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community health lecture notes, Lecture notes of Community Health

community health lecture notes

Typology: Lecture notes

2022/2023

Uploaded on 06/29/2025

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Chapter 15 Surveillance and Outbreak Investigation
Objectives
1. Define public health surveillance.
DISEASE SURVEILLANCE
-Definitions and Importance
Disease Surveillance
The ongoing systematic collection, analysis, interpretation and dissemination of specific health data for use in
public health.
Surveillance is important because it generates knowledge of a disease or event outbreak patterns (including timing,
geographic distribution, susceptible populations).
Event
Event outbreak patterns (including timing, geographic distribution, susceptible populations).
Biological terrorism
Anthrax=most feared of all biological terrorism agents
It doesn’t degrade easily.
It can become aerosolized and it’s very easy to distribute.
It’s very virulent and can cause a lot of death quickly.
Chemical terrorism
-Purposes of Surveillance
Assess public health status
Define public health priorities
Plan public health programs
Evaluate interventions and programs
Stimulate research
Helps public health departments:
Identify trends and unusual disease patterns.
Set priorities for using scarce resources.
Develop and evaluate programs for commonly occurring and universally occurring diseases or events.
Link public health priorities with HP 2020 – see how it changes and new ones are added…. The reason is
surveillance data/
2. List types of surveillance systems.
TYPES OF SURVEILLANCE SYSTEMS
1. Passive System:
1. case reports are sent to local health departments by health care providers (i.e., physicians, nurses), or
laboratory reports of disease occurrence are sent to the local health department (data bases).
2. Active System:
1. nurse, as an employee of the health department, may begin a search for cases through contacts with local
health providers and health care agencies.
2. Nurses initiates the investigation
3. Sentinel System:
1. monitors key health events when information is not otherwise available or in vulnerable populations to calculate or
estimate disease morbidity.
2. Find sentinel spot: where did it begin?
4. Special Systems:
1. developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel
systems.
5. Syndromic surveillance systems
1. a result of bioterrorism, these newer systems are being developed to monitor illness syndromes or events
2. Don’t act upon diagnoses, they act upon manifestations.
1. Lots of diarrhea going on or rashes. Not diagnosing it as measles, just noting that there are a lot
of rashes. Cases aren’t reported yet. Just the observations.
2. Chickenpox vs. Smallpox
1. Look very similar. Vesicular. Tell em apart-p. 488*** When chickenpox presents itself,
rash usually begins on the belly then goes out from there. Smallpox starts on face,
mouth, nose, lips area and goes out from there. Lesions same stage in all areas for
smallpox-it’s all bad. Intermittent healing with chickenpox wait for it to fall off.
2. Why? Eradicated conditions we don’t see anymore. Eradication means it’s gone
worldwide. We don’t see it anymore. Don’t know what it looks like. That’s why we
need to look at manifestations. Eradication vs. elimination***
3. Identify steps in planning, analyzing, interviewing, and evaluating surveillance.
4. Recognize sources of data used when investigating a disease/condition outbreak.
Data Sources for Surveillance
1. Cases reported by clinicians, health care agencies, and laboratories to state health departments
2. Death certificates
3. Administrative data (i.e., billing)
1. Find out what hospital billed for, like laboratory testing.
4. Sentinel surveillance system
1. http://www.ncbi.nlm.nih.gov/books/NBK11770/
5. Describe role of the nurse in surveillance and outbreak investigation to the national core competencies for public health nurses.
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Chapter 15 Surveillance and Outbreak Investigation  Objectives

  1. Define public health surveillance.  DISEASE SURVEILLANCE -Definitions and Importance  Disease Surveillance  The ongoing systematic collection, analysis, interpretation and dissemination of specific health data for use in public health.  Surveillance is important because it generates knowledge of a disease or event outbreak patterns (including timing, geographic distribution, susceptible populations).  Event  Event outbreak patterns (including timing, geographic distribution, susceptible populations).  Biological terrorism  Anthrax=most feared of all biological terrorism agents  It doesn’t degrade easily.  It can become aerosolized and it’s very easy to distribute.  It’s very virulent and can cause a lot of death quickly.  Chemical terrorism -Purposes of SurveillanceAssess public health statusDefine public health prioritiesPlan public health programsEvaluate interventions and programsStimulate research Helps public health departments:Identify trends and unusual disease patterns.Set priorities for using scarce resources.Develop and evaluate programs for commonly occurring and universally occurring diseases or events.Link public health priorities with HP 2020 – see how it changes and new ones are added…. The reason is surveillance data/
  2. List types of surveillance systems. TYPES OF SURVEILLANCE SYSTEMS **1. Passive System:
  3. case reports are sent to local health departments by health care providers (i.e., physicians, nurses), or laboratory reports of disease occurrence are sent to the local health department (data bases).
  4. Active System:
  5. nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies.
  6. Nurses initiates the investigation**
  7. Sentinel System:
  8. monitors key health events when information is not otherwise available or in vulnerable populations to calculate or estimate disease morbidity.
  9. Find sentinel spot: where did it begin?
  10. Special Systems:
  11. developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems. **5. Syndromic surveillance systems
  12. a result of bioterrorism, these newer systems are being developed to monitor illness syndromes or events
  13. Don’t act upon diagnoses, they act upon manifestations.
  14. Lots of diarrhea going on or rashes. Not diagnosing it as measles, just noting that there are a lot of rashes. Cases aren’t reported yet. Just the observations.
  15. Chickenpox vs. Smallpox
  16. Look very similar. Vesicular. Tell em apart-p. 488*** When chickenpox presents itself, rash usually begins on the belly then goes out from there. Smallpox starts on face, mouth, nose, lips area and goes out from there. Lesions same stage in all areas for smallpox-it’s all bad. Intermittent healing with chickenpox wait for it to fall off.
  17. Why? Eradicated conditions we don’t see anymore. Eradication means it’s gone worldwide. We don’t see it anymore. Don’t know what it looks like. That’s why we need to look at manifestations. Eradication vs. elimination*****
  18. Identify steps in planning, analyzing, interviewing, and evaluating surveillance.
  19. Recognize sources of data used when investigating a disease/condition outbreak. Data Sources for Surveillance
  20. Cases reported by clinicians, health care agencies, and laboratories to state health departments
  21. Death certificates
  22. Administrative data (i.e., billing)
  23. Find out what hospital billed for, like laboratory testing.
  24. Sentinel surveillance system
  25. http://www.ncbi.nlm.nih.gov/books/NBK11770/
  26. Describe role of the nurse in surveillance and outbreak investigation to the national core competencies for public health nurses.

-Collaboration among Partners  A quality surveillance system requires collaboration among a number of agencies and individuals.  Such collaboration promotes the development of a comprehensive plan and a directory of emergency responses and contacts for effective communication and information sharing.  Nurses are often in the forefront of responses to be made in the surveillance process.  The type of information to be shared includes the following:  How to use algorithms to identify which events should be investigated (i.e., using a precise step-by-step plan outlining a procedure that in a finite number of steps helps to identify the appropriate event)  How to investigate  Whom to contact  How and to whom information is to be disseminated  Who is responsible for appropriate action -Nurse Competencies  Core Competencies include:  Analytic assessment skills  Communication  Community dimensions of practice  Basic public health science skills  Leadership and systems thinking  A hospital is a system-own unique way of doing business.  Nurse needs to look at system and leadership and see how we can positively impact it  Introduction  Disease surveillance has been a part of public health protection since the 1200s.  The Constitution of the United States provides for “police powers” necessary to preserve health safety as well as other events. These powers include public health surveillance.  State and local “police powers” also provide for surveillance activities.  Disease surveillance has been a part of public health protection since the 1200s during the investigations of the bubonic plague in Europe.  Wanted to see what was happening and why people were sick  The Constitution of the United States provides for “police powers” necessary to preserve health safety as well as other events (see Chapter 7). These powers include public health surveillance.  State and local “police powers” also provide for surveillance activities.  Health departments usually have legal authority to investigate unusual clusters of illness as well.  Global Infectious Disease Surveillance Frameworks (framework/model for global surveillance) -Uses of Public Health Surveillance  Public health surveillance can be used to facilitate the following:  Estimate the magnitude of a problem (disease or event).  Determine geographic distribution of an illness or symptoms.  Portray the natural history of a disease.  Detect epidemics; define a problem.  Generate hypotheses; stimulate research.  Think of causal plausibility of why a problem is happening. Statistics do not improve causation, they link things together. They don’t ever cause it. That happens when we have documentation of records, specific things happening, we’ve observing this. That’s plausibility. Plausability can generate a hypothesis that stimulates research.  Evaluate control measures.  Monitor changes in infectious agents.  Detect changes in health practices.  Facilitate planning.  Minnesota Model of PH Interventions: Applications for PHN practice  Public Health Nursing Section: Public Health Interventions–Applications for Public Health Nursing Practice. St. Paul: Minnesota Department of Health, 2001.  NATIONAL NOTIFIABLE DISEASES  Box 15-3 shows the national notifiable infectious diseases  National Notifiable Disease Surveillance System (NNDSS)  Reporting of disease data is essential if trends are to be accurately monitored.  Morbidity and Mortality Weekly Report  Summary of Notifiable Diseases – United States (annual report)  State Notifiable Diseases  Requirements for reporting diseases are mandated by law or regulation.  Each state differs on the list of reportable diseases.  http://www.healthy.arkansas.gov/programsServices/epidemiology/Documents/ReportableDisease.pdf  Not all nationally notifiable diseases are legally mandated for reporting in a state.  National Electronic Telecommunications System for Surveillance (NETSS)  National Electronic Disease Surveillance System (NEDSS)  Follow-up to NETSS  When reporting nationally, all automated systems can communicate with each other. Also, throughout the world.  Before using the National Electronic Disease Surveillance System (NEDSS), CDC developed and used the National Electronic Telecommunications System for Surveillance (NETSS). NETSS is a computerized public health surveillance information system that provided CDC with weekly data regarding nationally notifiable diseases. NETSS continues to be used by reporting

 Standard Precautions  Response to bioterrorism or large-scale infectious disease outbreak may require the use of  Protecting health care providers from exposure including use of standard precautions when coming in contact with broken skin or body fluids, use of disposable nonsterile gowns and gloves followed by adequate handwashing after removal, and use of a face shield Summary  Surveillance is practiced at local, state, regional, national and international levels  Many uses for public health surveillance that are very similar to the steps in the epidemiology process.  According to S and L ( 2014), surveillance system evaluate the effectiveness of PHP (public health programs), Monitor and decrease incidence of chronic diseases, and note and help prevent occupational exposure and diseases.  What is the difference between Active and Passive Surveillance?  Passive: Building a database  Active: Nurse seeks out investigation  Patterns of occurrence are important to the Surveillance Investigation. Ex: Common Source, Point source, mixed… WHY?  Important to prevent spread by knowing where it started. You can go back and decide how to prevent it and see if interventions worked or not.  Active is imitated by a nurse to identify an event ( timing, geographic distribution, susceptible populations) look at unusual incidence of diseases… example common source bronchitis in school system.