A Communicable Disease Tool for Schools: A Local Public Health Agency Addresses School Districts Needs Surrounding Infec

State: CO Type: Model Practice Year: 2009

The goal of the program was to identify and effectively address the needs of the 15 school districts in the TCHD region regarding infectious disease prevention and response. The objectives were to conduct an assessment of 100 percent of District Nurse Coordinators and Risk Managers in the 15 school districts in the TCHD region regarding their needs surrounding infectious disease prevention and response by December 31, 2005; identify the three most common needs regarding infectious disease prevention and response among school districts, based on the assessment, and implement recommendations that meet these needs by July 31, 2007; evaluate the effectiveness of TCHD in meeting the identified needs of the school districts regarding disease prevention and response by surveying at least 80 percent of school districts for feedback by December 31, 2007.
Although there is certainly precedence for a local health department providing resources to schools, a search of the literature and presentations at public health conferences revealed that TCHD’s use of a CD-ROM was an innovative and inexpensive way to reach schools and meet their infectious disease resource needs. The school districts asked for trainings to improve infectious disease and outbreak management knowledge among their health staff. Providing infectious disease-related trainings to individual schools is certainly a practice that exists among local health agencies. However, in the TCHD jurisdiction, there are 15 school districts with more than 300 schools; presenting trainings to health staff at each of these schools would have been extremely resource intensive for the health department. Rather than divert health department staff time to provide individual presentations for individual schools within each of the 15 districts, TCHD’s CD-ROM allowed distribution of infectious disease-related presentations, guidelines, and fact sheets to the district nurse coordinators, who could then use them or distribute them to individual schools as needed. Furthermore, creating the CD-ROMs was inexpensive and was determined to be user-friendly by the school districts. This can be an innovative and cost-effective way for local health departments to meet the training and infectious-disease resource needs of schools.
Agency Community RolesSchools are important partners for local health departments regarding disease surveillance, outbreak investigations, and disease prevention. School nurses are required by law to report certain conditions and diseases to local or state health departments, and schools also participate in disease surveillance activities, such as influenza-like illness reporting, to help health departments identify areas of high disease activity in the community. Working with schools to identify and meet their infectious disease-related needs is essential for local health departments to bolster disease detection, control, and prevention activities. TCHD’s role in this process was to serve as a resource for school health personnel regarding infectious disease prevention and response. The process also helped strengthen internal collaboration within TCHD. The original assessment of school districts demonstrated internal collaboration efforts between the disease control, nursing, emergency preparedness, and environmental health divisions of TCHD. The assessment tool was designed in collaboration with all these divisions to address any overlapping issues the schools may have had regarding communicable disease control and prevention. For example, if schools had questions regarding pandemic influenza, they were immediately referred to the emergency preparedness division at our agency. If the schools had questions about proper food preparation to reduce disease transmission, they were immediately referred to our environmental health division in our agency. The initial assessment encouraged interdivisional collaboration within our agency in our attempts to meet the needs of the school districts. School district nurse coordinators played a key role in planning and implementing this practice. It was their feedback that allowed TCHD to identify needs for educational materials, guidelines, and trainings, which led to the creation of the CD-ROM. It was also their efforts to distribute the CD-ROM’s contents to individual schools within each district that enabled TCHD to reach schools throughout its jurisdiction. Furthermore, it is their feedback that has helped us evaluate this tool. Two months after the CD-ROM was distributed, the school district nurse coordinators were surveyed again to obtain feedback on the CD-ROMs. The response rate was 87 percent. Among those who responded, 91.6 percent reported having already used the CD-ROM materials in their work, and 100 percent found the content of the CD-ROM, including viewing, opening, and navigation, easy to use. This indicated that the creation of the CD-ROM was meeting the school districts’ needs for information and training on communicable disease control and prevention. This project has strengthened collaboration and communication between TCHD and school districts. The face-to-face interviews with district nurse coordinators and risk managers improved rapport and communication between TCHD staff and the school districts. Furthermore, during the interviews, contact information was exchanged. The school district contact information was then added to TCHD’s Health Alert Network (HAN) database, a fax-based system that allows TCHD to quickly send out health information and advisories to healthcare providers and other organizations in our jurisdiction. By adding the district nurse coordinators and risk managers to our HAN database, we were able to improve our ability to distribute health updates and alerts to them in a timely manner. The school districts, in turn, had the direct contact information of our disease control staff, whom they could thereafter contact immediately whenever an infectious disease-related question arose. Overall, this project has improved communication and the flow of information between TCHD and schools. This helps with the overall goal of improving infectious disease prevention and reponse in schools, by enabling more frequent and more rapid interactions between schools and the health departments Costs and ExpendituresIn this project, educational CD-ROMs were made to meet the infectious disease-related needs of school districts, as identified in our assessment. The CD-ROMs included outbreak management and reporting guidelines, communicable disease training presentations, and disease-specific fact sheets. The total cost of creating and mailing the CD-ROMs was $207.75. The unit cost was $2.77 per CD-ROM,which included costs for shipping five CD-ROMs to each of the 15 school districts. The CD-ROM took approximately 40 hours of TCHD staff time for compilation, formatting, and medical review. This time was likely mitigated by the fact that many of the presentations, fact sheets, and guidelines were already created for other infectious disease-related training and educational needs. ImplementationTCHD conducted an assessment of 100 percent of 15 school districts in the metro-Denver area regarding disease prevention and response. The analysis revealed that commonly expressed needs included disease-specific trainings, fact sheets, and information on guidelines, immunizations, and pandemic/avian influenza. As a result of this assessment, a CD-ROM tool was created to better address the communicable disease-related needs of schools. We developed a questionnaire on disease prevention and response and conducted one-on-one interviews with each district’s nurse coordinator and risk manager (February–July 2005). We created a follow-up a questionnaire and sent it to district nurse coordinators to disseminate among school nurses to collect more specific information on their immediate needs (October–December 2005). This questionnaire collected information on each district’s structure, quantity, and primary functions of nursing and health aide staff, protocol for communicable disease reporting, and needed resources. We analyzed data to determine the most frequently requested items from all 15 districts. The three most commonly expressed needs of school districts were for information on communicable diseases and immunizations, state guidelines for communicable disease control, and communicable disease trainings for health aides (August 2006). We created a CD-ROM containing PowerPoint presentations that could be used to train nurses and health aides on infectious disease transmission and prevention, basics of outbreak investigations, vaccine preventable diseases, and other diseases commonly encountered in schools. The CD-ROM also included 45 factsheets, both in English and Spanish, on specific communicable diseases, as well as state guidelines for communicable diseases, disease report forms, and an updated list of notifiable disease (January 2007). We mailed five CDs to each school district nurse (March 2007). All district nurse coordinators were called three weeks after packages went out to confirm receipt and inquire about the need for more copies. CD-ROMs were then distributed by district nurse coordinators to school nurses and/or health aides. We created and sent an online evaluation survey to each cistrict nurse coordinator to assess the CD-ROM’s technical functionality, content, quality, benefits, distribution, and frequency of use (May 2007). The survey had a response rate of 87 percent. We analyzed responses from the survey to assess the usefulness and ease of use of the CD-ROM (June 2007).
The main stakeholders in this project were TCHD and the school districts. TCHD as an agency has found this practice to be a cost-effective way to consolidate and distribute training materials and information. Based on the positive responses of the school districts during our evaluation of the project, we believe that the school districts found it useful as well. Therefore, TCHD plans to update and resend the CD-ROMs to school districts periodically, as new infectious-disease related guidelines emerge. To ensure school district commitment, we plan to reevaluate the tool, and whether it meets their needs, periodically.