Fate and Transport of Onsite Wastewater Treatment System Derived Nitrogen in Coastal, North Carolina

A two year study (2009-2011) was conducted to assess the impacts that on-site wastewater systems (OSW) have on contributing nitrogen to water resources in coastal North Carolina. More specifically, soil water and shallow groundwater adjacent to two OSW, deeper groundwater from nearby water supply and/or irrigation wells, and estuarine waters were sampled and analyzed for both organic and inorganic nitrogen species. Nested piezometers were installed up and down-gradient of the on-site wastewater systems to allow for sampling groundwater at different depths beneath the water column. Multi-depth, suction lysimeters were installed up and down-gradient of the OSW for soil water sampling and analyses. The levels and quality of groundwater were monitored for 2 years. Various isotopic analyses were used to help quantify nitrogen concentration reduction processes. Results indicated that the concentration of nitrogen in soil water, shallow groundwater beneath and down-gradient from OSW were elevated relative to background wells. Nitrogen concentrations in shallow groundwater decreased with increasing distance from the OSW due to dilution, denitrification, and other processes. Nitrogen concentrations in existing irrigation wells (deeper than the monitoring piezometers) at sites 1 and 2 were similar to background levels. However, shallow groundwater down-gradient of OSW and near the estuary did contain elevated nitrogen concentrations. Above average rainfall was observed during the first year of study, leading to high water tables, while the second year had below average rainfall and deeper water tables. Organic and NH4 were the dominant N species during high water table periods, while NO3 was the dominant nitrogen species during periods of deeper water tables.

The Relationship between Local Health Department Capacity, Performance, and National Environmental Public Health Leadership Institute Participation in Providing Environmental Public Health Services, and Disease Ratios in a C

This project seeks to explore the relationship between local public health agency performance as assessed by the National Environmental Public Health Performance Standards (NEPHPS) instrument and various measures of local health agency capacity contained in contemporaneous data collected by the 2008 National Association of County and City Health Officials (NACCHO) Profile of Local Health Departments survey instrument, such as distribution of regulation, inspection and licensing activities in a community, as well the ratio of observed/expected cases of E.Coli, Shigella and Salmonella contained in the Community Health Status Indicators (CHSI). Our specific research questions are:

1. What is the effect of direct (local health department) versus indirect (other government agency or contracted to third party) provision of services on public health performance and on community health as reflected by the CHSI data mentioned above?
2. What is the relationship between variations in performance as measured by the NEPHPS instrument and community health as reflected by the CHSI data mentioned above?
3. What is the relationship between variations in environmental workforce capacity (number of FTEs classified as environmental health specialists, as epidemiologists, and as "other environmental scientists or technicians) and public health performance and on community health as reflected by the CHSI data mentioned above?
4. How do LHD that participated in EPHLI compare with peer counties on community health as  reflected by the CHSI data? Data from the NEPHPS instruments comes from public health system personnel, mostly health department personnel, responsible for providing environmental health services in a community; this data will be matched with the 2008 Profile and version 2.0 of the CHSI.
Preliminary findings reveal that that those LHDs with increase EH budget have improved performance. There also appears to be a relationship between EPHLI participating and improved environmental health outcomes compared to their peer counties.

Passing Parasites: A Rare Foodborne Giardiasis Outbreak at a Restaurant

Over a five-week period in 2010, five individuals diagnosed with giardiasis were reported to the Alexandria (VA) Health Department. Patronage at a specific restaurant between March and August was the only commonality. A review of the foods consumed did not identify any commonalities.  An Epi-Ready-trained multidisciplinary team conducted an investigation to assess possible sources of Giardia lamblia. An EH evaluation of the restaurant was

performed, focusing on food sources, backflow prevention and employee hygiene.  No food source or backflow prevention problems were identified. Many instances of inadequate handwashing and bare-hand contact with ready-to-eat-foods were observed. The restaurant had an unofficial employee health policy, but many employees were not aware of it.  Steps were taken to identify infected employees through antigen testing of stool specimens. Due to possible intermittent shedding, two specimens were collected from staff. Testing initially focused on kitchen staff, but was expanded following early results to include bartenders and wait staff. In total, 13 (28%) of 46 employees were positive for G. lamblia; only two reported symptoms within the past six months. Four of these employees cooked, the others were wait staff and bartenders.

A meeting with restaurant management established appropriate control measures.  To avoid closure, the restaurant agreed to develop a written risk control plan, an employee health policy and to require employee training. The risk control plan included strict hand washing, gloving, restriction of some employees, and paid sick leave for excluded employees. Also, the restaurant paid for lab tests.  Treatment of infected food workers was coordinated through the health department.  Frequent EH evaluations and strict control measures were key to controlling this outbreak. These included identification of infected food service workers, restriction or exclusion of positive employees, and hygiene training for restaurant staff.

OELs, and PELs, and SLs…Oh My?: A Review of Industrial Hygiene and Environmental Reference Levels and their Applicability to Indoor Air Quality Investigations

Analysis of indoor air quality sampling data can be complicated and challenging with the variety of reference values available as resources for comparison today. Industrial occupational exposure levels such as the Occupational Safety & Health Administration Permissible Exposure Limits (PELs) and American Conference of Governmental Industrial Hygienists Threshold Limit Values (TLVs) or outdoor/unaffected area controls have traditionally been viewed as the benchmark for comparison during IAQ investigations of most occupational settings. However, environmental reference levels, such as the OEHHA Reference Exposure Levels (RELs) and the Environmental Protection Agency’s Screening Levels (SLs) have become more readily available are now more frequently referenced as baselines of comparison, especially in office buildings and other non-industrial settings. Industrial hygienists and environmental, health & safety professionals must have a detailed understanding of the meaning and applicability of both traditional industrial hygiene and current environmental reference values in order to perform a comprehensive analysis of IAQ sampling data. This presentation will provide an overview of the development an intended application of several industrial hygiene and environmental reference levels, and discuss considerations for applicability to indoor air quality investigation scenarios.

The Risks and Thrills of cheap Elelctronic inspection systems

Interested in EIS but it's a budget breaker? In this presentation we will explore the use of hand-crafted and inexpensive (if not free) electronic inspection solutions through the eyes of a food safety professional and computer scientist in his never ending quest to avoid actual paperwork for half his career. Along the way, we will explore user requirements for any EIS system, deployment in the field, cost effective and cost - cutting measures when going high tech, and how to avoid lugging a laser printer down the snowy streets of Chicago. We also discuss the use of EIS by owner/operators in the current app market.

Do restaurant food handler knowledge gaps predict violations identified during inspections?

Approximately half of the foodborne outbreaks reported to the CDC are associated with restaurants or delicatessens. Periodic restaurant inspection by the local health authority helps to assess food handling behaviors but it is not designed to identify gaps in knowledge related to food safety. Therefore, the combination of measuring food handler knowledge and review of restaurant inspection scores allows a more complete understanding of the restaurant food handler.  To determine food safety knowledge gaps, we interviewed 729 suburban Chicago food handlers in 211 participating restaurants.  A 50 question survey was administered in English or Spanish during June 2009 through January 2010. 

The reports for inspections performed just prior to conducting the surveys were reviewed and violations were quantified.  Participants scored an average of 72% on the survey, with substantial knowledge gaps related to cross contamination, cooking temperatures and thawing and storage of food. The mean score for certified food managers was 79%.  Restaurants had an overall mean inspection score of 90.6 and the number of violations ranged from 0 to 19.  Among the most commonly reported violations, two were critical; one for the failure to maintain temperature requirements of potentially hazardous food (29%) and the other for inadequate food protection from potential cross-contamination (28%).  No significant correlation was observed between overall inspection score and certified food manager knowledge score as a result of regression analysis.  In general, knowledge gaps were not directly correlated with food safety citations in practice. However, there was a significant association between an inspection with a violation related to food handler hygiene and employing at least one certified food manager who missed at least one hand hygiene question, on the knowledge survey (RR=1.96, p=0.05). The results of this study suggest that restaurant inspection reports do not correlate well with certified food manager knowledge. Interpretation of these results should consider that some violations may be corrected during the inspection and not recorded on the report form.  Future research should focus on enhancing restaurant manager knowledge and determining what factors may motivate restaurant managers to ensure compliance with food safety policies that inspections are intended to monitor.         

Serving Up An Education: Online Food Safety Training

Washington State requires all food workers to complete a basic course on food safety.  Tacoma-Pierce County Health Department inspectors have taught food worker classes since the 1950’s.  Recently, in response to consumer demand, the department began searching for a more convenient way food workers could obtain the State required training.  

In January 2011, Tacoma-Pierce County Health Department launched the State’s first web based food safety training and testing program.  The interactive program offers users a 30 minute course on food safety in 8 different languages and closed captioning.  Upon completion of the course users take a test, pay for the course with a debit or credit card and print a copy of their food worker card.  

The online food worker class has been a success.  Nearly 80% of Pierce County’s food worker cards are now issued online.  Seventeen additional counties participate in the program, and more than 10,000 cards are issued monthly to food workers in those counties.  User surveys show a high rate of satisfaction with the class and significant time and travel savings. 

Participating health departments have realized cost savings and other incidental benefits. The development and launch of this online food safety program presented many challenges as well as opportunities.  This presentation will discuss the challenges, lessons learned, and benefits realized by both food workers and participating local health jurisdictions.

State Environmental Health Policy

The National Conference of State Legislatures (NCSL) is the trade association for state legislatures, meaning both the elected officials and the staff that serves them.  NCSL is the only organization that provides an open, bipartisan, national forum for lawmakers to communicate with one another and share ideas. NCSL's tracks state legislation, policies and chaptered laws to identify legislative trends and needs of the state legislative audience.  Most substantive state policies and programs require legislative approval, funding, and oversight.  As well, the most innovative or unique state policies come from state legislatures.

This session will review the state environmental public health legislation that was introduced and enacted during the 2011 state legislative sessions, including laws on food safety (particularly the cottage food industry), water and waste water (including private well and waste water use), natural gas fracking, chemical regulations (green chemistry) and zoonotic rules.  NCSL covers legislation from the 50 states, territories and the district of Columbia.  

Legislatures also hold the purse strings in state government and determine the funding levels of state agencies and programs.  Many legislatures appropriate federal funds designated for state and local programs and make policy decisions about their use.  As in Washington, D.C., health policy initiatives at the state level require legislative approval before they become policy.  For example, many innovative health initiatives and pilot programs sponsored by private foundations or federal grants require state legislative involvement, understanding, and approval if they are to succeed in the long term.

Handwashing: The Game-Changing Scale For Success in 2012

Poor hand hygiene has become the entrenched industry standard. Inability to implement broad risk-based interventions has resulted in hand hygiene being the  perennial winner of the title for "Single-most cited contributing factor in foodborne outbreaks." Year after year acceptance of poor handwashing behaviors has calcified the issue with a trail of frustration and repetitious trials of failing programs.  The common factor is the lack of measurement and the inability to sustain temporary enhancements. Everything routinely tried is rich in the sciences except for behavioral science and its attendant math. Think about changing your weight. First there is the commitment and then a scale to monitor success. Do you know anybody who has successfully dieted without a scale?  That is where we are at with hand hygiene.

Jerold R. Mande, USDA Former Deputy Under Secretary for Food Safety put it this way What doesn't get measured doesn't get done. Food workers first need measurable objectives to understand expectations and build everyday confidence and professionalism. They need to know where they are at on the scale of success.

The PIC, Person-In-Charge, addition to the Model Food Code is a major success yet it appears to have done little to resolve the number one problem – poor hand hygiene. PICs need tools to measure, document and manage.  This is a call to all operators and their 30,000+ inspectors to be open to change and onboard in creating an environment of innovation in kitchens across the country. Start small. Pick the easiest first step. Inspectors are asked to bring their full compliment of coaching skills and help operators build a hand cleanliness culture tailored to the establishment.  This presentation serves up a menu of three easy to adopt measures to improve hand hygiene standards. It starts with a new way to look at raising the handwashing priority for the workers. Second, is a series of examples of successful compliance monitoring techniques. Finally, a case is made to measure surface cleanliness – for those surfaces most likely to contaminate hands and the food prepared and served.

Army Field Sanitation Team: The Past, Present, and Future

US Army Field Sanitation Teams (FST) have served as public/environmental health extenders to company sized units (130 Soldiers) since World War II.  This is an additional duty assigned to two unit members who receive a 40 hour course in field sanitation covering subjects such as water quality, pest management, sanitation, and waste disposal.  If used properly, they are considered a valuable combat multiplier while reducing the unit's disease and non-battle injury rate.  FSTs are backed by an Army regulation but often fail because of competing interests, FST organization, and lack of command emphasis.  This presentation will look at levels of environmental health organization in the US Army, FST history, describe current problems reducing the effectiveness of FSTs, and present recommendations to improve these valuable teams. 

Using Environmental Public Health Tracking Data to Assess State Public Health Laws

In addition to tracking many of the exposures and health effects that may be related to environmental hazards, CDC’s Environmental Public Health Tracking Network is a tool that can be used by policymakers to assess the effectiveness of public health laws.  The tracking network provides standardized data that can be used to compare and contrast public health policy approaches from various jurisdictions.  

With support from the Centers for Disease Control and Prevention, the National Conference of State Legislatures has conducted research on select environmental public health laws in states participating in CDC’ Environmental Public Health Tracking Network.  This research analyzed different state approaches to reducing environmental exposures and adverse health conditions and compared these approaches using health outcome data from the Tracking Network.  

This session will provide an overview of select states’ environmental public laws targeting three health outcomes: asthma, childhood lead poisoning, and carbon monoxide poisoning.  Asthma prevention policies include surveillance, education and intervention programs.  State childhood lead poisoning prevention policies include different standards for lead in paint, dust, soil, water and consumer products, as well as surveillance and intervention programs.  While carbon monoxide detector requirements are the primary state strategy for preventing carbon monoxide poisonings, the scope of these laws vary by state. 

For each of the three targeted health outcomes, different state policy approaches will be presented and analyzed using specific data on asthma hospitalization rates, elevated blood lead levels in children, and carbon monoxide poisoning hospitalizations.