Toolkit to Promote the Use of the

CIFOR Guidelines

Jeanette Stehr-Green, MDCSTE Consultant

June 13, 2011

CIFOR Guidelines• Comprehensive description of the overall approach to

outbreaks of foodborne diseases• Allow agencies to

– Compare to existing procedures– Fill in gaps, create procedures, update procedures– Train staff

• Challenges in use– Lengthy document with overlap

between chapters– Range of recommended practices– Implementation depends on

host of factors

CIFOR Guidelines Toolkit

1. Better understand their current foodborne disease outbreak response activities,

2. Become more familiar with the CIFOR Guidelines and recommended practices,

3. Identify specific CIFOR recommendations appropriate to the agency, and

4. Make plans to implement those recommendations.

A process and set of supporting materials which help agencies:

Document 0 Toolkit Contents

Document A Toolkit Overview

Document B  Toolkit User Instructions

Document C  Toolkit User Instructions (Cheat sheet for Facilitators)

Document D  Preliminaries Worksheet

Document E  Selecting Focus Areas Worksheet 

Documents F1-F12-  Individual Focus Area Worksheets 

Focus Area 1 Worksheet Relationships with relevant agencies and organizations

Focus Area 2 Worksheet Necessary resources

Focus Area 3 Worksheet Communications

Focus Area 4 Worksheet Notification/complaint systems

Focus Area 5 Worksheet Pathogen-specific surveillance

Focus Area 6 Worksheet Initial steps of an investigation

Focus Area 7 Worksheet Epidemiology investigation

Focus Area 8 Worksheet Environmental health investigation

Focus Area 9 Worksheet Laboratory investigation

Focus Area 10 Worksheet Control of source at implicated facility

Focus Area 11 Worksheet Food recall

Focus Area 12 Worksheet Control of secondary spread  

Document G  Sample Focus Area Worksheet

Document H  Crosswalks among National Initiatives and CIFOR Toolkit

Document I  Toolkit Tips for Facilitators

Document J  Participant Evaluation Form 

CIFOR Toolkit Documents

Understanding the Toolkit

• Multi-step process designed to use time efficiently 1. Preparation/preliminaries2. Selection of areas of focus 3. Examination of priority areas individually

• Easy-to-use worksheets− Clearly labeled documents (with electronic versions)− Step-by-step approach with embedded instructions− Space to record discussion highlights/decisions

• Repackaging of CIFOR recommendations− Removal of supporting text (with hyperlinks)− Bringing together relevant recommendations− Organized for easier review

Step 1: Preliminaries• Undertaken by lead person or key decision-makers• Purpose:

– Identify program/agency/jurisdiction for which decisions will be made.

– Brief decision-makers.– Identify who should be involved.– Identify support staff.– Collect relevant background materials.– Decide on time frame.

• Needed time: <1 hour (plus time to arrange and prepare for follow-up meetings)

• Timing: before other steps; revisited periodically

Prelim

inaries

Step 2: Select Priority Focus Areas• Undertaken by key staff with knowledge, expertise, and

practical experience in local outbreak response• Purpose

– Determine if critical outbreak response activities, relationships, and resources are already in place.

– Consider priorities of other projects or problem areas in past outbreak response experiences.

– Prioritize areas of outbreak response that are most critical to agency and in need of improvement.

• Needed time: 1-2 hours• Timing: immediately following preliminaries or at a later time

Planning and preparation

Surveillance and Outbreak

Detection

Investigation of Clusters and

Outbreaks

Control Measures

• Relationships• Resources• Communications

• Notification/ complaint systems• Pathogen-specific surveillance

• Initial steps• Epidemiology investigation• Environmental health investigation• Laboratory investigation

• Control of source• Food recall• Control of secondary spread

Focus AreasCritical aspects of outbreak response broken into “bite-sized” chunks that allow users to systematically examine current activities and focus on the areas most critical to their agency.

Select P

riority F

ocu

s Areas

one-page for each Focus Area

Step 3: Examine Priority Focus Areas• Undertaken by larger group with broader areas of

expertise and a wider range of experience• Purpose

– Describe current activities/procedures in Focus Area and identify targets for improvement.

– Prioritize CIFOR recommendations to address targets.– Outline steps to implement high priority CIFOR

recommendations. • Needed time: 2-3 hours per Focus Area• Timing: schedule highest priority Focus Areas first;

consider separating efforts on different Focus Areas

Exam

ine P

riority F

ocu

s A

reas

set of pages for each Focus Area

Exam

ine P

riority F

ocu

s A

reas

Exam

ine P

riority F

ocu

s A

reas

Exam

ine P

riority F

ocu

s A

reas

●

Target Audience

• Staff from public health, environmental health, and food regulatory agencies and public health laboratories

• Local and state (and even federal) level

• Persons likely to be involved in a foodborne outbreak response who have subject matter expertise and knowledge of local procedures, resources, and politics

• Interdisciplinary groups vs. single program, agency, or person

Settings

• Meetings held specifically to address improving foodborne outbreak response locally

• As part of an after-action review of an outbreak response

• During planning meetings with other programs and agencies to define working relationships, communication processes, data sharing, etc.

• As part of local capacity development efforts (e.g., Public Health Performance Standards)

• As adjunct to trainings and professional meetings

Final Tips for Using the Toolkit

• Don’t get distracted by the volume.• Involve the right people.• Be clear on the process so as not to get lost.• Keep moving. Don’t get caught up in too much

detail.• Record highlights of discussions and decisions.• Focus on a few realistic changes as opposed to

detailed expansive plans.• End with specific action plans including a time frame

and assigned responsibilities.

Toolkit Use So Far• 250 hard copies of Toolkit distributed• Many more copies downloaded from website• Informal feedback positive• 19 state and large urban areas funded to conduct

trainings using the toolkit

Thanks to Jeff Duchin and Public Health Seattle-King County for piloting the Toolkit!

CIFOR Toolkit documents are available at

For more information, please contact:Lauren RosenbergCSTE

770.458.3811 lrosenberg@cste.org

http://www.cifor.us/toolkit.cfm or www.cste.org.