1. CIFOR Toolkit: An Overview of Focus Area 2 – Necessary Resources
New York Integrated Center of Food Safety Center of Excellence – July 27, 2016
Paula Huth, MPH
Bureau of Communicable Disease Control
New York State Department of Health

2. Background
This is the third webinar in a series of monthly webinars from the New York Integrated Center of Food Safety Center of Excellence (CoE)
Session will cover the CIFOR Toolkit Focus Area 2: Necessary Resources
Supplementary sessions will be devoted to assist states that wish to complete internal evaluations using the metrics and target ranges developed for the 16 CIFOR performance measures.

3. Background
Additional sessions will focus on emerging issues in food safety including culture‐independent diagnostic testing, antimicrobial resistance, and advanced molecular detection/whole genome sequencing
All webinars will be recorded and available through the NYSDOH Learning Management System (LMS) at:
Slide decks for all webinars will be posted to the NY CoE website at:

4. Objectives How to use the CIFOR Toolkit? What is Focus Area 1?
Planning and Preparation
Define “Keys to Success”
Review “Keys to Success.”
Roles and Responsibilities
Communication
Multijurisdictional Outbreaks
Making Changes
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5. How to Use the CIFOR Toolkit
Describe Your Current Activities and Procedures in relation to the Focus Area
Complete the Worksheet as a Team (Workgroup)
Epidemiology, Laboratory and Environmental Health and Other Agencies
Describe your agency’s/jurisdiction’s current activities and procedures based on the Focus Area
Refer to written protocols/procedures
List current activities and procedures related to the Focus Area

6. How to Use the CIFOR Toolkit
Prioritize CIFOR Recommendations to Address Needed Improvements
Review the CIFOR recommendations related to the Focus Area of interest
Rate the priority for implementing each recommendation based on its likely impact on foodborne outbreak response
Rate each recommendation
Identify activities and procedures in need of improvement

7. What is Focus Area I?
Relationships with Relevant Agencies and Organizations
Goals: Agency/jurisdiction can swiftly launch an outbreak response that is coordinated with all relevant agencies, minimizing confusion and redundant efforts and taking advantage of all available resources

8. Toolkit Tracks and Focus Areas
In developing the Toolkit, outbreak response activities have been divided into four major “tracks,”
corresponding to the four main chapters of the CIFOR Guidelines
Planning and Preparation brings the right expertise to the investigation, communicating quickly with all organizations that should be involved, and rapidly sharing investigation findings can accomplish the goal.

9. Keys to Success
Activities, relationships, and resources that are critical to achieving success in a Focus Area
Applying metrics and measures can help you identify the success of your program or investigation process
Roles and Responsibilities
Communication
Multijurisdictional Outbreaks
Making Changes

10. Roles and Responsibilities
Establish relationships with other agencies
Local
State
Federal
Tribal
Academic
Are agency or jurisdiction roles defined?
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11. Roles and Responsibilities
Determine in advance the role of the Incident Command System (ICS) in outbreak response
Is this something your agency will be using?
Ensure staff training in ICS
Decide how to routinely apply an ICS structure to foodborne disease outbreak response
Prepare an outbreak response protocol

12. Roles and Responsibilities
Are procedures and protocols written and easily accessible?
Joint protocols with combined agency response
Memoranda of Understanding
Do they define agency or jurisdiction roles?
Do staff understand their roles and responsibilities?
Do staff understand jurisdiction barriers?
Exercise Protocol and Response

13. Communication
Communication is critical and is one of the most important factors in successful outbreak control – from detection through investigation and response to debriefing
Should be decided on the basis of roles, both internal and external of your agency
Contact information, contact lists especially contact lists for after hour communication are crucial
Ensure contact lists are updated and distributed

14. Communication
Contact information:
Internal
Laboratory, Epidemiology, Environmental Health and Media Contacts
External
Local, State, Federal, Tribal and Industry

15. Communication Develop an investigation/outbreak response team
Face to Face meetings strengthen the team
Establish routine communication amongst team members before an outbreak
Develop a formal communication process and data sharing agreements amongst team members

16. Communication Foster working relationships with external partners
Prior to the occurrence of an outbreak:
Hold joint meetings
Planning/training sessions
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17. Multijurisdictional Outbreaks
Be able to readily recognize signs suggestive of a multijurisdictional foodborne disease outbreak
Establish a framework for rapidly assessing whether a given foodborne disease outbreak or other event affects multiple jurisdictions
Communication agreements, mutual aid agreements or memoranda of agreement should be in place to facilitate outbreak investigation and response across jurisdictions

18. Multijurisdictional Outbreaks
Training
Local
Regional
Table Top Exercises
Across agencies
Industry
Law Enforcement
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19. Multijurisdictional Outbreaks
Establish protocols and processes to allow rapid and open information sharing between public health and food-regulatory agencies
Immediately notify all proper agencies
distribution lists/List serves
Conference Calls
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20. Multijurisdictional Outbreaks
Coordination is important
Establish a lead investigator
At what level was the investigation detected?
State
Local
Federal
Where will most investigative materials reside?
Is an agricultural commodity involved?

21. Multijurisdictional Outbreaks
Coordination is important
Be prepared to shift leadership if the focus of the investigation shifts
Coordinate the release of information to provide a consistent message

22. Making Changes After each outbreak
Conduct a debriefing with all collaborating agencies, summarizing the effectiveness of communication and coordination among jurisdictions and identify gaps or problems that arose
Hotwash
After Action Report
Refine protocols if needed

23. Summary

24. Helpful Tips for Using the Toolkit
Don’t get distracted by the volume
Be clear on the process
Keep moving – don’t get caught up in too much detail
Focus on a few realistic changes
End with specific action plans with time frames and responsible persons
Appoint a facilitator and a recorder for each discussion
Emphasis on realistic changes than can actually occur. Facilitator and recorder can be within the group or from an outside party. Also doesn’t all have to be done at once, but gradually over the span of months, year, etc.

25. Why Should My State Use the Toolkit?
Improve overall foodborne outbreak investigation and response
Enhance partnerships with agencies/partners in foodborne outbreak investigations
Identify areas needing improvement that may have gone unrecognized
Comment on what other states are doing or have done – Examples from the field section. Ask if any states on the call would like to share an experience? Maybe mention the use in NY so far – needs assessment via SurveyMonkey and setting up regional trainings, to then extend to counties?

26. Where to Find the CIFOR Products
Online at: wwwciforus
Paper copies are also available from CSTE
Contact Dhara Shah at
Examples of CIFOR product use by other states:

27. Next Scheduled NY CoE CIFOR Webinars
Wednesday, July 27, 2-3 PM
Focus Area 2: Necessary Resources
Course announcement and link to register is posted on the NY CoE website, as well as, the DOH Learning Management System (LMS): wwwnylearnsphcom

28. NY CoE Food Safety Symposium Cornell University, Ithaca, NY from July 19-21, REMINDER TO REGISTER!
Each participant from your state (maximum of 3) is required to register for the symposium by June 17, 2016 using the following link:
There is no registration fee associated with the symposium

29. Resources Comments or questions for NY CoE can be directed to:
Paula Huth, NY CoE Program Coordinator or
Integrated Food Safety CoE Websites:
NY CoE:
CDC:

30. Questions For More Information Contact: David C. Nicholas, MPH
Research Scientist/Epidemiologist
Environmental Health Specialist Coordinator
NORS Reporting Site Administrator
New York State Department of Health
Ph: Fax: