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in Publications: Font size:    
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 Mar 2004 - Volume 3, Issue 2Inside this Issue • Aurora’s Boil Order: The Local Public Health Perspective: Interview with
Michael Isaacson and Cindy Gross Aurora’s Boil Order: The Local Public Health Perspective Please share your experiences with the recent water contamination incident in the City of Aurora. Isaacson: The Illinois Environmental Protection Agency (EPA) regulates municipal water systems by requiring a certain number of water tests each month to look for various contaminants. The City of Aurora conducts 120 tests per month and up to 5% of them can be positive for “total coliform” without the city incurring a violation of EPA safe drinking water standards. A positive total coliform indicates bacterial presence in the water. City of Aurora water production employees take samples from endof- the-line faucets in places like people’s homes and public building restrooms. The City of Aurora draws a portion of its drinking water from the Fox River and a portion from deep wells.
On February 6, 2004 (a Friday afternoon), we received notification that a
couple of water samples were positive for total coliform. The Illinois Department
of Public Health (IDPH) had also received notification about the positive tests.
I learned from a water department employee at a Maryland municipal terrorism
response conference that the water department is responsible for delivering
test results to the EPA, so communication flows between the water department
and the EPA. However, no communication flows directly between the city’s water
department and the county health department. Legislation is pending, which,
if passed, would require municipal water programs to alert local health departments
about positive water tests, too. From our perspective, leaving the local health
department out of the loop is a tremendous omission. Can you explain the purpose for including the food sanitarians on the conference call? Isaacson: Food establishments were our primary responsibility at the local health department because we license them. During the conference call, we learned that a test result had turned positive for the presence of E. coli. Gross: We learned on the call that the first positive total coliform tests were obtained earlier in the week. The EPA requires a repeat test if a positive total coliform result is obtained. If the repeat test is positive, then the fecal or E. coli test is performed. When fecal tests come back positive, our alarms go off. Isaacson: Issuing a municipal boil order was appropriate, according to the EPA representative on the conference call. EPA regulations require the water department Friday at 4:30 p.m. to notify us that we needed to start boiling all of our water. IDPH contacted us because they license hospitals. The local health departments license restaurants, so they notified the restaurants. Even though Kane County Health Department is across the street we needed to wait for IDPH to notify us from Springfield, Illinois. The nursing supervisor activated our internal disaster plan, which is “Code Green” or “utilities failure”—in this case, water interruption because of biologic contamination. Our director of facilities was still at work and was able to quickly mobilize his staff to put up “Don’t Drink” signs on all drinking fountains in the hospital. He fortunately had 100 gallons of bottled water on hand in preparation for an offsite project in which water would be shut off. These bottles immediately were distributed to patient care units. Security officers bought ice from the local gas stations and distributed it to nursing units. We had very little downtime when no water was available. By 6:40 p.m., we had 200 gallons of bottled water in-house already. A local supply company provided us with water coolers, which we put on patient units. Everything went smoothly. What about hand washing? Dominick’s Store donated 550 1/2 gallons of bottled water to us free of charge. This kind of great community support enabled us to get the quantities of bottled water we needed for that nine-day period. We used 4,694 gallons of bottled water and 4,400 pounds of ice. The total cost of water and ice calculated to $5,340. Approximately 218 extra man hours were required to obtain and distribute water and ice. How did the operating rooms manage through the boil order? And the emergency department— how did it manage? The neonatal unit? The renal dialysis unit? What did you do when the boil order was lifted? The First 72 Hours: SEMP’s First Publication Coming Soon
The gamut of perspectives is laid out in the book, including the roles of doctors and hospitals, city managers, police officers, firefighters, paramedics, Red Cross volunteers, hospital accreditors, the media, business managers, utility companies, emergency managers, public health officials, academics, and elected public officials. In their own words, these individuals convey the importance of learning how to map the myriad organizations involved in local disaster preparedness and response, and analyzing, refining, and rehearsing local roles. The First 72 Hours is an essential resource for professionals and private citizens who want to better prepare their communities to survive future disaster.
The Aurora Boil Order: Code Green at Provena Mercy CenterAnthony Stull, RN, is the infection control nurse at Provena Mercy Center in Aurora, Illinois, one of two hospitals affected by the boil order. The following dialogue with Margaret O’Leary on March 11, 2004, has been edited for publication.
What is the hospital perspective on the boil order advisory on February
6, 2004? What about hand washing? How did the operating rooms manage through the boil order? And the emergency department— how did it manage? The neonatal unit? The renal dialysis unit? What did you do when the boil order was lifted?
Kane County’s New EpidemiologistCindy M. Gross, MT, SM, (ASCP), CIC is a medical microbiology and infection control professional who in late 2003 joined Kane County Health Department as epidemiologist. Her current responsibilities include the Communicable Disease Program; creating and maintaining passive and active surveillance systems with local hospitals, medical providers and laboratories; assisting in development and maintenance of bioterrorism/ emergency preparedness plans; and educating the community and medical professionals.
Ms. Gross shared her experiences during a recent interview, which has been edited for publication: “Hamilton, N.J., is a little village outside of Trenton. The anthrax letters disseminated in September and October 2001 were processed at the Trenton Processing and Distribution Center in Hamilton Township, which meant that all of the postal workers were exposed to anthrax. This postal facility happened to be a corporate health client of Robert Wood Johnson University Hospital-Hamilton where I worked. Corporate health became the postal facility’s medical provider since the exposure occurred on the job. Antibiotics were already being handed out in Florida and the Washington, D.C. area. Postal workers in Hamilton became concerned when it was discovered that the anthrax letters were disseminated from the Hamilton, N.J., postal facility. Very quickly on a Friday afternoon (everything happens on a Friday afternoon), the hospital became deeply involved in providing medical care for the 1,400+ postal workers. There wasn’t a stockpile of antibiotics waiting to be used. The hospital pharmacist put out feelers to the pharmaceutical companies. That area of New Jersey is a pharmaceutical mecca, which was fortunate for us. The pharmacist had a police escort to pick up the Cipro and doxycycline, which he transported back to the facility. In the meantime, internally we were setting up an on-the-spot clinic to assess the postal workers, orient them to the paperwork that needed completion, and process them through. The hospital administration was adamant about a physician screening each postal employee for illness. Then we got into the nasal culture issue, which was very controversial as to whether you should or shouldn’t do it. The Centers for Disease Control sent Epidemiologic Intelligence Service (EIS) officers to Hamilton who said, yes, we want you to do it! From an epidemiological standpoint, the goal was to screen all 1,400+ postal workers who had direct exposure to anthrax because this might lend some information about how much exposure was needed to become colonized vs. infected with anthrax. The postal workers were screened by a physician, cultured with nasal swabs and then given a five-day supply of antibiotic. As you know, the length of suggested anthrax prophylaxis eventually extended to 60 days. But this was all unfolding and the recommendations were changing not on a daily basis but on an hourly basis. The initial recommendation was five days of antibiotics. We no sooner had processed the 1,400+ postal employees than the recommendation changed to seven days, so we needed to bring them back to distribute antibiotics for two additional days. During that two day time period, the recommendation changed again and went up to 60 days. There was a lot of internal stress on the hospital because 1,400 nasal cultures coming through the facility was a lot for the laboratory to handle. We also had hospital employees and community members who were alarmed and concerned about their own well being. I don’t know how fast we processed the postal workers. It went on and on. I do recall that we initially asked the postal system to send people with last names starting with A-M on Friday evening and people with last names starting with N-Z on Saturday morning. I recall that we had everyone seen and processed within that weekend time period. The three physicians doing the screening were two corporate health physicians and the hospital medical director whose background is in internal medicine. Hamilton Township’s public health officer and a number of communicable disease nurses on staff there helped out. The New Jersey Department of Health and Senior Services was also deeply involved. It’s situated in Trenton, which is the capital of New Jersey, and its director was the liaison with the Centers for Disease Control and Prevention. The initial triage area involved paper work and taking postal employees’ vital signs (temperature, blood pressure, and pulse). Postal employees then saw a physician for evaluation of symptoms consistent with pulmonary or cutaneous anthrax, passed through to another station for nasal culturing, and finally out to the pharmacist. As it turned out, none of the 1,400+ nasal cultures were positive for anthrax. The three persons treated for anthrax at Robert Wood Johnson University Hospital-Hamilton survived. Two were postal workers and one was a receptionist at an accounting firm who managed a large volume of mail. One person was treated for pulmonary anthrax and the other two were treated for cutaneous anthrax. As you might imagine, there was a lot of uncertainty as the anthrax incident unfolded. The postal facility didn’t want to go down the medical screening route until they had confirmation of positive environmental cultures from the postal facility, which eventually there were. On the other hand, the postal facility already had individuals diagnosed with anthrax illness, so they realized that there had already been exposure. The postal employee union became involved and 2001 was an election year for the Hamilton mayor, so he got involved. That’s a good thing, because the postal facility workers did need to be screened.”
Federal Action Needed to Address Security Challenges at Chemical Facilities*This new General Accounting Office (GAO) report (Feb. 23, 2004) found, not surprisingly, that chemical factories may be attractive targets for terrorists. This is a concern because many chemical facilities exist in populated areas where a chemical release could threaten thousands of people. At present, chemical facilities have no federal security requirements relating to the intentional release of chemicals, as in a terrorist attack. The Environmental Protection Agency (EPA) reports that 123 chemical plants located throughout the U.S. could each potentially expose more than a million people if a chemical release occurred in a worst-case scenario. To date, no entity has comprehensively assessed the security of the chemical facilities. Environmental activists and news reporters continue to gain access to vulnerable chemical facility assets. Chemical facilities manufacture or house large quantities of chemicals. The EPA has been involved in preventing and mitigating the accidental (but not intentional) release at chemical facilities under provisions of the Clean Air Act (1989). The EPA identified 140 toxic and flammable chemicals that, when present above certain threshold amounts, would pose the greatest risk to human health and the environment if released. Approximately 15,000 facilities in a variety of industries produce, use, or store one or more of these chemicals beyond threshold amounts. Who secures the nation’s chemical infrastructure? Individual chemical firms are responsible for securing their sites. No federal oversight of this process, however, exists at the current time. The 2003 President’s National Strategy for the Physical Protection of the Critical Infrastructures and Key Assets has directed the EPA and Department of Homeland Security to begin work on this problem. To date the following other critical infrastructures have federal security requirements:
The chemical industry faces challenges in preparing facilities against terrorist attacks, including:
To read the full GAO report, go to: http://www.gao.gov/new.items/d04482t.pdf.
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Michael
Isaacson, MPH, is emergency response coordinator and Cindy Gross, MT, SM, (ASCP),
CIC, is epidemiologist with the Kane County Health Department, Illinois. The
following dialogue with Margaret O’Leary on March 1, 2004, has been edited
for publication. 
is
an anthology by public and private sector leaders who came together after Septermber
11, 2001, to design more disaster-resilient communities. Under the umbrella
of the Suburban Emergency Management Project, these leaders learned from national
experts and one another that all disasters are intensely local at first and
that most communities are "on their own" immediately following disaster impact—often
for as long as 72 hours. This new awareness mandates updating strategies to
improve disaster preparedness, particularly in light of the threat of terrorism.
What
is your role in Provena Mercy Center? Stull: My role as infection
control nurse is to monitor and minimize nosocomial infections in our hospital.
I educate our staff and patients and implement different protocols designed
to keep our staff and patients safe. I am the one designated infection control
nurse, but infection control is everyone’s responsibility. 
Ms.
Gross moved to the Fox River Valley from Hamilton, New Jersey (26 miles north
of Trenton) where she coordinated and managed all aspects of the infection
control program at Robert Wood Johnson University Hospital-Hamilton. This 160-bed
acute care hospital served as the clinic site for medical screening and distribution
of antibiotics to approximately 1,400+ postal workers at the Trenton Processing
and Distribution Center in Hamilton Township. The anthrax letters sent to the
Editor of the New York Post and Tom Brokaw, NBC TV, on September 18, 2001,
and to Senator Daschle on October 9, 2001, passed through this postal facility
and bore its postmark. 
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2007 - SEMP INC., All Rights Reserved.