AZ Dept. of Health Services Director's Blog

Will Humble, ADHS Director

Posts Tagged ‘investigation’

SARS… A 10-Year Retrospective

May 10th, 2013

This Spring marks 10 years since Severe Acute Respiratory Syndrome (SARS) arrived on the global public health scene. It started as a mystery illness in SE Asia- without name, origin, or cure in February of 2003. The CDC immediately began working with the World Health Organization to investigate the outbreak. Public health scientists across the globe scrambled to understand and contain this health threat… which ultimately infected more than 8,000 people- killing about 10% of them.

By March of 2003, the CDC had confirmed that the disease wasn’t caused by an influenza virus, but they didn’t know the culprit… so they named it after the symptoms (Severe Acute Respiratory Syndrome) rather than the causative agent (it turned out to be a new Coronavirus). March of ’03 also marked the time when the CDC figured out that the virus was spread via face-to-face human contact. That’s also when the CDC and WHO recommended strict infection control measures including hand washing, gloves, avoiding sharing household items, and limiting interaction between ill patients and others.

Exactly 10 years ago today CDC figured out that there were some “super-spreaders” that were a particular problem with the growing epidemic. May ’03 also marked the month in which the investigation and public health and clinical interventions matured- bringing the full weight of the global public health and clinical management system to bear on the virus. Interventions like concise case definitions and reporting standards, laboratory diagnostic tests, travel restrictions, and clear clinical management and infection control guidelines all worked together to eradicate the virus by the Summer of 2003.

The forensic investigation continued for a few months after the virus was eradicated. The investigation kept pointing toward an animal called a Civet as the source of the new Coronavirus. A SARS-like virus had been isolated from civets captured in areas of China where the SARS outbreak originated and sold in live animal markets. It’s a mammal with a catlike body, long legs, a long tail, and a masked face resembling a raccoon or weasel. By January of ’04 it was pretty clear that a Civet was the probable source, and the CDC issued a “Notice of Embargo of Civets”, which banned the importation of civets into the US. The ban is currently still in effect. China also implemented some control measures on them.

Interested in the whole story? Check out “Remembering SARS: 10 Years Later” on the CDC’s website.

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Posted in Preparedness

Tags: CDC Centers for Disease Control China Civet clinical interventions clinical management system coronavirus epidemic forensic forensic investigation global public health gloves hand washing health threat human contact ill illness infection infection control infection control guidelines influenza virus investigation laboratory diagnostic tests Notice of Embargo of Civets outbreak public health scientist Remembering SARS: 10 Years Later SARS South East Asia Sudden Acute Respiratory Syndrome super spreaders symptoms travel restrictions virus WHO World Health Organization

ADHS’ Disease Detectives

July 25th, 2012

Awhile back, our epidemiology and licensing team of disease detectives including Jason Lempp, Cara Christ, Vinita Oberoi, Jessica Rigler, Ken Komatsu, Kathy McCanna, Connie Belden, Ken Komatsu, and Shoana Anderson learned of a severe case of a Methicillin -resistant Staphylococcus aureus (MRSA) through our 24-hour disease reporting system. Our team quickly contacted the county public health department which immediately began an investigation into the cause.

Their investigation quickly uncovered more people with the infection who had been seen the same day. The detectives also found that a single-dose vial of solution used for pain meds was diluted and used for more than one patient. Medication shortages often push health-care providers to search for solutions to provide comparable care using limited supplies- which is what looks like happened in this case.

Our work with the county led to an improvement in the clinic’s practices through discontinued use of mixed products; appropriate use of single dose vials; using personal protective equipment, such as face masks, during medication preparation and injections procedures; education of all staff on infection control practices; and the development of a plan to report further suspected infections. This Arizona investigation was written up in this week’s CDC Feature Article and has added to the national picture on injection safety best practices.

Note: Health-care-associated infections (HAI) affect nearly 100,000 people every year and result in over $30B in unnecessary health-care costs (HHS). Our HAI Program works with partners across the state to rapidly identify and help prevent these infections. Traditionally, the focus of preventing HAIs has been in hospital settings, but more and more people are being identified outside of hospital settings. They can happen at any health-care facility, but simple steps can help protect patients.

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Posted in Prevention

Tags: best practices Cara Christ CDC Centers for Disease Control clinic Connie Belden disease disease detectives disease reporting system epidemiology face masks HAI Health Care Associatied Infections health care providers HHS hospital infection control injections investigation Jason Lempp Jessica Rigler Kathy McCanna ken Komatsu medication shortages methicillin-resistant Staphylococcus aureus MRSA pain meds protective equipment public health public health department Shoana Anderson single dose vials Vinita Oberoi

A Look in the Mirror

September 15th, 2011

Many folks don’t know that our Licensing division undergoes a periodic audit (survey) to look at compliance to our Federal contract with the Centers for Medicare Medicaid Services (CMS). This past week, 3 surveyors from the regional office of CMS came to review our Long Term Care and Medical Facilities areas. This survey centered on complaint surveys and their prioritization, initiation and investigation. This audit is much like the surveys the Division of Licensing performs on our licensees. There’s an “entrance” whereby the Surveyors explain why they’re here, what they’re going to look at and items that they’ll need in order to help them with their survey. Then there are a few days of what can be intensive record review, interviews with staff and other associated investigatory activity.

Then the Surveyors compile their information and hold an “exit” with the staff to review what they did, found and suggestions from the survey. During this, exit the staff finds out areas the Surveyor reviewed and if there are any areas they will need to improve upon (findings). CMS asks for a plan of correction where we would provide a description of how the issue(s) will be resolved, when they’ll be resolved and how we’ll maintain and monitor things.

Lots of hard work goes into preparing for these CMS visits. Thank you’s go to everyone who work in the Bureaus of Long Term Care Licensing and Bureau of Medical Facilities Licensing. It is truly a team effort as CMS looks at the field work/documentation of the Surveyors, the reviews of the Team Leaders and Bureau Chiefs and the documentation files etc. the Program Project Specialists and the Support Staff maintain. We don’t have our report back yet- but all indications are that we did well on our assessment.

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Posted in Licensing

Tags: audit bureau chiefs CMS Division of Licensing exit interview Federal investigation Licensing Long-term Care Medical Facilities Medicare Medicaid Services support staff survey surveyor team leaders