2006 Model Practice Application (Public)

The Control of Infectious Diseases Within Hurricane Katrina Evacuee Shelters

Dallas County Health and Human Services

This program addresses the elimination of potential public health threats by reducing all possible transmissions of infectious communicable diseases and foodborne illnesses. The target population consists of assistant managers, relief workers, volunteers and Hurricane Katrina evacuees.

In order to reduce the number of food borne illnesses and infectious diseases associated with operating these emergency evacuee shelters, the environmental health division developed a set of preventive health guidelines and recommendations Preventive health practices in food safety, communicable disease control, and general sanitation became an immediate concern for Dallas County Health and Human Services in Katrina evacuee shelter.

Through an effort to prevent a major communicable disease epidemic within these shelters and throughout the Dallas County community, the environmental health division of DCHHS assembled a preventive health inspection team to ensure that all preventive health recommendations and guidelines were installed and utilized in each shelter.

DCHHS was responsible for providing preventive health measures whenever communicable diseases are identified with Dallas County. The epidemiological staff of DCHHS received information that some Katrina evacuees were identified as being infected and exposed to various communicable diseases.

A public awareness campaign was implemented by posting signs and posters informing the evacuees about the presence of communicable diseases in these shelters. This program stressed the importance of adhering to personal preventive health practices to reduce the transmission of communicable diseases. Adequate hand washing was recognized as the most productive means of eliminating disease transmission throughout shelters. An aggressive hand washing and hand sanitizing campaign was created to reduce and eliminate disease transmission inside each shelter. All persons entering these shelters were required to apply hand sanitizer.

Daily inspections of designed food providers could possibly eliminate the threat of a food borne illness outbreak with each emergency shelter. On-site consultations were conducted and a public education program were implemented to educate food handlers on proper food protection and safety techniques.

The environmental health and epidemiology staff of DCHHS utilized existing tools, knowledge, and resources to develop a comprehensive set of recommended Preventive Health Guidelines and measures to address all public health concerns during this unprecedented Katrina evacuation effort.

An innovative strategy was developed to utilize law enforcement officers, military, and emergency personnel to maintain public health and safety within each shelter. These individuals were utilized to assist and provide protection for medical staff and volunteer workers and were used to help implement preventive health guidelines and recommendations.

Dallas County Health and Human Services became a major stakeholder as the lead public health agency for detection, prevention, and control of communicable diseases at emergency evacuee shelters. The environmental health and epidemiology divisions worked closely with various stakeholders during the planning and development phases of a preventive health plan.

Relief workers, volunteer organizations, support staffs, and evacuees were identified as important stakeholders and were utilized to implement the application phase of the preventive health measures and procedures within emergency shelters. This group of stakeholders were also responsible for ensuring that all recommended preventive health guidelines and measures were performed on a daily routine.

Local law enforcement officers and military personnel were employed to provide public safety and maintain civility within each shelter. Fire, emergency, and rescue workers provided large emergency decontamination units that were used as evacuee showers. Emergency and military personnel were used to encourage the use of hand sanitizers by all persons entering and leaving shelters.

Food service providers worked collaboratively with the environmental health staff to prevent the possible occurrence of a food borne illness outbreak. Food providers played an important role in providing nutritious meals to a large amount of people on a daily basis. Safe food preparation was a vital tool for shelter operations.

To foster collaboration with community stakeholders the environmental health division of DCHHS began an innovative public awareness campaign to inform, educate, and empower workers and evacuees about health issues by using posters and signs that addressed preventive health measures throughout each shelter.

To encourage proper hand washing, signs and posters were placed in and/or near restroom facilities, diaper changing stations, designated food service areas, and throughout the entire shelter. Hand sanitize stations were placed at all entrances, exits, restrooms, food service stations, relief worker stations, telephones and other hand contact equipment. These stations were manned by volunteer workers and the use of hand sanitizer was required. Sanitarians performed daily inspections to ensure that hand washing stations and hand sanitize stations were properly equipped and operating according to recommended guidelines.

Food preparation and service areas were inspected daily by sanitarians to ensure that proper food handling procedures and techniques were maintained during emergency shelter operations. The environmental health division worked closely with all designed food providers.

Diaper changing was identified as a critical control points, therefore designed diaper changing areas were placed in all shelters. Each infant requiring diapers were issued a personal supply of anti-rash ointments to eliminate possible cross transmissions of infectious diseases. Signs and posters were placed throughout each facility to emphasis the importance of utilizing proper diaper changing procedures.

Industrial janitorial support was identified as an important component in the preventive health guidelines and recommendations. Emergency shelter organizers and managers provided the janitorial staff and equipment necessary to ensure that each emergency shelter was maintained in a sanitary manner. An immediate and timely public health response was required and achieved by DCHHS to integrate these Preventative Health Recommendations and Guidelines into the daily operation of each emergency shelter.

There was sufficient stakeholders commitment to perpetuate the control of infectious diseases and food borne illness through the implementation of these preventive health guidelines and recommendations. To ensure commitment from stakeholders, Dallas County Medical Director demonstrated to all stakeholders the urgency to practice preventive health guidelines and recommendations to reduce and eliminate the threat of a food borne illness and infectious disease epidemic within the evacuee shelters.

Goal: To detect, protect, and control infectious diseases and food borne illness within the Katrina evacuee shelters.

Objective: To develop and implement a set of preventive guidelines and recommendations what would reduce and eliminate the threat of an infectious disease and food borne illness epidemic in shelters:

• Performance measures: Empowerment of all stakeholders through public health awareness campaigns. Daily meeting were held with all stakeholders (medical community professions, DCHHS sanitarians and epidemiology staff, volunteer workers, shelter managers, etc.) to ensure that preventive health guidelines and recommendations are incorporated into shelter operations by staff and evacuees as well.
  
  
• Data collection: 1) type and numbers of infectious diseases and food borne illnesses in shelters were reported; 2) data were collected by emergency physicians, clinicians, and health care workers of the Dallas County Medical Community; 3) data was collected by Dallas County Medical Community through an effort to provide medical assistant to ill evacuee patients.
  
  
• Outcomes (long-term): A desired outcome was the result achieved by the development and application of recommended preventive health guidelines and measures.