received and whether the well is safe or unsafe on the Well Water Test Kit log.

The link to interpreting nitrate levels in drinking water can be found here:



http://www.slh.wisc.edu/ehd/pamphlets/nitrate.dot


EVALUATION:


REFERENCES/LEGAL AUTHORITY:

  • Wisconsin State Laboratory of Hygiene


POLICY TITLE: Access to Vital Records

EFFECTIVE DATE: 10/1/03

DATE REVIEWED/REVISED: 7/13/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer /Director
PURPOSE STATEMENT:
1) To protect the privacy of clients at Pepin County Health Department.

2) To review vital records to identify trends, concerns, or gaps in services.


POLICY:
Pepin County Health Department will follow the Standards of Practice for Handing Identifying Data or Information from the Bureau of Health Information when dealing with birth record data. In addition, parameters set forth in the Data Release Agreement between the Pepin County Register of Deeds Office and the Pepin County Health Department will be followed.


PROCEDURE:


  1. Birth data is received by the health department. These records contain identify and confidential health information. In order to protect the privacy of Pepin County residents, all birth data will be handled according to these standards.

    • Standards of Practice for Handling and Identifying Data or Information from the Bureau of Health Information, Vital Records Birth Data Files.
    • Regulations on Timely Usage of Identifying Data or Information from the Bureau of Health Information, Vital Records Birth Data Files.


  2. Any of these records will be stored in a locked file cabinet in the health department. Birth records area shredded to later than one year after they were received.

  3. Death records will be reviewed by health department staff in order to monitor the prevailing trends related to causes of death. All death certificate information will be handled according to the guidelines set forth in the Data Release Agreement between the Pepin County Register of Deeds Office and the Pepin County Health Department.



EVALUATION:


REFERENCES/LEGAL AUTHORITY:


  • Data Release Agreement Between the Pepin County Register of Deeds Office and the Pepin County Health Department

  • Standards of Practice for Handling Identifying Data or Information

POLICY TITLE: Birth Records Use and Retention Policy



EFFECTIVE DATE: 7/16/12

DATE REVIEWED/REVISED: 7/16/12

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


  1. Review for families whose infants may benefit from early postpartum public health interventions or community referral services.

  2. Mailing of health department resources or detection of infants whose mailing should be delayed/held related to NICU admission or infant demise.

  3. Entry of the infant into the Wisconsin Immunization Registry.

  4. Aggregate birth data for community health improvement planning.



POLICY:

The Pepin County Health Department has access to birth records through the SPHERE system based on the mother’s county of residence. Health Department staff may be allowed access to these records through the Local Organization Administrator.

As a condition of use, the Pepin County Health Department agrees to follow the parameters outlined in the Standards of Practice for Handling Identifying Data and the Regulations for Timely Usage of Identifying Data from the Wisconsin Vital Records Birth Data Files.

PROCEDURE:


  1. All staff who have access to birth record data will review and sign the Authorization and Agreement To Access Birth Record Data for Volunteers on employment and annually thereafter. The Pepin County Health Officer will sign an Agreement for Use of Birth Record Data required by the Wisconsin Department of Health and Family Services.

  2. Authorized Health Department staff that has access to the SPHERE system for birth records will access this data at least two times a week. They will print out the short version of the individual birth record and batch view of the day’s records.

  3. Birth records that have been incorrectly sent to Pepin County through SPHERE may be forwarded to the appropriate county of residence through the HIPAA secured SPHERE system.

  4. Birth record data must not be passed on to any unauthorized person in any form at any time.

  5. Birth records will be reviewed for:

    1. Women with identifying information that may indicate they would benefit from early public health intervention or community resource referral. Criteria for referral to the parent child health team include:

      1. Infant born to a mother of 18 years of age or younger

      2. Infants born to a mother 18-21 years of age with one risk factor identified on the birth report.

      3. Infants born to a mother 21 years of age and older with two risk factors identified on the birth report.

      4. Risk factors include:

-Mother’s education less than high school graduate/GED completed

-Mother smoked

-Mother attended 6 or less prenatal visits

-Any identified risk factors during this pregnancy

-Any infections presented/treated during this pregnancy

-Premature rupture of membranes

-Mother transferred

-Steroids for fetal lung maturation received by mother during labor

-Clinical chorioamniotis diagnosed during labor

-Any maternal morbidity complications

-Low birth weight: weighing less than 5 lb 8 oz

-Clinical estimate of gestation under 37 weeks

-Any abnormal conditions of the newborn

-Any congenital anomalies

-Infant transferred


    1. Infants whose birth outcomes are poor i.e. infant demise or illness/prematurity that leads to NICU admission.

Follow-up on infant demise will be to assure clerical staff is notified that resource listing will not get mailed to the family. Follow-up on infants admitted to NICU will require the birth record reviewer or one of the public health nurses to contact NICU Case Managers to assess infant’s medical stability or hold the chart until a public health referral is made or the mother of the infant has notified WIC of baby’s condition.

    1. Birth records may be reviewed by nurses for women enrolled in the PNCC program for birth outcome data collection. SPHERE Individual/Household demographic information fields may be copied from birth reports for public health clients.

    2. The department may print aggregate birth record reports for departmental and community health improvement planning.

  1. Birth records will be provided to the clerical staff that will enter the infant data into the WIR immunization registries.
  2. Clerical staff will use birth records to print mailing labels to individual mailings so they arrive to the family in a timely manner.


  3. Once birth records have been reviewed and handled for clerical needs, the records are stored in a locked cabinet.

  4. Birth records will be retained for one calendar year and destroyed by shredding on site.

See standards of practice for further information on birth record retention.


EVALUATION:
REFERENCES/LEGAL AUTHORITY:


  • Standards of Practice for Handling Identifying Data or Information from the Wisconsin Vital Records Birth Data Files from the Bureau of Health Information (BHI).

  • Regulations for Timely Use of Identifying Data or Information from the Wisconsin Vital Records Birth Data Files from the BHI.

  • Wisconsin Statutes 69.20(3)(b) and (3)(c).

  • Nurse Practice Act.


POLICY TITLE: Confidentiality of Client Information / Access to Client Health

Care Records

EFFECTIVE DATE: 8/1/03

DATE REVIEWED/REVISED: 6/26/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
PURPOSE STATEMENT:
To protect the client’s right to privacy and protect clinical records from loss, alteration, unauthorized use, or damage.
POLICY:
Health Department staff and interdisciplinary team members are committed to providing confidentiality for clients and clients’ clinical records. Access to such records will be provided according to s.146.82 and 146.83 Wisconsin Statutes.
PROCEDURE:

The Pepin County Confidentiality and Non-Disclosure Statement will be signed by all employees upon hire. In addition, the statement will also be signed by volunteers, students, interns or others who may have access to client information during the course of their visit to the Pepin County Health Department.

All requests for client information are reviewed by the director or designee to determine whether or not the individual requesting the information will be allowed access to the information. If the director or designee is unable to determine whether access to client information is lawful or not, Corporation Counsel will be contacted for a legal opinion.
s. 146.83 Wisconsin Statutes – Access to Patient Health Care Records


  • Except as provided in s. 51.30 (mental health act) or 146.82(2), any client may, upon submitting a statement of informed consent:

    • Inspect the health care records pertaining to that client at any time during regular business hours, upon reasonable notice; and

    • Receive a copy of the client’s health care records upon payment of a reasonable fee.

Health Department staff shall note the time and date of each request by a client or other person authorized in writing by the client to inspect the client’s health care records, the name of the inspecting person, the time and date of inspection and identify the records released for inspection. No person may do any of the following:



      • Intentionally falsify a client health care record;

      • Conceal or withhold a client health care record with intent to prevent its release to the client, to his or her guardian appointed under ch. 880, or to a person with the informed written consent of the client, or with intent to prevent or obstruct an investigation or prosecution;

      • Intentionally destroy or damage records in order to prevent or obstruct an investigation or prosecution.

Special Note: s. 146.835 Parents Denied Physical Placement Rights – A parent who has been denied periods of physical placement under s. 767.24(4)(b) or 767.325(4) may not have the rights of a parent or guardian with respect to access to that child’s health care records under s. 146.82 or 146.83.

s. 146.82(2) – Confidentiality of Patient Health Care Records


  • All client health care records shall remain confidential. These records may be released only to the persons designated below or to other persons with the informed written consent of the client or other person authorized by the client.

  • Health care records shall be released upon request without informed consent in the following circumstances:

    • To staff committees, accreditation or health care service review organizations for the purposes of conducting management audits, financial audits, program monitoring and evaluation, health care service reviews, or accreditation.

    • To the extent that an employee’s duties require access to the records, such as:

      • The person is rendering assistance to the client;

      • The person is being consulted regarding the health of the client;

      • The life or health of the client appears in danger and the information contained in the client health care record may aid the person in rendering assistance;

      • The records are needed for billing, collection, or payment of claims.

        • Under lawful order of a court of law.

        • In response to a written request by any federal or state governmental agency to perform a legally authorized function.

        • For purposes of research if the researcher is affiliated with the health care agency and provides written assurances to the custodial of the health care records that the information will be used only for the purposes for which it is provided to the researcher, the information will not be released to a person not connected with the study, and the final product of the research will not reveal information that may serve to identify the person whose records are being released.
        • To the county human services agency, sheriff, police department, or district attorney for purposes of investigation of threatened or suspected child abuse or neglect or prosecution of alleged child abuse or neglect if the person conducting the investigation or prosecution identifies the subject of the record by name.


        • To a school district employee with regard to client health care records maintained by the school if the employee is responsible for preparation/storage of records or access is necessary to comply with law.

        • To a school or day care facility that provides written or verbal request for immunization records.

s. 146.81(2) – Informed Consent



          • By definition, “informed consent” means written consent to the disclosure of information from client health care records to an individual, agency, or organization that includes all of the following:

            • The name of the client whose record is being disclosed;

            • The type of information to be disclosed;

            • The types of health care providers making the disclosure;

            • The purpose of the disclosure, such as whether the disclosure is for further medical care, for an application for insurance, to obtain payment for an insurance claim, for a disability determination, for a vocational rehabilitation evaluation, for a legal investigation, or for other specified purposes;

            • The individual, agency, or organization to which disclosure is to be made;

            • The signature of the client or the person authorized by the client and, if signed by a person authorized by the client, the relationship of that person to the client or the authority of the person;

            • The time period during which the consent is effective;

            • That the consent may be revoked at any time.

s. 146.81(5) – Person Authorized by the Client


              • “Person authorized” means the parent, guardian or legal custodian of a minor client, the personal representative or spouse of a deceased client, any person authorized in writing by the client, or the legal power of attorney for health care. If no spouse survives a deceased client, “person authorized” means an adult member of the deceased client’s immediate family, as defined in s. 632.895(1)(d).

Additional confidentiality measures:



              • Professional personnel and individuals not directly involved with the client’s clinical care are not permitted access to the client’s clinical record without a completed and signed informed consent form allowing such access.

              • It is unlawful to use any information obtained through access of records, phone calls, interoffice communications, etc. for personal, political, or commercial purposes.

              • Client information shall not be discussed in or out of the office except in an official capacity such as supervisory or consultative purposes by professional personnel directly involved.

              • The original client clinical record will be maintained in a file in the health department that is locked and will not be removed from the office except under subpoena for court cases when the court does not accept certified copies.

              • Appropriate copies of client clinical records may, whenever necessary, be taken by public health staff to the client home in order to assist staff members in providing care to the client.

              • Faxed information must have a confidentiality statement on the cover page and is received and sent in an area accessible by only designated personnel.

              • This policy and procedure will not in any way limit the use of information for a summary or statistical purposes or in any form that does not identify the individual.



The Pepin County Confidentiality and Non-Disclosure Statement will be signed by all employees upon hire. In addition, the statement will also be signed by volunteers, students, interns or others who may have access to client information during the course of their visit to the Pepin County Health Department.

EVALUATION:

Any actual or confirmed breaches of client confidentiality will be reviewed by the director and a plan will be developed to prevent future occurrences.


REFERENCES/LEGAL AUTHORITY:


  • Wisconsin Statutes Chapter 146

  • HIPPA Regulations


POLICY TITLE: Correction of Errors in Client Records



EFFECTIVE DATE: 11/1/03

DATE REVIEWED/REVISED: 7/16/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
PURPOSE STATEMENT:
To provide uniform guidelines for health department staff regarding correction of errors in client medical records.
POLICY:
Pepin County Health Department employees respect legal regulations related to client medical records. Any errors in medical records will be corrected in an acceptable, ethical manner in accordance with this policy/procedure.
PROCEDURE:
The following guidelines will be followed by all health department staff when correcting errors in client hard copy medical records:

  1. Correction fluid/tape will not be used under any circumstance.

  2. Word correction: draw one line through the incorrect word or phrase, initial by it, and write in the correct word or phrase above it.

  3. Extra words: draw one line through the word, initial by it, and write “ME” above it.

  4. If several lines are incorrect, cross them out with one line, initial near it and write “ME” by the incorrect lines.

  5. Late entry: write “late entry” in the left hand column, write in the date and time the entry is actually made, and document the narrative of the late entry. Sign the entry at the end.
  6. Specific situations not addressed above will be discussed with the health department director.

The following guidelines will be followed by all health department staff when correcting

errors in client electronic copy medical records:

1. Electronic records will be maintained according to software agreements

2. Nightengale Notes is the primary electronic medical record software for the Pepin County Health Department

3. Charting and documentation of client activities will be completed per policy

4. Lock/unlock indicates whether an activity can be edited or not. Locked activities cannot be deleted

5. Activities are automatically locked seven days after the date of the activity

6. If an error has been made in entering an activity, charring or vitals an addendum activity should be entered rather than making changes to any original charting.

7. The notes in the addendum activity should document the correct information, reason for the note and mention which activity it is concerning.



EVALUATION:

REFERENCES/LEGAL AUTHORITY: N/A
POLICY TITLE: Interpreter / Translator Services

EFFECTIVE DATE: 2/20/09

DATE REVIEWED/REVISED: 6/18/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
PURPOSE STATEMENT:
To assure accurate communication between health department staff and clients or potential clients; to provide the foundation of cultural competence; to assure individuals, regardless of language spoken, receive needed public health services, information, and referrals.
POLICY:
The Pepin County Health will provide the necessary interpreter/translator services for all clients.
PROCEDURE:

For a Non-English Speaking Individual Presents in the Office

1. If a Non-English speaking individual presents at the front desk of the health department, the yellow “Language Identification Card” will be used to help determine what language the individual speaks.

2. Show the individual the yellow card (both sides). The message listed in the several languages says “Point to your language. An interpreter will be called”

3. Once the language has been established, on appropriate interpretation/translation provider to request services.

4. Talk with the provider and advise of the situation, what you wish to accomplish, and any special instruction. Then advise the provider that he or she will be placed on speakerphone.

5. Press the “Speaker” button on the telephone and hang up the receiver.

6. Engage in the conversation as usual. Begin by having the interpreter tell the client that he/she is the interpreter for the health department.

7. To end the telephone call, press the “Speaker” button on the telephone.

For a Non-English Speaking Individual Who Calls the Office

1. Ask the individual if he/she speaks English. If he/she does not, ask what language is spoken. Do your best to determine what language is spoken.

2. Request that the individual call back when interpreter services can be arranged.
To Place a Call to a Non-English Speaking Individual

1. Contact the appropriate interpreter to arrange for services.

2. Arrange for the interpreter to meet with you to make the call.

3. Dial the client’s number and ask the interpreter to tell the client that he/she is the interpreter for the health department and that they will be on speakerphone.



4. Engage in a conversational as usual. Hang up when you are finished.

EVALUATION:
REFERENCES/LEGAL AUTHORITY: N/A

POLICY TITLE: Public Records Availability for Inspection and Copying

EFFECTIVE DATE: 6/1/04

DATE REVIEWED/REVISED: 7/2/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
PURPOSE STATEMENT:
To provide public records available to clients in a legal manner.
POLICY:
Pepin County Health Department Office. This Department is a governmental agency organized under Chapter 140.09 of the Wisconsin Statutes. The policies and activities are governed by the Board of Health, which is appointed by the Pepin County Board. The Department has responsibility for protection of the health of residents of Pepin County. The office is located at 740 7th Avenue West, Durand, Wisconsin, 54736.

PROCEDURE:

Established time for access to public records– Office hours are Monday through Friday, 8:30 AM until 12:00 PM and 12:30 PM until 4:30 PM, except for established holidays.

Place of access– Second floor of 740 7th Avenue West, Durand, Wisconsin, 54736.
Legal Custodian of public records– Heidi Stewart, RN, Director. Alternate: Terri Reiland, RN, Assistant Director.
Methods of Access– Requesters of information shall ask to speak with the legal custodian or her alternate. Each requester shall be required to reasonably describe the type of record or information requested. Requests without reasonable limitation as to subject matter or length of time represented by the record may be denied by the custodian. Identification shall be required of the requester only when security reasons or federal law or regulations so require. Personal medical records are excluded from this policy relating to access of public records, as are those specifically covered by state statutes or their interpretation. It shall be the responsibility of each requester of public records and information to abide by and comply with all regulations or restrictions upon access to or use of information specifically prescribed by the law. In this respect, the legal custodian will not provide the requester with advice and he or she should seek legal counsel of his or her choice. In accord with the responsibilities under law, as soon as is practicable, legal custodians shall notify requesters of partial or complete denials of access. Oral requests may be denied orally. In the event that the requester submits, within five (5) business days of the oral denial, a written demand for a written statement of reasons for denial, the custodian shall provide such written statement.
Copying of Records– Requester of records or information shall ask the custodian to prepare, at cost, copies of the same.

Cost of copies and research – Requesters shall be assessed with the cost of providing copies at the rate of $1.00 per page for the first 5 pages, 6 through 10 pages shall be $0.75 each, and over 10 pages, $0.50 each, except where the fee to be charged is fixed by the State. In the event that the cost, in terms of labor and other expenses, of locating a record exceeds $50.00, the requester shall be assessed with said costs. In addition, requesters shall pay the actual cost of mailing or shipping.

See DHS Chapter 117 in regards to the fees for copies or healthcare provider records:

https://docs.legis.wisconsin.gov/code/archive/2009/637b/remove/hfs117
EVALUATION:


REFERENCES/LEGAL AUTHORITY:


  • Department of Health and Family Services – HFS Chapter 117

POLICY TITLE: Record Retention



EFFECTIVE DATE: 10/1/03

DATE REVIEWED/REVISED: 7/2/12

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


  1. To assure records generated by the Pepin County Health Department are retained and dispose of appropriately.

  2. To provide guidance to staff via a records retention schedule.


POLICY:
Local health departments have a significant role in establishing and maintaining a public records management system for the use, preservation, and destruction of records. This management system must be compatible with state and federal regulations.
PROCEDURE:


  1. Per s.16.61 (B) (e), s.19.21 (5) (d), and s.44.09 (2), patient health care records are exempt from the requirement of offering old records to the State Historical Society of Wisconsin. Therefore, records will be maintained according to the Pepin County Records Retention Ordinance 1.35 Guidelines described in the Wisconsin Records Retention Handbook for Local Health Departments will be used in updating this ordinance.
  2. All records will be destroyed per the Destruction and Disposal of Client Health Information HIPPAA policy and procedure.




EVALUATION:

REFERENCES/LEGAL AUTHORITY:


  • Local Ordinance 1.35: Records Retention Ordinance

  • Wis. Stats. 16.61(B)(e), 19.21(5)(d), and 44.09(2)

POLICY TITLE: Amish Health Education Screening and Immunization



EFFECTIVE DATE: 7/16/12

DATE REVIEWED/REVISED: 7/16/12

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


  1. To assure adequate information, health education, screening and services.

  2. To reduce the incidence of vaccine-preventable illnesses.


POLICY:
Transportation, cost, and cultural barriers have prevented the Amish population from receiving public health services, causing them to be at high risk for illness and preventable diseases. In order to remove barriers, Pepin County Health Department will offer in-home or school health education, screenings and immunizations for the Amish population due to transportation and communication barriers.

PROCEDURE:


  1. Health Education Screening Immunizations Staff will include one nurse, support staff and students or interns.

  2. The office or personal cell phone will be carried for emergency contact.

  3. Adrenaline and blood pressure equipment will also be on hand (Emergency Kit).

  4. Regular immunization clinic protocols will be followed.
  5. Immunizations will be entered in to WIR upon returning with the forms to the office. The public health nurse may contact the office by phone or consult WIR records for children who may have had prior vaccine doses.


  6. Completed WIR records will be mailed to the families once entered in the computer. A second copy will be kept for reference when returning for future vaccinations within the Amish Community.

  7. The public health nurse will counsel families about vaccine concerns before administration.

  8. Routine consent forms will be completed and signed. Families unable to read forms will be assisted in their completion by nursing staff.

  9. All families receiving vaccine will receive the most current VIS forms for the vaccines administered.


EVALUATION:
The Amish illness rates will be monitored in WEDSS. Communication effectiveness will be assessed with primary contact.
REFERENCES/LEGAL AUTHORITY:


  • Epidemiology and Prevention of Vaccine-Preventable Disease, most recent edition

  • Division of Public Health Immunization Policy Manual

  • ACIP Guidelines for Vaccine Recommendations and Administration

  • Wisconsin Statute 252.04 Immunization Program

  • Wisconsin Statute 448 Medical Practices


POLICY TITLE: Emergency Vaccine Retrieval and Storage Plan

EFFECTIVE DATE: 07/07/10

DATE REVIEWED/REVISED: 06/26/12

AUTHORIZED BY: Heidi Stewart, BSN, Health Officer / Director
PURPOSE STATEMENT:
To protect the vaccine inventory in the event that there is an emergency.
POLICY:
Pepin County Health Department will protect the vaccine inventory and minimize potential monetary loss when a potentially compromising situation occurs.

PROCEDURE:

The following emergency procedures shall be implemented in advance of the event if possible. If there is no warning and the emergency event is already occurring or has already occurred, identical procedures must be followed. Pepin County Health Department will follow the State Health Department Immunization Program policy and contact either the manufacturer’s quality control office or the immunization program (608-266-1506) for guidance.
Emergency Plan:

 Suspend vaccination activities before the onset of emergency conditions, if possible. This will allow sufficient time for packing and transporting vaccine.

 Notify staff at the alternate vaccine storage facility (Chippewa Valley Hospital at 715-672-4211 – pharmacy and lab).

 Document the vaccine storage unit temperature at the time the vaccine is removed for transfer. (Log located on side of lab fridge/freezer)

 Conduct an inventory of the vaccines and record the actions taken. Use the Emergency Response Worksheet attached. Note if water bottles were in the refrigerator and if frozen packs were in the freezer at the time of this event.

 Pack and transport the affected vaccines. Pack up frozen vaccine last using the VaxiPac with frozen packs. Use the Vericor Vaccine Transporter and Yeti with frozen packs (insert barriers between frozen packs and vaccine) and cold packs to transport the refrigerated vaccine. Attach labels to the outside of the each transport container to clearly identify the contents as being “fragile vaccines”.



  • Transport containers immediately to Chippewa Valley Hospital via an air conditioned vehicle. Vaccine is NOT to be transported in a vehicle trunk.

For further information, see immunization policy and procedure manual.


EVALUATION:

REFERENCES/LEGAL AUTHORITY:



  • Wisconsin Department of Health Services

POLICY TITLE: Immunizations: General Procedure for Adults and Children



EFFECTIVE DATE: 06/23/2006

DATE REVIEWED/REVISED: 07/16/2009, 04/14/2012

AUTHORIZED BY: Jen Rombalski, Health Officer
PURPOSE STATEMENT:
To minimize and/or prevent the incidence of vaccine preventable (communicable) diseases and to assure the proper use of vaccines and immunization of its residents, the BCDHHS shall provide an immunization program in collaboration with local medical advisor and state personnel, and in accordance with Wis. Stats. 252.04.
RESPONSIBLE STAFF:
WIC Technician

Public Health Nurse

Registered Nurse

Maintenance/Sheriff’s Department

Support Staff

Parent, Guardian, or Client


PROCEDURE:


  1. For CLIENT RELATED EMERGENCY SITUATIONS AT IMMUNIZATION CLINICS see EMERGENCY ADMINISTRATION OF EPINEPHRINE policy/procedure and pages 11-14 of the Policies and Procedures for Public Health Clinics. Require clients/babies receiving vaccines for the first time to stay at the clinic site for at least 20 minutes following vaccinations to observe for adverse reactions.

  2. Check expiration date of epinephrine supply (located in the locked medicine cabinet and in the Immunization Bag) every 6 months. Pick up new prescription from Kassel City Drug Pharmacy in Alma before expiration date and replace all previous supply. The expired epinephrine may be used for training purposes, but then should be discarded.
  3. Read, follow and understand procedures as outlined in the manual entitled Policies and Procedures (Protocols) for Public Health Clinics provided by the Wisconsin DHFS.


  4. Check CDC website for Vaccination Information Statements (VISs) and Vaccine

Administration Records (DPH 4702) at

(http://dhfs.wisconsin.gov/forms/DPH/dph04702.pdf for revisions on a bi-monthly basis. Download new versions of forms and photocopy; discard outdated forms as appropriate.


  1. To ensure proper use of VFC vaccines, see Appendix B and B1 of Policies and



Procedures (Protocols) for Public Health Clinics.

  1. Bring and be familiar with the contents of the immunization binder (which contains this procedure and other supplemental information useful at immunization clinics) to any and all immunization clinics, whether on site or off site of BCDHHS.

  2. Pack immunization bag utilizing the Packing Checklist for Immunization Clinics.

  3. For clinics off-site, use portable “FridgeFreeze.” Pack vaccines and make sure digital temperature gauge is set to appropriate level for refrigerating vaccines (35-46 degrees F or 2-8 degrees Celsius) Place a travel thermometer in the FridgeFreeze portable cooler next to the vaccines and monitor the temperature during all travel time and clinic time (including if vaccine needs to be stored in a staff member’s home refrigerator). Be familiar with how to operate the FridgeFreeze—insert located inside compartment. Reference Task #15 if temperature is out of the desired range at any time. Reference Policies and Procedures (Protocols) for Public Health Clinics and vaccine inserts for specifics on vaccine storage temperatures.
  4. In the event the fridge-freezer is not available, pack a small cooler using the following technique: ice packs on the bottom of the cooler (and on sides if in the summer), followed by a barrier to keep the vaccine boxes dry, followed by the vaccines, followed by another barrier, followed by more ice. Place a travel thermometer in the cooler next to the vaccines and monitor the temperature during all travel time and clinic time (including if vaccine needs to be stored in a staff member’s home refrigerator). Reference Task #15 if temperature is out of the desired range at any time. Reference Policies and Procedures (Protocols) for Public Health Clinics and vaccine inserts for specifics on vaccine storage temperatures.


  5. Prior to the administration of any vaccine, reference the Vaccination Quick Reference for important reminders.

  6. Call PHD ahead of time to ensure varicella vaccine availability if client needs a varicella vaccination at clinics off-site of BCDHHS. (This is required because varicella is a fragile, frozen vaccine that cannot be re-frozen once thawed. See package insert for more information.)

  7. For minors not accompanied by an adult, provide the Vaccine Administration Record (consent form): DPH 4702 prior to the immunization clinic and have the minor return the form completed and signed by a parent/guardian before administering vaccinations. See Appendix D of Policies and Procedures (Protocols) for Public Health Clinics in addenda for more information regarding consent.

  8. Track immunizations and recall those due for vaccinations monthly or bimonthly until the primary immunization series is complete or until the family/client asks to be removed from the recall list.

  9. In the event a family/client refuses or requests to be waived from immunizations, send Student Immunization Record-Step 4: Waivers (DPH 4020L) for their signature and return for future reference and evidence of desire to be removed from the recall list.
  10. Vaccine Storage and Handling: Monitor temperature of refrigerator and freezer that house vaccines twice daily on weekdays. Temperature range should be 35 to 46 degrees Fahrenheit (inclusive) for refrigerated vaccines and not above –5 degrees Fahrenheit for frozen vaccines. If the temperature falls out of this range, take immediate action to get vaccines into an appropriate temperature range and contact vaccine suppliers per individual vaccine to determine appropriate action (ie: must vaccine be discarded and how). Notify the state immunization program for all affected VFC vaccines.


  11. Vaccine Safety in Power Outage: Store all vaccines according to manufacturer’s instructions (see insert provided with vaccine). In the event of a power outage, therefrigerator is on a back-up generator outlet. In the event the generator is not working and the temperatures in the refrigerator or freezer go outside the set safety range, the unit will alarm. Take immediate action to get vaccine to a unit that can maintain proper storage temperature. Work with the Maintenance Department to conduct a drill every 6 months to ensure the unit is backed-up or does alarm if the generator is not working properly. Ensure the Sheriff’s Department knows to use the Public Health Emergency Call Tree if the power goes out and especially the generator fails during evenings, weekends, or holidays when the office is closed.

  12. Expired Vaccines: All expired vaccines should be immediately removed from the refrigerator or freezer. VFC vaccines get shipped back to _____ and all non-VFC vaccines should be discarded. Proper disposal includes placing vials in approved sharps containers.

  13. Vaccine Ordering, Shipping and Receiving:

Public Vaccine--VFC vaccines are ordered on line through theWisconsin Immunization Registry website. It is suggested that we order enough vaccine to last 2 months. It takes the vaccine about 2 weeks to get here. It is shippedfrom Mc Kesson Specialty Distribution, 4853 Crumpler Road, Memphis TN, 38141. Any outdated vaccine is returned to that address. It can be returned in an ordinary cardboard box, no special packing requirements. Shippers are returned to Mc Kesson as per their instructions, packed in each shipment. They do not accept the ice packs, we must keep or dispose of them.

Private Vaccine--Engerix B (adult Hep B vaccine), is ordered from GSK, with ordering information in the white binder in Sandy’s Office ("VFC VACCINES, PRIVATE VACCINES, PUBLIC HEALTH SUPPLIES, WIC SUPPLIES, ORDERING INFORMATION"). Tubersol is ordered online from vaccineshoppe.com (Sanofi Pasteur), with ordering information in the same binder. Private vaccine shippers are not returned.

REFERENCES/LEGAL AUTHORITY:
Wis. Stats. 252.04

Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-



Preventable Diseases (latest edition). (Also known as “The Pink Book”)

Wisconsin Immunization Registry (WIR)

Vaccine Information Statements (VIS)

Immunization Action Coalition

General Recommendations on Immunization: Recommendations of the ACIP, MMWR,

December 1, 2006, Vol. 55, No. RR-15

POLICY TITLE: Seasonal Influenza Vaccine Administration

EFFECTIVE DATE: 7/17/12

DATE REVIEWED/REVISED: 7/17/12

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


  1. To assure the availability of influenza vaccine to Pepin County Residents.

  2. To encourage influenza vaccination by the public to reduce influenza-related morbidity.


POLICY:

Pepin County Health Department will offer seasonal influenza vaccination annually to adult staff. Seasonal influenza vaccine is also offered annually through the Vaccine for Children Program (VFC) at different sites in Pepin County and in the health department office. The health officer will monitor the community accessibility to adult seasonal influenza vaccine that is provided by local clinics, pharmacies, and private organizations. If the community health status is threatened by an increase in influenza-related morbidity or an outbreak of a novel subtype of influenza, the health department will assure adequate access to vaccination through mass clinics as outlined in the Public Health Emergency Plan (PHEP). Home visits may also be offered for elderly and disabled individuals who are unable to leave their homes to attend a mass clinic.


PROCEDURE:


  1. Have the client or parent/guardian complete and sign a consent form. Answer any questions he/she may have.

  2. Review contraindications and side effects.

  3. Draw up the appropriate dose of influenza vaccine.

  4. Cleanse the deltoid area with alcohol and allow to dry. For children less than 2 years of age, use the anterior lateral aspect of the upper thigh.

  5. Inject the medication intramuscularly.

  6. Apply Band-Aid as needed.


Intranasal:

  1. Have the client or parent/guardian complete and sign a consent form. Answer any questions he/she may have.

  2. Review contraindications and side effects.

  3. administer intranasal vaccine. Each sprayer contains a single dose of vaccine. Half of the dose from the sprayer is administered into each nostril while the recipient is in an upright position. Insert the tip of the sprayer just inside the nose and rapidly depress the plunger until the dose-divider clip stops the plunger. The dose-divider clip is removed from the sprayer to administer the second half of the dose into the other nostril.

  4. Once the intranasal vaccine has been administered, the sprayer should be disposed of in the sharps container.

  5. Offer the client a tissue to catch any dripping vaccine from the nostril.


Availability:

Influenza vaccine is generally available from mid-October through December without a written physician order for the client. Standing orders allow health department staff to administer influenza vaccination.


Because of the potential for a delay in delivery of the vaccine in any given year, the health department will assure that any contingency plans received from the State of Wisconsin will be followed.

Contraindications to inactivated (injectable) influenza vaccine


  • Allergy to eggs or another component of the vaccine

  • Guillan-Barre’ syndrome

  • Severe illness with a fever


Contraindications/Precautions to live attenuated (intranasal) influenza vaccine

  • Allergy to eggs or another component of the vaccine

  • Concomitant aspirin therapy in children and adolescents

  • Recurrent wheezing

  • Severe illness with a fever

  • Guillian-Barre’ syndrome

  • Immunocompromised persons

  • Pregnancy

  • Persons <2 years or ≥ 50 years old

Dosage

Age Group

Product

Dosage


# of Doses

Route


6-35 months

3-8 years

9-12 years

>12 years

2-8 years

9-49 years



Split virus only

Split virus only

Split virus only

Whole or split

Live intranasal

Live intranasal



0.25 ml

0.50 ml


0.50 ml

0.50 ml


0.20 ml

0.20 ml

1 or 2

1 or 2


1

1

1 or 2



1

IM

IM

IM



IM

Intranasal

Intranasal



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