PICKAWAY COUNTY GENERAL HEALTH DISTRICT 2016 ANNUAL REPORT

PICKAWAY COUNTY GENERAL HEALTH DISTRICT 2016 ANNUAL REPORT Letter From the Health Commissioner: 2016 was an eventful year in public health and for our health district. Our staff were challenged with several disease outbreak investigations including shigella, pertussis, and legionella. We are continuing to make progress with accreditation. We are in the process of developing the Community Health Improvement Plan (CHIP) with help from community stakeholders. Through the accreditation process, we have continued to improve upon our services provided by Vital Statistics, Clinical Health Services, Environmental Health Services, Public Health Emergency Preparedness, and other essential core public health services for Pickaway County. We were fortunate to obtain two new grants through the Ohio EPA for mosquito control and surveillance activities and household sewage treatment system replacement projects. I would like to thank all of Pickaway County s support for the health district and would like to confirm we are continually striving to improve public health services for those in Pickaway County. Our services are just a phone call, office visit, or site visit away. Respectfully, Vernon G. Bolender, MD Health Commissioner Dr. Vernon G. Bolender, Health Commissioner Contact Us Give us a call for more information about our services. Pickaway County General Health District 110 Island Rd. Circleville, OH 43113 (740) 477-9667 Visit us on the web at www.pchd.org Check out our Community Health Assessment and Community Health Improvement Plan online at www.pchd.org Current Board Members Dr. Gary Gillen, President, District Advisory Council Appointment Mike Wolford, Vice President, District Advisory Council Appointment Craig Stevenson, District Advisory Council Appointment Art Goodwin, District Licensing Council Appointment Tony Mosley, City of Circleville Appointment Jay Elsea, City of Circleville Appointment Tami Clark, City of Circleville Appointment

Environmental Health Services 2016 Environmental Health Report Obtained Ohio EPA Mosquito Control Grant to conduct seasonal mosquito control activities including surveillance/ trapping, larvacide application and scrap tire abatement projects as well as providing a mosquito control program internship with the health district. Over 904 scrap tires removed from nuisance properties and 1700 scrap tires collected during the Fall 2016 Collection Event. Increased food safety training opportunities by holding several Level 2 Current Staff: Kelly Dennis, Environmental Health Director Candy Schwalbauch, Clerk Emily Dieterich, Sanitarian-in-training Jenifer Hassinger, Registered Sanitarian Ohio Certification courses for local food service industry. A total of 64 food service managers successful passed the certification program in Pickaway County in 2016. Obtained Water Pollution Control Loan Funds from Ohio EPA for eligible homeowners to fund repair and replacement of sewage treatment systems and began sewage system replacement projects in October of 2016. Conducted investigations,/ inspections of food operations, pools, schools, campgrounds, private water systems, solid waste and composting operations, & sewage systems. Completed nuisance and rabies investigations. 2016 EH Program data Inspections Food 830 1288 Sewage 862 1977 Water 219 477 Pools 71 122 Camps 29 92 Nuisances 402 369 Solid Waste Program 57 83 Animal Bites / Rabies 116 140 Mosquito Control 241 347 School Inspections 46 81 Other Inspections 33 114 Totals for 2016 2906 5090 Additional activities Data above shows number of inspections vs. activities performed by Environmental Health Sanitarians during 2016. Inspection totals include standard inspections and follow-up inspections. Activities include emails, phone calls, letters, reports, meetings, and other activities with each program. Food Protection Program Data 385 382 830 686 320 332 636 496 956 826 2015 2016 Data above reflects on comparison of number of animal bite investigation by species. We were fortunate to have 0 zero animals test positive for rabies during 2016. Data above shows a comparison of number of food operations licensed in Pickaway County, number of inspections completed by PCGHD, and number of violations / critical violations documented during 2016 vs 2015. While # of inspections increased in 2016, number of violations documented decreased in 2016. With an increase in number of inspections by health dept. as well as increased food safety training provided by health district during 2016 could have lead to fewer critical violations and non critical viola-

Environmental Health Services Mosquito Surveillance Traps set up at a location outside of New Holland, Perry TWP Environmental Health Services Provided 2016 Mosquito Control Grant PCGHD Scrap Tire Clean Up Projects Five Points Pike Scrap Tire Open Dump (Monroe TWP) 495 Logan Street Alley (Circleville) 25 Heffner Road Scrap Tire Nuisance (Saltcreek TWP) 304 Hayesville Road Scrap Tire Nuisance (Pickaway TWP) 80 PCGHD, RPHF Solid Waste District, Pickaway Commissioners Tire Collection Event Fall 2016 1700 Total 2604 2016 Mosquito Surveillance Data Total Number of Mosquitos Trapped and tested 1455 Data below indicate number of scrap tires removed from nuisance properties and collections events utilizing Mosquito Control Program funds during 2016. By removing scrap tires from communities, we can help reduce mosquito harborage conditions which can help reduce risks of mosquito borne illness such a s West Nile Virus and encephalitis. # of Tires Removed Total Number tested positive for West Nile Virus 3 pools (pools consists Percentage Tested Positive For West Nile Virus < 10.3 % Data above indicates evidence of West Nile virus in the mosquito population from mosquitos trapped and tested from Pickaway County during 2016. West Nile Virus (WNV) can be spread through the bite of an infected mosquito and can cause illness in humans and animals. When evidence of WNV is discovered in mosquito populations, health district staff will increase awareness within areas evident of WNV as well as try and coordinate removal of nuisance conditions that can harbor mosquitos or mosquito breeding (i.e. tall grass and weeds, stagnant water, scrap tires) Public Health Nuisance investigation data (left) demonstrates number of complaints investigated in 2015 compared to 2016. We observed an increase in complaints reported in 2016. Food Operation Licensing, inspection, consultation, and training programs Well permitting and water sampling Sewage system permitting, inspection services, real estate evaluations. Swimming pool licensing inspection and consultation. Campground licensing, inspection, and consultation School Environmental Health Inspections Animal Bite Investigation and Rabies testing Nuisance complaint investigation and enforcement Solid Waste and Compost Facility Inspection and licensing Scrap Tire Generator Inspection and Enforcement Disease Outbreak Investigation Tattoo and Body Art Facility Permitting and Inspection Vector Control and Mosquito Surveillance and Prevention Visit our website at http://www.pchd.org/ environmental.html to

Clinical Health Services Current Employees: Elaine Miller, RN,BSN, Clinical Health Director Sabrina Alphin, Clerk Barbara Steward, Public Health Nurse Karen Geider, BCMH Nurse Mindy Shears, Emergency Preparedness Coordinator CLINICAL SERVICES AVAILABLE TO PICK- AWAY COUNTY RES- IDENTS IN 2016 Tuberculosis Screenings and Clinics Free HIV Testing and Education Pregnancy Testing 2016 Clinical Health Services Report The Clinical Health Services Department at Pickaway County General Health District is dedicated to protecting and improving the health of the residents of our community. Our goal continues to be the evaluation and promotion of services to meet the ever-changing health care needs of the residents of Pickaway County. Immunizations are provided through the Vaccine For Children Program sponsored by the Ohio Department of Health. These vaccines are provided at no cost to eligible children through 18 years of age that are Medicaid eligible, uninsured, under-insured, American Indian, or Alaskan Natives. Our agency must screen these children appropriately for eligibility. Our BCMH program is going full force again. Our nurse provides needed assistance through home visits and case management for children with special health needs in the community. There are currently 109 children on this program in Pickaway county. This program provides billable revenue of our department. Our department participated in numerous activities though out the year in our community including the Community Baby Shower, Westfall Mall Day, Pickaway County Fair, Kids Day at the YMCA, Kindergarten Registration at Laurelville Elementary, Westfall POD set up, and a functional Exercise at the Pickaway County General Health District. The Director of Clinical Services routinely attends various agency meetings including, but not limited to, Family and Children First Council, Local Emergency Preparedness, Health Care Coalition, and the Continuum of Care Meeting. Our agency collaborates well with other local agencies to ensure that accurate resource material is available and services are not being repeated. Much of this year has been spent preparing for the Accreditation process. We have been assigned Domains, that we are responsible for finding and maintaining the proper documentation. We have participated in meetings for the CHIP (Community Health Improvement Plan) and for the QIA( Quality Improvement and Assessment) process. We have had several outbreak investigations that occurred during 2016, among which were, a Shigella Outbreak, a Pertussis outbreak, and a Legionella Outbreak. It requires a great deal of time to track and document these outbreaks. We continued to track our routine diseases as well. There are over 110 mandated infectious diseases that must be reported to our local health departments. These include tuberculosis, meningitis, Hepatitis C, pertussis, sexually transmitted diseases, influenza, and food-borne illnesses. Nurses enter information into ODRS(the database), make home visits, interview clients, and provide educational counseling to those with reportable diseases. Immunizations Health Education Free Vision Vouchers for Children Hemoglobin Screenings Communicable Disease Reporting and Tracking Head Lice Checks SIDS Follow-up Newborn Screenings Blood Pressure Checks Lead Tests/Lead Investigations in Homes Emergency Preparedness Child Fatality Review BCMH Program Home Visits Foster Family Nursing Assessments Our ongoing goal is to provide the highest quality of services to the Pickaway County residents in an efficient and timely manner.

Clinical Health Services Communicable Disease Report 2015 2016 Brucellosis < 5 0 Campylobacteriosis < 5 10 Chancroid 0 < 5 Chlamydia 142 172 Cryptosporidiosis < 5 10 E. coli < 5 < 5 Giardiasis < 5 < 5 Gonorrhea 16 24 Haemophilus influenzae < 5 < 5 Hepatitis A 0 5 Hepatits B 34 59 Hepatits C 140 215 Legionnaires' disease < 5 5 Lyme disease 0 < 5 Meningitis Bacterial < 5 < 5 Mumps < 5 0 Mycobacterial Non-TB 5 < 5 Pertussis 8 43 Salmonellosis 7 9 Shigellosis 0 14 Steptococcal disease, Group A < 5 < 5 Streptococcal disease Group B < 5 < 5 Streptococcus Pneumoniae < 5 8 Varicella 7 < 5 Zika 0 < 5 Total 392 596 Influenza Influenza-associated hospitalization 34 13 Influenza Suspected 221 229 Influenza Confirmed 141 139 Influenza Confirmed Type A 50 33 Influenza Confirmed Type B 53 < 5 Total Influenza Cases 362 368 TB Tests Given 279 230 Correctional Facility Communicable Disease Reports 2015 2016 Chlamydia 26 31 Coccidioidomycosis < 5 0 Giardiasis <5 0 Gonorrhea 9 15 Hepatitis B 37 60 Hepatitis C 1299 1950 Hepatitis E 0 < 5 Influenza-associated hospitalizaion 0 4 Legionnaires' disease 0 < 5 Mycobacterial Non-TB < 5 < 5 Salmonellosis < 5 0 Total Correctional Facility Communicable Diseases 1376 2063 2016 Disease Outbreak Investigation Data 14 0 3 SHIGELLOSIS LEGIONELLA PERTUSSIS 5 2015 2016 2016 Disease Outbreak Response Activities: Due to the increase number of suspected cases of shigellosis, pertussis, and legionella, our agency increased public awareness and disease prevention outreach within the community to help reduce public health risks associated with such diseases. Outreach activities for pertussis prevention included collaboration with school nurses and medical professionals to help inform and educate community about prevention measures for pertussis which include immunization. Some of our outreach activities due to the increased number of suspected cases of shigella included making public health advisory announcements for safe recreational water activities, educating local schools about prevention measures for shigella including frequent handwashing for both staff and students, and protecting food from contamination from infected food handlers. As for our legionella investigations, we increased awareness for patient care facilities about potential sources or harborage conditions for legionella, which included recommendations for facility inspections, monitoring and maintaining proper water temperatures in plumbing systems, ensuring facilities have adequate ventilation systems, and testing high risk populations for legionella. 8 43 Data above indicates number of communicable diseases investigated by disease type and does not indicate total number of diseases confirmed and shows trends from 2015 to 2016.

Accreditation What is Public Health Department Accreditation? The measurement of health department performance against a set of nationally recognized, practice-focused and evidenced-based standards. The issuance of recognition of achievement of accreditation within a specified time frame by a nationally recognized entity. The continual development, revision, and distribution of public health standards. The goal of Ohio s mandated national accreditation requirement is to improve and protect the health of the public by advancing the quality and performance of local health departments. A Message from Sharon Stanley, Accreditation Coordinator Pickaway County General Health District Pickaway County General Health District (PCGHD) is now in its second year of accreditation preparation. We started in 2015 with a Community Health Assessment, one part of almost a 100 requirements in 12 separate performance areas that will need to be uploaded for the National Public Health Accreditation Board (PHAB) review. PCGHD is carefully following its timeline for the review and visit progress. The PHAB Site Visitors will come to Pickaway County from the Washington D.C. area in the spring of 2018. The health department continues to meet its monthly self-planned timelines in terms of its accreditation process and has completed most all of six of the twelve Domain requirements at the end of 2016. We also formally registered with PHAB and received an approval for our application. In 2017, we will launch the other six areas of Domain work and pull it all together for a final look just prior to our submission of documents in late fall. Although the requirements for the initial review are documents, the real purpose of accreditation is to make sure that our operations and activity is reflecting what we say we do on paper. The good news is that PCGHD doesn t have to do everything that the accreditation requires by itself, a relief given our 12-employee agency and the operational restraints within our current budget. We do have to lead the effort, though, and our staff is staying extra busy these days. PCGHD must make sure that residents in our community are receiving essential and core services of public health to: 1) Prevent epidemics and spread of disease 2)Protect against environmental hazards 3) Prevent injuries 4) Promote and encourage healthy behaviors 5) Respond to disasters and assist communities in recovery 6) Assure the quality and accessibility of services. The health department is engaging the help of longtime partners and supporters to make sure that we have the policy and operations in place across our county to protect the public s health. You may have heard that we are now working on a Community Health Improvement Plan (a CHIP) after finishing our Community Health Assessment. This plan will be released in August of 2017 and involves over 40 partner agencies and members of the public. If you might be interested in joining our effort to assure A HEALTHY COMMUNITY it s not too late! Please call Sharon at 740.477.9667 Ext. 139. In Ohio, 15 out of 120 local health departments are already accredited. The mandate for LHD accreditation is to accomplish this process by 2020. Ohio is the only state that mandates what was designed as a voluntary process by the Public Health Accreditation Board. Screenshot credited to PHAB, 2017, retrieved from http://www.phaboard.org/

Clinical Services BCMH Bureau for Children with Medical Handicaps (BCMH) # of children active in BCMH diagnostic, treatment, etc 219 # of children contacted (unduplicated by phone or visits) 135 # of children with primary care physician or medical home identified 89 # of children with Primary dentist identified 73 Number of Children that have: a. Individualized Education Plan (IEP) 34 b. Individualized Service Plan (ISP) 7 c. Individualized Habilitation Plan (IHP) 0 d. 504 Plan 6 e. Comprehensive Service Plan (CSP) < 5 f. Individual Family Service Plan 7 Barriers to care for all children served Family Health issues <5 Lack of BCMH providers <5 No Transportation 7 Nutritional Issues <5 Family Dynamics <5 BCMH Program Activities BCMH Stats # of Site Visits 82, 6% 1250, 94% # of activities conducted in program Data to the left shows BCMH program statistic for clients within Pickaway County for 2016. Data above shows activity summary of our BCMH nurse for 2016 including site visits vs. number of program activities. Vital Statistics and Administration Vital Statistics Services Provided: Birth Certificates Death Certificates Burial Permits Files medical supplements Files Certificates of Service Issues Birth Correction Affidavits Executes Birth Correction Affidavits Processes Birth / Death Verifications Processes Paternity Affidavits Issues Government Use Only Copies Assists in Genealogy Research 2016 Vital Statistics Number Births Registered 377 Births Verified 15 Birth Certificates Issued 321 Birth Affidavits Processed 14 Paternity Affidavits Processed 1 Deaths Registered 373 Burial Permits Issued 316 Fetal Deaths Registered 4 Deaths Verified 16 Death Certificates Issued 1382 Death Affidavits Filed 14 Certifcates of Service Filed (Death) 4 Certified copies of birth and death certificates are $28.00 in Pickaway County. Of the $28.00 fee, $1.45 goes to Domestic Violence Prevention Fund, $1.00 goes to the Local Subsidy Fee, $2.91 to the Ohio Children Trust Fund, $3.00 Vital Statistics Base Fee to Ohio Department of Health, $5.00 to Vital Statistics Technology Fee to Ohio Department of Health, and $14.64 remains locally in our Vital Statistics fund to help cover costs of administering the program. Current Vital Statistics / Administration Employee Paula Johnston (Deputy Registrar and Accounts Clerk) manages the vital statistics office for Pickaway County as wells as all accounts for the health district. Vital Statistics office is where you obtain birth and death records/ certificates in Pickaway County.

Current Fiscal Officer: Steve Hawkins 2016 Fiscal Report TRAVEL REMIT TO STATE SUPPLIES/EQUIP. CONTRACTS OTHER CHARGES MOSQUITO CONTROL ADVANCES AND TRANSFERS PERSONNEL 2016 Expense Report