1. Toolkit to Promote the Use of the CIFOR Guidelines Jeanette Stehr-Green, MD CSTE Consultant June 13, 2011

2. CIFOR Guidelines Comprehensive description of the overall approach to outbreaks of foodborne diseases Allow agencies to –Compare to existing procedures –Fill in gaps, create procedures, update procedures –Train staff Challenges in use –Lengthy document with overlap between chapters –Range of recommended practices –Implementation depends on host of factors

3. CIFOR Guidelines Toolkit 1.Better understand their current foodborne disease outbreak response activities, 2.Become more familiar with the CIFOR Guidelines and recommended practices, 3.Identify specific CIFOR recommendations appropriate to the agency, and 4.Make plans to implement those recommendations. A process and set of supporting materials which help agencies:

4. Document 0 Toolkit Contents Document A Toolkit Overview Document B Toolkit User Instructions Document C Toolkit User Instructions (Cheat sheet for Facilitators) Document D Preliminaries Worksheet Document E Selecting Focus Areas Worksheet Documents F1-F12- Individual Focus Area Worksheets Focus Area 1 Worksheet Relationships with relevant agencies and organizations Focus Area 2 Worksheet Necessary resources Focus Area 3 Worksheet Communications Focus Area 4 Worksheet Notification/complaint systems Focus Area 5 Worksheet Pathogen-specific surveillance Focus Area 6 Worksheet Initial steps of an investigation Focus Area 7 Worksheet Epidemiology investigation Focus Area 8 Worksheet Environmental health investigation Focus Area 9 Worksheet Laboratory investigation Focus Area 10 Worksheet Control of source at implicated facility Focus Area 11 Worksheet Food recall Focus Area 12 Worksheet Control of secondary spread Document G Sample Focus Area Worksheet Document H Crosswalks among National Initiatives and CIFOR Toolkit Document I Toolkit Tips for Facilitators Document J Participant Evaluation Form CIFOR Toolkit Documents

5. Understanding the Toolkit Multi-step process designed to use time efficiently 1.Preparation/preliminaries 2.Selection of areas of focus 3.Examination of priority areas individually Easy-to-use worksheets −Clearly labeled documents (with electronic versions) −Step-by-step approach with embedded instructions −Space to record discussion highlights/decisions Repackaging of CIFOR recommendations −Removal of supporting text (with hyperlinks) −Bringing together relevant recommendations −Organized for easier review

6. Step 1: Preliminaries Undertaken by lead person or key decision-makers Purpose: –Identify program/agency/jurisdiction for which decisions will be made. –Brief decision-makers. –Identify who should be involved. –Identify support staff. –Collect relevant background materials. –Decide on time frame. Needed time: <1 hour (plus time to arrange and prepare for follow-up meetings) Timing: before other steps; revisited periodically

7. Preliminaries

8. Step 2: Select Priority Focus Areas Undertaken by key staff with knowledge, expertise, and practical experience in local outbreak response Purpose –Determine if critical outbreak response activities, relationships, and resources are already in place. –Consider priorities of other projects or problem areas in past outbreak response experiences. –Prioritize areas of outbreak response that are most critical to agency and in need of improvement. Needed time: 1-2 hours Timing: immediately following preliminaries or at a later time

9. Planning and preparation Surveillance and Outbreak Detection Investigation of Clusters and Outbreaks Control Measures Relationships Resources Communications Notification/ complaint systems Pathogen-specific surveillance Initial steps Epidemiology investigation Environmental health investigation Laboratory investigation Control of source Food recall Control of secondary spread Focus Areas Critical aspects of outbreak response broken into “bite-sized” chunks that allow users to systematically examine current activities and focus on the areas most critical to their agency.

10. Select Priority Focus Areas one-page for each Focus Area

11. Step 3: Examine Priority Focus Areas Undertaken by larger group with broader areas of expertise and a wider range of experience Purpose –Describe current activities/procedures in Focus Area and identify targets for improvement. –Prioritize CIFOR recommendations to address targets. –Outline steps to implement high priority CIFOR recommendations. Needed time: 2-3 hours per Focus Area Timing: schedule highest priority Focus Areas first; consider separating efforts on different Focus Areas

12. Examine Priority Focus Areas set of pages for each Focus Area

13. Examine Priority Focus Areas

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17. Target Audience Staff from public health, environmental health, and food regulatory agencies and public health laboratories Local and state (and even federal) level Persons likely to be involved in a foodborne outbreak response who have subject matter expertise and knowledge of local procedures, resources, and politics Interdisciplinary groups vs. single program, agency, or person

18. Settings Meetings held specifically to address improving foodborne outbreak response locally As part of an after-action review of an outbreak response During planning meetings with other programs and agencies to define working relationships, communication processes, data sharing, etc. As part of local capacity development efforts (e.g., Public Health Performance Standards) As adjunct to trainings and professional meetings

19. Final Tips for Using the Toolkit Don’t get distracted by the volume. Involve the right people. Be clear on the process so as not to get lost. Keep moving. Don’t get caught up in too much detail. Record highlights of discussions and decisions. Focus on a few realistic changes as opposed to detailed expansive plans. End with specific action plans including a time frame and assigned responsibilities.

20. Toolkit Use So Far 250 hard copies of Toolkit distributed Many more copies downloaded from website Informal feedback positive 19 state and large urban areas funded to conduct trainings using the toolkit Thanks to Jeff Duchin and Public Health Seattle-King County for piloting the Toolkit!

21. CIFOR Toolkit documents are available at For more information, please contact: Lauren Rosenberg CSTE 770.458.3811 lrosenberg@cste.org http://www.cifor.us/toolkit.cfmhttp://www.cifor.us/toolkit.cfm or www.cste.org. www.cste.org