Archive for the ‘Prevention’ category

Bed Bugs: A Most Unwelcome Nuisance

August 29th, 2014

12705_thumbJust the idea of bed bugs makes folks squirm…which is understandable, but here in Arizona we have scarier bugs like Rhipicephalus sanguineus or Culex quinquefasciatus that actually transmit diseases like Rocky Mountain spotted fever and West Nile virus.  Bed bugs don’t transmit disease but they can cause skin reactions and psychosocial stress (e.g., anxiety and sleeplessness).

Bed bugs feed on human blood, and can cause itchy skin welts.  If people scratch their welts with dirty hands, it’s possible they can get a skin infection, but bed bugs themselves don’t spread disease.  Bed bugs like to hide in small dark places close to humans or animals (think mattress seams, stuffed animals, and piles of dirty clothes).  They typically live within a meter of where people sleep and they shed their exoskeleton routinely, so you might suspect a problem if you see bed bug shells or rusty-colored blood spots around your sleeping area.

Aristotle and ancient historians tried desperately, but unsuccessfully to eradicate bed bugs from their homes by spreading dust, hanging a dead rabbit at the foot of the bed, and placing legs of the bed in pans of water.  Modern attempts seem equally scattered, we’ve tried using natural predators, insecticides, and even room heaters.  The current standard is to employ integrated pest management – a combined approach of chemicals and common sense practices to eliminate bedbugs from the home.

The best intervention is really prevention.   Bed bugs usually hitchhike into your home (they can’t fly)…so watch what you bring inside.  Leave the “free” curbside couch on the street, carefully inspect consignment store purchases, spread your own sheets when other children sleep over, and leave your luggage outside for a few nights after returning from a trip.  If you see or suspect a bed bug, act immediately.  If not, you might be tempted to add dust, rabbits and pans of water to your extermination plan!

The 5th “Vital Sign” & the Painkiller Epidemic (Part V of V)

August 27th, 2014

clinicianIn Parts I, II, III, and IV of this series we established the acute and growing effects that the opiate painkiller epidemic is having in America, and how it has been driven (in part) by aggressive pain management strategies that were implemented since Pain was identified as the 5th Vital Sign.  Since then, public health and other sectors have been responding by developing and implementing strategies (presented in Part IV) to break the cycle of opiate misuse and abuse.  Today, we continue presenting interventions being conducted to address the epidemic.

In 2008 the Arizona Legislature passed and Governor signed a law establishing the Controlled Substances Prescription Monitoring Program.  The law required the Arizona State Board of Pharmacy to establish a controlled substances prescription monitoring program requiring pharmacies and medical practitioners who dispense controlled substances to report prescription information to the Board of Pharmacy on a weekly basis.  The Monitoring Program is one of the most important tools health care providers can use to manage patients.

The passage of a new law this year allows prescribers to appoint an office designee to access their patient’s medication history from the Monitoring Program just like they do patient charts.  This will cut down on prescriber time and still ensure patient safety and minimize liability concerns.  The system will be ready to accept designees starting in early September.  The new legislation requires updates every 24 hours (rather than weekly) and will help reduce dangerous drug combinations and high-dose prescribing.

At the national level, the U.S. Drug Enforcement Administration is revamping rules on providing prescription drug drop boxes in the community.  Currently the only place that can have a drop box is at the police department.  People may be more likely to properly dispose of unused drugs if they can do so year-round in places other than at a police or sheriff’s department.  Existing drop box locations are posted on the Arizona Prescription Drug Misuse & Abuse Initiative website.

The University of Arizona’s Office of Continuing Medical Education in conjunction with the Center for Rural Health is developing an online prescribing education tool that provides controlled substance prescribers in Arizona continuing graduate medical education credits for free upon completion of the interactive program.  The online education will align with and help promote Arizona’s Opioid Prescribing Guidelines.

Non-traditional approaches to pain management are finding their way into the conversation as alternative means individuals can embrace in order to manage their pain experience without having to depend on prescription drug therapy.  Meditation, yoga, acupuncture, changes to diet, chronic disease self-management, and a number of other choices are being adapted and adopted as viable alternatives to traditional pain management therapies.

The key to winning this battle is to align and focus our future efforts in a comprehensive manner.  The Institute of Medicine set this strategy in motion with their 2011 publication, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.  The Blueprint emphasized steps individuals, providers, and communities can take to prevent pain from occurring in the first place.  For example, public health partnering with primary care to provide community education to address behavior and lifestyle choices that lead to chronic disease, i.e., obesity, that contribute directly to the prevalence of chronic pain.

The painkiller misuse and abuse problem represents a perfect storm.  In the last several years a number of forces have coalesced to create a complex and dynamic public health problem for which no single silver bullet policy has been able to successfully take down.

Steps continue to be taken to develop, implement, and assess the effectiveness policies are having on reversing the deleterious effects of this epidemic – but the jury is still out on the question of whether the constellation of interventions that are being implemented at the federal, state and local level are enough to turn the tide on this critical public health crisis.

Snus Causes Cancer Too

August 22nd, 2014

ash-logoSmokeless tobacco has made recent headlines with former MLB players citing their habitual use for their cancer diagnosis, including Tony Gwynn, who recently died after battling salivary gland cancer, and this week, Curt Schilling, who publicly announced his diagnosis of squamous cell carcinoma (cancer of the mouth).  Both attributed their cancer to their 30+ years of chewing.

The percentage of adults using chew in Arizona has remained steady at just over 3% (about 17% of Arizonans smoke cigarettes).  The “chew” rate is three times higher in rural AZ.

Smokeless tobacco isn’t safe.  It affects the mouth and throat more directly than smoking, and is absorbed directly into the gums causing immediate as well as long-term damage.  It increases a person’s chance of being diagnosed with oral, esophageal, pancreatic and stomach cancer.  Smokeless tobacco users are four times more likely to develop oral cancer than non-users, and their risk for cancer of the cheek or gums increases 50-fold.

But there’s good news.  The Arizona Smokers’ Helpline helps smokeless tobacco users too.  Since a support system like ASHLine can make the difference for people who decide to stop using any form of tobacco, it’s important that chewers know that ASHLine coaches are here for them too.  The ASHLine has almost twice the success rate of other quit lines nationally, and offers free telephone quit coaching at 1.800.55.66.222 and free online quit coaching services via WebQuit ™ at

Updated Infection Control Prevention Guidelines

August 19th, 2014

hospital settingThe Society for Hospital Epidemiology of America and the Infectious Diseases Society of America partnered with several healthcare organizations to publish evidence-based and best practice recommendations for preventing healthcare-associated infections in acute care hospitals.  Referred to as the “SHEA Compendium”, these recommendations have served as a cornerstone of infection control and prevention since their publication and are a staple on the desks of infection preventionists and healthcare epidemiologists worldwide.

The Compendium focuses on strategies to prevent healthcare associated infections like surgical site infections, central-line associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, Clostridium difficile, and Methicillin-resistant Staphylococcus aureus.  The Compendium includes information on outbreak management and special circumstances, and recommends performance measures to monitor implementation and outcomes.

The revised 2014 version of the Compendium sections is published by the journal Infection Control and Healthcare Epidemiology and is freely available online.  This year’s update also features a new section focusing on strategies to prevent infection through hand hygiene, which is the simplest and most effective approach to infection prevention.

Life Coach Tips for College Freshmen

August 15th, 2014

teenGoing to college is fun and exciting.  As is the case with all life transitions, getting some helpful hints in advance can smooth out the adjustment time and help create a better and healthier outcome.  Make it a point to review the following “life coach tips” with your young adult (like I’ve been doing with my soon-to-be Freshman).

  • Maintain a healthy lifestyle starting with diet and exercise.  Many young men & women gain weight their 1st  year at college (a.k.a. the Freshman 15).  Follow an eating plan with correct portions of the basic food groups…and remember that beverages add extra calories.  You’ll be surprised when you find out how many calories are in a Caffe Latte or Caffe Mocha.  Get into an exercise routine right away when you get to college – with at least 30 minutes of solid exercise every day.
  • Sexual assault is a problem on college campuses. One in five women are sexually assaulted in college.   Be aware of your surroundings.   Know your rights and seek help immediately if you or someone they know is the victim of violence.
  • Binge drinking is dangerous.  It increases your chances for risky sexual behavior, sexual assault, unintended pregnancy, sexually transmitted diseases, car crashes, violence, and alcohol poisoning. When bad things happen at college – alcohol was likely involved.  Recognize up-front what might happen in binge drinking situations (often involving competitive drinking games) and make a commitment to protect yourself and your friends to avoid binge situations.
  • Sexually transmitted infections are common on college campuses these days.  Half of all sexually transmitted infections occur among people 15 to 24 years old. College students and others who are sexually active should get tested to know their status and protect themselves and their sexual partners.
  • Smoking harms nearly every organ of the body and causes many diseases like cancer, and heart and respiratory diseases.  About 17% of young adults smoke cigarettes.  Don’t start smoking when you get to college.  Most likely you’ll meet new friends and some of them will be smokers.  Don’t succumb to the peer pressure – be the person of reason that gets them to quit.
  • Managing stress and maintaining good balance is important for college students. A few ways to manage stress are to get enough sleep, avoid drugs and alcohol, connect socially, and get help from a medical or mental health professional, including if depressed.  Suicide is the 3rd leading cause of death among people 15 to 24.  If you or someone you know is thinking about suicide contact the National Suicide Prevention Lifeline at 1-800-273-8255.
  • Protect yourself from meningitis. First-year college students living in dorms have a higher risk for meningococcal disease, which can deadly. If you haven’t already gotten your meningitis vaccine get it done before move-in day.  If you got the shot before you turned 16, you need a booster.
  • Use your campus resources. There are many professionals on campus that specialize in college transition and all the issues listed above (counseling center, residence halls, commuter center, health services, etc.).

Get a Healthy Jump on the School Year

August 8th, 2014

Believe it owic2r not, it’s already back to school time.  Whether kids are heading off to school for the first time, or going back for their senior year of high school, it’s important for parents, grandparents and students to do everything they can to insure the school year is safe and healthy.

One of the best ways to keep kids healthy during the school year is to keep them physically active.  In Arizona we’re lucky to have great weather that allows kids to walk or bike to school nearly year round.  Check out our Arizona Safe Routes to School website to find safe ideas to get to school.  As drivers, we need to be on the lookout for more kids in our neighborhoods.  Drive with extra caution.  Children don’t always see or hear cars approaching when they are talking to their friends or when they have head phones in.  And 15 mph means 15 mph.  Be extra careful when driving in school zones.

Another way to make sure kids will have a healthy school year is to help them eat a balanced diet.  We have some info on our Back to School website like tips to help your kids eat healthier meals at school and at home and ways to keep sack lunches safe.  School gardens can help kids eat healthier, keep them physically active, and give them a sense of pride and accomplishment.  Take a look at our School Gardens website for information about this great program.

Sun safety is also a priority – especially right now.  Take a look at our SunWise Sun Safety site for tips on staying safe in the sun.  We also have an Extreme Weather website where you can find more resources, including a video about Heat Illness Prevention in Schools.

On our Back to School website you’ll also find valuable information about birth certificates, shot records, and a list of vaccines kids need.  The website also has information about bullying and links to safe teen driving.


Summer Rabies Update: Rabies & Skunks

August 5th, 2014

skunk_web2014 has already proven to be a very active year for rabies in Arizona.  So far this year, there have been 70 animals reported positive for rabies.  Last year at this time there were 40 animals reported positive.  We’re seeing an especially high number of rabid skunks this year.  39 skunks have been reported so far, all of them coming from Southern Arizona.  We have noticed that every few years we have an increase in rabies activity (an epizootic) among wildlife in Arizona.  Arizona’s 3 most common animal reservoirs are bats, foxes, and skunks.

These animals carry their own distinct rabies virus variant or “strain”.  When rabies activity within these animal groups increases (like what’s happening with skunks in Southern Arizona) the risk of rabies “spillover” into other mammal species, such as bobcats, coyotes, javelinas, cats, dogs, horses, or cows, increases.  When spillover rabies occurs in domestic animals, the risk to humans is increased.  That’s why it’s important to keep rabies vaccinations up-to-date for your pets and livestock. Unvaccinated dogs, cats, and ferrets exposed to a rabid animal may have to be euthanized or kept under a strict quarantine for 6 months.  So don’t take that risk and vaccinate your pets!

In Arizona, we see an increase in rabies activity in wildlife this time of year.  People who are camping, hiking, or hunting should avoid touching, handling, or adopting wild or stray animals.  Hunters should always wear gloves and protective eyewear when field dressing game to protect them from many diseases, including rabies.  You should always secure all food sources so not to attract wildlife.

Lastly, notify your local animal control or Game and Fish if you see wild animals acting out of the ordinary or a large number of dead skunks or foxes.  Rabies in humans is 100% fatal, but the good news is that it is 100% preventable through prompt appropriate medical care.  So be sure to call your healthcare provider and county health department if you are bitten by a wild animal or have been exposed to their saliva.

Rocky Mountain Spotted Fever

July 23rd, 2014

rocky-mountain1The monsoon season marks the tick season here in Arizona, and one of most important tick-borne disease threats in the state is Rocky Mountain spotted fever.  The symptoms usually start with a fever of two or more days and can lead to a nasty “spotted” rash (although the rash is not always present in the cases seen in Arizona).  Early treatment with the correct antibiotic is critical because delayed or untreated cases are often fatal.

The hard part about this disease is that doctors need to use patient symptoms to diagnose the disease rather than wait for lab results – which can take weeks to complete.  Public health officials and doctors have worked together to create special protocols in high-risk areas to make sure people who might have been exposed to ticks are treated correctly in order to prevent deaths caused by this disease.

You can take steps to protect yourself, your family, and your pets from Rocky Mountain spotted fever.  Dogs should be treated with tick control products year-round, and pets and people should be checked for ticks after being in rural or wilderness areas.  If ticks are found, they should be removed carefully with tweezers, grasping close to the skin’s surface and to the tick’s mouthparts, and pulling straight up without twisting or jerking.  Weeds and grass should also be trimmed and any debris should be regularly removed to get rid of tick habitats.  If ticks are found around homes, it might be necessary to treat the area with pesticides.

AZ Losing Traction on Vaccine Front

July 21st, 2014

Boy getting an injection.Arizona law requires kids to get certain vaccines in order to attend school unless a doctor signs a medical exemption form or a parent signs a religious or personal belief exemption form.  There’s been an increasing number of parents who are signing personal belief exemption forms- putting herd immunity at risk.

Every year we examine our exemption rates…which gives us information about how we’re doing and where we need to focus our efforts.  This year’s analysis found that exemption rates increased again.  Childcare exemption rates went from 3.8% to 4.1% over the last 2 school years.  Kindergarten exemption rates went from 3.9% to 4.7%.  For some perspective-in 2004 only 1.6% of school kids in Arizona were vaccine exempt.

This year’s report shows a noticeable difference in exemption rates between school types.  Public, charter, and private schools all reported higher exemption rates than last year…but exemptions are much higher in charter & private schools than in public schools.  More than 9% of charter school kindergartners were exempted by their parents.  Likewise, 7.5% of private school kindergartners were exempted by their parents (compared to 3.6% of public school kindergartners).

Over the last 18 months we’ve been working with partners using data collected by the U of A to stem the tide.  Last year’s initiatives included implementation of our Action Plan to Address Vaccine Exemptions which included updating the vaccine exemption form (which reinforces to parents know how important it is to vaccinate their kids and the consequences if they don’t).  The form also makes it clear that if there’s an outbreak of a vaccine-preventable disease in a school and their child isn’t vaccinated, he or she may not be allowed to attend school for up to 3 weeks or until the risk period ends.

We’ve also been working with partners to increase information about what vaccines are needed and how the public can find the needed vaccines easily.  We also created a reference and resource document to help schools and childcare facilities better understand the requirements.  We’ll be analyzing this year’s report to identify additional evidence-based strategies to combat this troubling trend toward lower vaccination rates in our schools.

With school about to start, it’s a great time to make an appointment and talk to your healthcare provider to see if your child needs any vaccinations and pick up a copy of those records for the school.

Long-Term Care Infection Prevention and Control Collaborative

July 18th, 2014

hospital settingOur Licensing, Preparedness and Healthcare-Associated Infections shops joined forces with APIC Consulting Inc. to provide a free day-long event to provide training to skilled nursing facilities about how to prevent  healthcare-associated infections.  The training will be based on the Infection Preventionist’s Guide to Long-Term Care.

The goals are to help healthcare providers to:  1) identify infection prevention challenges in the long-term care setting; 2) teach the basics of infection prevention; 3) better understand the essential components of an effective infection prevention program; and 4) better understand the management of multidrug-resistant organisms.

Infection Preventionists from skilled nursing facilities will learn key concepts and basic principles for infection prevention and how to deliver tools and evidence-based interventions to reduce risk in healthcare facilities…helping us to achieve targeted improvements in public health outcomes as part of our strategic plan.

The 2014 Arizona Long-Term Care Infection Prevention and Control Collaborative is scheduled for today at the Black Canyon Conference Center.  The event will highlight Division of Licensing data and opportunities, ADHS Outbreak and Exposure Protocol, surveillance, isolation precautions, seasonal influenza, best practices to prevent infections, environment and equipment to name a few.  It’s a great opportunity for you to connect with partners and exchange information and knowledge of current infectious disease topics.