Over 130 years o f public hea lth

On behalf of the New Hanover County Board of Health

and the staff of the New Hanover County Health Depart-

ment, we are pleased to present our Annual Report for

fiscal year 2011-2012. Our Annual Report represents the

provision of public health programs and services for peo-

ple in New Hanover County.

All of us at New Hanover County Health Department believe that we can make

a difference as we strive to become the healthiest county in North Carolina. Our

mission is to promote a safe and healthy community. This mission is accom-

plished through assessing the health needs of the community and establishing

health objectives to maintain essential personal, family, animal, community and

environmental health services.

During fiscal year 2011-2012, the Health Department experienced many chal-

lenges and opportunities. A great deal of important work was done during the

year, and is described throughout this report. Among the most notable high-

lights were:

North Carolina Association of County Commissioners 2011 Productivity Award

New Hanover County Community Health Assessment

Financial Management Transitioned to New Hanover County Finance Department

Animal Control Services Transitioned to Sheriff’s Office

New Hanover County Board of Health Mosquito Policy Adopted

North Carolina Public Health Best Practice for Surveillance and Reporting Award

Our annual report focuses on many programs, services and activities. For a more detailed account of our Health Department, please visit our website at: www.nhchd.org. We hope you find our report useful.

We are proud of our history of serving our community for the last 130 years. “From the Northeast River to Federal Point, and from the Cape Fear to the Sea—City, Suburb, Village and Farm—we are one people striving for healthful "and useful living.”

David E. Rice, MPH, MA Health Director

New Hanover County Board of Heal th

Members

Michael E. Goins, OD, Chair

Virgina Adams, PhD, Vice-Chair

Commissioner Rick Catlin

Melody Speck Evans, DVM

James R. Hickmon, RPh

Robert E. Lewis

Linda (Candy) Robbins

Robert Schiffel, DDS

Robert M. Shakar, Jr., MD

C. Benjamin Spradley

Karen L. Valiquett, PE

NEW HANOVER COUNTY HEALTH DEPARTMENT

Caption

2029 South 17th Street

Wilmington, NC 28401

910-798-6500 phone

910-341-4146 fax

www.nhchd.org

www.facebook.com/NHCHealth

www.twitter.com/NHCHealth

2011-2012 Annual Report

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North Carolina Association of County Commissioners

2011 Local Government Federal Credit Union Employee

HEALTH PROGRAMS ADMINISTRATION

The New Hanover County Health Department’s Quality Improvement team has been recognized by the North Carolina Association of County Commissioners. The team was awarded the 2011 Local Government Federal Credit Union Employee Productivity Award for improving vaccine accountability in the health department. This multi-disciplinary team developed a project intended to reduce discrepancies between actual physical vaccine inventory and the recorded inventory. Among other improvements, the group has produced an instructional video for nurse training in order to sustain the continued consistency in drawing doses from multi-dose vials. This quality improvement project has been selected to be highlighted by the North Carolina Center of Public Health Quality as an example for other local health departments in the state and has drawn interest from the Centers for Disease Control in Atlanta, Georgia as well as the State of North Carolina’s Immunization program. This is the second NCACCO Productivity award for NHCHD in recent years. For this project, the team included Trena Ballard, Larry Grimsley, Kelley Honeycutt, Paula Jenkins, Tami LaNunziata, Kristin Neal, Kim Roane, Maria Standfest and Nikki Todd. The group includes employees from the Support Services Division’s Billing Unit and Fiscal Support teams, Personal Health Services’ Clinic and Community Health teams and the County’s Information Technology Department.

The team was awarded the 2011 Local Government Federal Credit Union

Employee Productivity Award for improving vaccine accountability in the

health department.

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HEALTH PROGRAMS ADMINISTRATION

NE W HANOV ER COUN T Y COMMU N IT Y HE ALTH ASS E SSME N T

The 2011 New Hanover County Community Health Assessment has been released and distributed throughout the community. Every three years, the community health assessment involves a collaborative process among community partners to evaluate the health status of the county, by collecting information firsthand from residents and health data from local, state and federal sources. This provides the opportunity to identify the leading health priorities and develop a plan to effectively address these health issues in New Hanover County. During the interim periods, a State of the County Health Report (SOTCH) is completed annually to highlight the progress of programs, policies and environmental changes related to health priorities and improving the health status of the community.

Below are some key findings from the 2011 New Hanover County Community Health

Assessment:

New Hanover County and North Carolina shared the same top five leading causes of death: heart disease, cancer (all sites), cerebrovascular disease, chronic lower respiratory disease, and unintentional injuries. Heart disease is the leading cause of death in New Hanover County with 1,982 deaths from 2005-2009.

New Hanover County death rate is higher than the rate for North Carolina; 200.5 compared to 191.7 per 100,000 persons.

Since 2007, New Hanover County continues to have higher percentages of heavy and binge drinkers than North Carolina.

As of 2009, 80.6 percent of adults in New Hanover County do not consume the recommended amount of fruits and vegetable servings per day.

Chronic diseases, obesity, and drug and alcohol abuse were voiced by residents as the county’s biggest health concerns.

New Hanover County residents collectively expressed the desire for continued community collaboration efforts, attention to youth prevention initiatives, pedestrian safety improvements and community well-being.

For the full version of the 2011 Community Health Assessment or to view the 2010 State of the County Health Report,

please visit the New Hanover County Health Department’s website page located under health reports:

http://www.nhcgov.com/Health/healthreports/Pages/default.aspx.

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Animal Control Services Transitions to Sheriff ’s Office

HEALTH PROGRAMS ADMINISTRATION

NHC-TV and New Hanover County Health Department partnered to provide ongoing health information to our community through a TV segment called Health Matters. This year, Health Matters provided a variety of health topics ranging from the health benefits of eating fresh

fruits and vegetables at available farmers markets in New Hanover County to showcasing the importance of pool inspections that ensure the safety of pool swimmers. Health Matters segments can be found on http://www.youtube.com/user/nhctv and on New Hanover County Health Department’s Facebook page at http://www.facebook.com/NHCHealth.

On March 1, 2012, the New Hanover County Sheriff’s Office assumed responsibility of Animal Control Services. Captain Ken Sarvis oversees the Animal Services Unit, which is now a division of the Sheriff’s Support Services Unit. Staff from the Health Department, Sheriff’s Office and County Finance worked together to ensure a smooth transition. Animal Control Services, now called Animal Services Unit, is part of the Support Services Division of the Sheriff’s Office. The Animal Services Unit will continue to provide animal services, such as rabies education, vaccinations and registration. The health department will continue in its role to help prevent human rabies after an animal exposure. Public health nurses follow up on referrals from the Animal Services Unit by providing education on rabies disease, prevention and post-exposure prophylaxis to victims of animal exposure situations. For more information about the Animal Service Unit call (910) 798-7500.

SOC I AL ME D I A In April 2011, the New Hanover County Health Department developed a Social Media Committee with the intent of estab-lishing our presence on Twitter and Facebook. The goal of this group is to increase marketing and community education for the Health Department. This committee is made up of representatives from Personal Health Services, Animal Control Services, Support Services, Health Programs Administration and Environmental Health and meets on a regular basis. In just over one year, we have made the following progress:

Twitter – 488 Tweets (messages), 73 Followers

Facebook – 231 Likes (fans), 87,427 friends of fans (potential reach)

HE ALT H MAT T ERS

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SAFE R CROS S WALKS F O R SAFER COMMU NIT I E S

HEALTH PROGRAMS ADMINISTRATION

Conflicting service requests during prior years made it imperative for us to propose a more formal process for citizens desiring their property to be excluded from spraying to kill adult mosquitoes. Staff conducted extensive research for recommendations through nationwide contacts with other jurisdictions, the American Mosquito Control Association, NCSU Cooperative Extension Service, and the US and NC Departments of Agriculture. We proposed and the Board of Health adopted unanimously a Mosquito Control Policy rather than regulatory protocols and procedures. It requires that individuals objecting to treatment of their property with adulticide make formal written application to the Health Department with the concurrence and signatures of two (2) adjacent occupants, and give notice to other impacted entities such as the home owner’s association and municipality in which the property is located. The objective has been to establish a process whereby the interests of all affected parties could be communicated and evaluated on an equitable basis. Until late spring, it was uncertain whether we would be able to continue our surveillance of arboviral diseases with sentinel chickens. The State Public Health Laboratory concluded their support of this activity in November 2011. Chickens do not amplify disease risks, but testing their blood will demonstrate any exposure to virus transmitting mosquitoes. Chickens, fencing and a APHIS-USDA laboratory in Ames, Iowa, however, were secured to continue this method of surveillance by the end of May.

Given the visibly increased risk of West Nile virus, it is fortuitous as we can immediately advise the public when mosquitoes carrying the disease are confirmed by testing the chicken blood. Through this same protocol, we issued public notifications in July of the presence of Eastern Equine Encephalitis (EEE) in the local mosquito population.

MOS QU I TO CONT ROL

The Safe Kids Cape Fear Coalition and City of Wilmington partnered to provide Wilmington’s streets with safer crossing options on 8th and Castle Street and 10th and Castle Street. On April 26th, the ribbon cutting event showcased two improved intersections with newly improved crossing signals. The pedestrian signal heads and highly visible cross walks were funded through an environmental task force grant of Safe Kids USA. In addition to the new pedestrian safety features, Safe Kids Cape Fear Coalition, sheriff’s deputies and city law enforcement also conducted bicycle and pedestrian safety education for children.

ENVIRONMENTAL HEALTH SERVICES

What does implementation of the Food Code

in North Carolina mean?

No Bare Hand Contact With Ready-To-Eat Foods – shall use clean utensils, single use deli paper or gloves.

Hand Washing – employees shall wash hands and all exposed portions of their arms.

Employees – shall not wear nail polish nor artificial nails; shall not wear jewelry on hands/arms except for a plain band

ring; may only eat and/or drink in designated areas to prevent contamination.

Employees shall notify the manager or person-in-charge – when they are sick and/or experience symptoms

including vomiting, diarrhea, jaundice, sore throat with fever, or an infected lesion or infection on the hands, wrists, or

exposed areas of the arm; if they have been diagnosed by a health practitioner as being sick from norovirus, hepatitis

A, Shigella, shiga toxin-producing E. coli, or Salmonella typhi; if they have been exposed to norovirus within the past

48 hours, shiga toxin-producing E. coli within the past 3 days, Salmonella within the past 14 days, and hepatitis A

within the past 30 days. Any sick, symptomatic, exposed or diagnosed employee shall be excluded or restricted.

Cold Holding – refrigeration units must maintain foods at or below 41°F except existing units that maintain foods at or

below 45°F. By January 1, 2019, all refrigeration units must continuously maintain foods at or below 41°F.

Date Marking – all ready-to-eat potentially hazardous foods held in refrigeration for 24 hours or more must be marked

with the date the food must be consumed, sold or discarded; refrigeration at or below 41°F – maximum 7 days, and

refrigeration at or below 45°F – maximum 4 days.

Consumer Advisory – if beef, eggs, fish, lamb, milk, pork, poultry or shellfish is served raw or under-cooked,

consumers must be advised of the increased risk by a disclosure and reminder using brochures, menu advisories,

label statements, table tents, placards or other effective means.

For copies of related documents and regulations:

http://ehs.ncpublichealth.com/food/docs/15A-NCAC-18A-2600-FINAL.pdf

http://ehs.ncpublichealth.com/food/docs/NC-FoodCodeManual-2009-FINAL.pdf

FO O D CODE

If you need to discuss any of these requirements, please call:

Environmental

Health Services

910-798-6667

Alicia Pickett, REHS

910-798-6579

Hours 7:30 a.m. – 5:00 p.m.

Mon-Fri

Ricky Gibbs, REHS

910-798-6615

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PERSONAL HEALTH SERVICES

GE N ER AL CL I N IC S ERV IC ES

LAB OR ATORY

The number of overall specimens processed in the lab for fiscal year 2011-2012 was less than 2010-2011. There was an increase in the fourth quarter with volumes at levels consistent with the prior year. The highest volume of tests still continues to be in the areas of hematology, syphilis/HIV screening and Gonorrhea testing. The lab continues to work with Health Department programs in support of their testing needs and to assist with phlebotomy in a variety of outreach situations.

The Breast and Cervical Cancer Control Program (BCCCP) met our goal for providing service to 100 women and received extra funding to provide services to fifteen women. Our BCCCP program screenings included eight women who were eventually found to have breast cancer and had treatment initiated.

The Immunization Clinic had a major change in vaccines which stated that everyone qualified for the Tdap (Tetanus, Diphtheria, and Pertussis), vaccine whether insured or not. The staff conducted sever-al outreach Tdap clinics such as with the March of Dimes. Our walk-in pregnancy testing fee policy was changed.

BR E AS T AN D CERV IC AL CANCE R PROGRAM

WOM EN ’S PR E VE N TIV E HE ALTH

Women’s Preventive Health Services provides women’s preventive health, family planning for men and women, STD services and well child health services. The clinic has an open access schedule and operates from 7:45am to 5:00pm, Monday through Friday. We implemented a few changes this past fiscal year such as providing long acting reproductive contraception, IUDs, for family planning patients, new state forms used for family planning and child health patients. The clinic has two full-time and one part-time Nurse Practitioner.

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PERSONAL HEALTH SERVICES

CAR E COORD I NATI ON

Pregnancy Care Management (PCM): Pregnancy Care Management is provided by a partnership between NC Division of Public Health, NC Division of Medical Assistance, and Community Care of NC. The purpose of the program is to improve birth outcomes with the following goals: providing case management to only the high risk pregnant women, to ensure that pregnant woman have one medical provider for prenatal/postpartum care; and decrease the number of non-urgent emergency room visits. We currently have four case managers, one of which is bilingual. The staffs work closely with New Hanover Regional Medical Center, Coastal Family Medicine and New Hanover Community

Health Center to meet the needs of these women. Two of these case managers are also state certified SIDS counselors for New Hanover County. They provide counseling to families who have experienced a SIDS death and provide education in the community about safe sleeping and reducing the risk of SIDS. Both Care Management Teams work closely with Wilmington Kiwanis Club to offer pack-n-play cribs to needy families.

Maternal Health: The Maternal Health program consists of two Public Health nurses. These nurses are responsible for completing new Obstetrician interviews at New Hanover Regional Medical Center- Obstetrics (OB) clinic, completing post-partum newborn home visits, making high-risk home visits to pregnant women, and diabetes instruction. The program also provides diabetic supplies to pregnant women who are not eligible for Medicaid.

Care Coordination for Children (CC4C):The program is provided in cooperation with NC Division of Public Health, NC Division of Medical Assistance, and Community Care of North Carolina. The goal of the program is to improve health outcomes of children birth to five years by improving access to quality care and supporting family self-sufficiency, while reducing costs to Medicaid. Staff work closely with other community agencies in New Hanover County serving young children such as local pediatricians, schools, Department of Social Services, Wilmington Children’s Developmental Services Agency, and private providers of services. The program served over 630 children this last year.

Family Counseling: The CC4C team includes a Licensed Clinical Social Worker who provides mental health services to young children in their homes. The clinical benefits of providing in-home counseling, in a family’s natural environment cannot be overstated. Working in the homes allows for accurate assessments and appropriate interventions – where life and conflict happens. This program is supported by the Cape Fear Memorial Foundation and Medicaid.

Child Health: The Child Fatality Prevention Team reviews the fatalities of all children under the age of eighteen years old that reside in New Hanover County, in order to identify any ways to prevent future deaths. The team consists of state mandated representatives for community agencies. Team members also participate in community forums offered to professionals and community members on topics related to child abuse prevention. The team purchased Infant Car Seats to distribute to low income families.

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PERSONAL HEALTH SERVICES

SC H OOL NUR S IN G

School nurses strengthen and facilitate the educational process by improving and protecting the health status to over 140,000 students. This is accomplished by using a holistic approach; monitoring acute and chronic health concerns; first aid and emergency care; medical assessment and consultation; training and

evaluation of school personnel performing care for students with special health care needs; mass screenings; and promoting and providing education for healthy lifestyles.

SC H OOL ME N TAL HEALT H

The School Mental Health program provided psychotherapy services to children and families of the New Hanover County School System. The program was able to provide these services to 549 students in four middle schools and eleven elementary schools. Therapists collaborated with many community programs to assure their clients had access to appropriate supportive services.

At the October 2011 North Carolina Women’s Infant and Children (WIC) Conference, the New Hanover County WIC Program won the Innovative Practice Award for the comprehensive WIC outreach done quarterly by the entire WIC staff. Breastfeeding promotion and support contin-ues to thrive and grow within the WIC Program. The WIC Breastfeeding Peer Counselor’s caseload grew from 126 in July 2011 to 168 by June 2012. The Region V WIC Lactation Training Center Breastfeeding Coordinator completed breast-feeding training for staff for three hospitals and three health departments in the region and for nineteen community volunteers. Seven food markets were approved to be new vendors for the WIC Program, for a total of forty-nine WIC vendors now in New Hanover County. A strong marketing effort has been made to promote the Diabetes Self-Management classes at the New Hanover County Health Department. In addition to the classes being held at the health department, classes are now also being held at the New Hanover County Govern-ment Center.

NU TR I T I ON AND WIC PROGR AM

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PERSONAL HEALTH SERVICES

The Communicable Disease (CD) program investigated five (5) Norovirus outbreaks in long-term care facilities in this fiscal year. Other significant outbreaks included a foodborne illness outbreak in a local restaurant as well as two cases of pertussis.

With the passage of NC House Bill 474 in May 2011, changes were made in infection prevention requirements for adult care homes. New sections were added to the existing law to address infection prevention requirements and reporting of suspected communicable disease outbreaks.

The Division of Health Service Regulation (DHSR) is responsible for monitoring compliance in these facilities and when certain types of breaches occur that could possibly lead to transmission of a bloodborne pathogen the DHSR notifies the NC Division of Public Health and works with the local health departments.

Since implementation of these new requirements, NHCHD has collaborated with the Division of Health Service Regulation to ensure the identified infection control breaches have not led to disease transmission and to reinforce education and safe infection control practices. This collaboration’s goal is to keep residents in adult care facilities and our community safe.

COMMU N IT Y HE ALTH–COMMUN IC ABL E D I S E ASE S

FY 2011 – 2012 REPORTABLE DISEASES

TOTAL

AIDS 3

Brucellosis 1

Campylobacter 14

Chlamydia 1041

Creutzfeldt-Jakob Disease 2

Cryptosporidiosis 2

E. Coli shiga toxin producing 3

Foodborne, other 12

Gonorrhea 269

Haemophilus Influenzae 2

Hepatitis B, Acute 3

Hepatitis B, Carrier 18

Hepatitis C, Acute 6

HIV Infection 4

Legionellosis 4

Lyme Disease 2

Nongonococcal Urethritis (NGU) 259

Pertussis 2

Rocky Mount Spotted Fever 8

Salmonella 120

Shigella 6

Streptococcal-Group A Invasive 2

Syphilis 3

Tuberculosis (TB) 6

Toxic Shock Syndrome 1

Vibrio 2

B E S T P R A C T I C E F O R SU RV E I L L A N C E A N D R E P O RT I N G AW A R D

The New Hanover County Health Department received the Best Practice for Surveillance and Reporting award from the NC Division of Public Health at the 3rd Annual Communicable Disease Conference and Tuberculosis Symposium on June 26, 2012. This award was in recognition of Local

Health Departments that demonstrate best practice for prompt disease investigation and timely data entry into the North Carolina Public Health Electronic Disease Surveillance System (NC EDSS).

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The Good Shepherd Center medical clinic served 312 unduplicated patients with 1,302 clinic visits in fiscal year 2011-2012. In this time period, the clinic staff managed to prevent 105 emergency room visits for medical conditions that did not warrant the need for emergency care. This represented a 55% increase from last fiscal year. A total of 704 prescriptions were filled for the homeless and 48 lab or diagnosed tests were performed in the course of their treatment.

In addition, 56 education classes were conducted with a total of 862 participants. Topics ranged from first aid, food safety, depression, nutrition and hydration to prevention and control of chronic diseases such as hypertension, diabetes and heart disease. These classes were taught by public health nurses, health educators, nutritionists and UNC-W nursing students.

PERSONAL HEALTH SERVICES

HOM E L ES S MED IC AL CL I N IC

The Miles of Smiles Mobile Dental Unit serves the dental needs of children ages three to eighteen with Medicaid or Health Choice insurance and children with no dental insurance. Services provided by the dentist and dental assistants include oral examinations, x-rays, cleaning, sealants, fillings, extractions and dental hygiene education. Services are provided at elementary and middle schools in New Hanover and Brunswick counties. In fiscal year 2011-2012, services were provided to 993 unduplicated patients, with 566 of these children being new patients for a total of 1,495 dental visits.

MOB IL E DE N TAL UNI T

In fiscal year 2011-2012, there were six cases of active Tuberculosis (TB) in our community. In addition, fifteen clients were started on the preventive TB drug therapy. In April 2012, the Centers for Disease Control (CDC) and NC State TB Control program approved an alternative TB medication regimen for clients with latent TB (non-infectious). This new drug therapy is one of the biggest breakthroughs in the treatment of Latent TB Infection since the 1960’s. The treatment con-sists of three months of once weekly doses of TB medication administration by a nurse instead of the standard nine months of daily self-administrated TB medication. The New Hanover County Health Department TB Program offers the

alternative regimen when applicable.

TUB ERCU LOS I S CON TOR L PROGR AM

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FINANCIAL MANAGEMENT

The revenues and expenditures for the New Hanover County Health Department were approximately $13.5 million for the year ending June 30, 2012. Below is a comparison of revenues over the last five years:

Following is a comparison of expenditures over the last five years:

-

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

16,000,000

2008 2009 2010 2011 2012

Revenue ComparisonFiscal Years Ended June 30

Federal & State Medicaid Fees Other Grants County Funds

0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

16000000

2008 2009 2010 2011 2012

Expenditure ComparisonFiscal Years Ended June 30

Personnel Operating Capital Outlay

Supervision of the New Hanover County Health Department’s billing and accounting activities shifted to New Hanover County’s Finance Department effective February 1, 2012. Every effort continues to make this an effective, efficient, and seamless transition.

Financial Management Transitioned to New Hanover County Finance Department

R E V E N U E S A N D E X P E N D I T U R E S

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Looking forward to the current fiscal year ending June 30, 2013, the New Hanover County Health Department has a budg-et of approximately $14.77 million. This no longer includes Animal Control Services, which became a law enforcement unit under the direction of the New Hanover County Sheriff on March 1, 2012.

The following chart summarizes budgeted revenue by source:

The corresponding budgeted expenditures are shown in the chart below:

Federal & State21% Medicaid

3%

Fees10%

Other Grants21%

County Funds45%

Revenue BudgetFiscal Year Ending June 30, 2013

Personnel86%

Operating 14%

Capital Outlay< 1%

Expenditure BudgetFiscal Year Ending June 30, 2013

FINANCIAL MANAGEMENT

F I S C A L Y E A R E N D I N G J U N E 2 0 1 3