1. State trainings to improve outbreak response using the CIFOR Guidelines for Foodborne Disease Outbreak Response CSTE Annual Conference June 5, 2012 Lauren Rosenberg, MPA CSTE

2. CDC ASTHO APHL AFDO CSTE FDA NACCHO NEHA USDA/ FSIS NASDA Council to Improve Foodborne Outbreak Response (CIFOR) NASPHV

3. Comprehensive, consensus-based guidelines Developed by a workgroup with representatives from state, local, and federal level as well as all disciplines Based on existing guidelines and practices Released in 2009 CIFOR Guidelines Development

4. CIFOR Guidelines Product Description of major functions in outbreak response Specific practices to improve outbreak response Performance indicators to determine effectiveness of activities Comprehensive but not stand-alone Does not provide instructions for implementing any particular recommendation

5. CIFOR Guidelines Toolkit Better understand their current outbreak response activities Become more familiar with the CIFOR Guidelines and recommended practices Identify appropriate activities to improve performance Make plans to implement those activities A process and supporting materials to help agencies and jurisdictions:

6. CIFOR Toolkit Goals To identify CIFOR recommendations most appropriate for your agency or jurisdiction To prioritize those recommendations to not overwhelm resources To designate a lead person to take responsibility for implementing each recommendation To agree on an action plan and timeline to increase the likelihood that changes will occur

7. Toolkit Tracks and Focus Areas Planning and Preparation Surveillance and Outbreak Detection Investigation of Clusters and Outbreaks Control Measures  Control of source at implicated facility  Food recall  Control of secondary spread  Relationships  Necessary resources  Communications  Notification/ complaint systems  Pathogen- specific surveillance  Initial steps  Epidemiology investigation  Environmental health investigation  Laboratory investigation

8. CIFOR Toolkit Steps Preparation: select participants, assemble supporting documents, prioritize Focus Areas Then: 1.Describe current activities/procedures in each Focus Area and identify areas for improvement 2.Prioritize CIFOR recommendations that address these targets 3.Outline steps to implement high priority CIFOR recommendations

9. Worksheets

10. Implementation: State-based trainings CSTE funded trainings in 22 sites 17 states: AK, AR, CT, DE, FL, IA, ID, IL, KS, KY, ME, MI, NV, ND, PA, WA, WV 2 county-based areas: Knox County (TN), Cuyahoga County (OH) 3 urban areas: Los Angeles, Philadelphia, Milwaukee

11. Implementation: State-based trainings Each site conducted a multidisciplinary training using the Toolkit to identify recommendations from the Guidelines to implement Evaluation form and summary report required upon completion of training Trainings took place starting Spring 2011

12. State-based trainings: 1,052 Participants

13. State-based trainings: Type of training All trainings: o Used the Guidelines & Toolkit o Introduced participants to Guidelines & Toolkit o Had a dedicated facilitator & recorder o Evaluated the Toolkit Types of trainings varied: o 1-day training (AK, CT, ID, IL, KS, KY, Knox County, Los Angeles County, ME, Milwaukee, ND, Philadelphia) o Multiple-day training (FL, IA, MI, NV) o Regional trainings (AR, Cuyahoga County, DE, PA, WA, WV)

14. State-based trainings: Focus areas completed Sites completed between 3 and 12 focus areas Most commonly completed focus areas: o 1 – Relationships o 2 – Communications o 7 – Epidemiology investigations o 3 – Necessary resources o 6 – Initial steps

15. State-based trainings: Common themes Many sites reported similar improvements to be made: o Better communication o Better coordination o More training o More post-outbreak debriefs/ after-action reports o Use standardized investigation/interview/other forms o Utilize written protocols (create if necessary)

16. State-based trainings: Common themes Many sites reported similar Guidelines recommendations to be implemented: o Chapter 3 – Planning & Preparation  3.1 – Agency roles  3.2.3.3 – Agency-specific response protocol & other resources  3.2.3.4 – Training for the team  3.6.2.2 – Communication among the agencies & units of the outbreak control team o Chapter 5 – Investigation of Clusters & Outbreaks  5.1.2.5 – Standardized data collection forms  5.2.5 – Coordinate investigation activities o Chapter 6 – Control Measures  6.6 – Debriefing

17. State-based trainings: What was learned “We consider ourselves to be ahead of the curve, but staff roles need to be better defined in an outbreak investigation.” “Utilizing the Toolkit to guide a review of current practices was very valuable. We learned that we are doing a lot of things right but also learned that standardization of foodborne outbreak detection & response practices statewide would be helpful & could be improved.”

18. State-based trainings: What was learned (continued) “Enabling all of the jurisdictions to send representatives from multiple disciplines allowed for excellent networking opportunities & face-to-face discussions. All participants learned a lot… local health jurisdictions have developed various strategies to enhance outbreak response.” “Having the opportunity to get together & talk about current practices & needed improvements was very helpful.”

19. State-based trainings: Next steps Follow-up with sites that conducted trainings o Progress on identified action items o Impact of training on outbreak response

20. The CIFOR Toolkit is now available at: www.cifor.us www.cste.org CSTE Exhibit Hall booth

21. Thank you!