Connecticut River Area Health District Annual Report 2012-2013

The Connecticut River Area Health District (CRAHD) is a three town health district providing core public health services to the towns of Clinton, Old Saybrook and Deep River.  The district is responsible for implementing programs that improve the health of its residents.  The district provides a strong environmental health component, targeted public health nursing services, health education and promotion venues, disease tracking and prevention activities and public health preparedness planning.  Currently, the district employs 5 full time professional staff, as well as 3 part time contractual program professionals.  The district is dedicated to carrying out its mission to maximize the highest quality public health services possible given its current resource level.  This report covers the period from July 1, 2012 through June 30, 2013.

Environmental Health:

This fiscal year, the district elevated one of its 3 Sanitarian positions to Chief Sanitarian and promoted from within.   The Chief Sanitarian supervises the district’s 2 full time Licensed Sanitarians and 2 part time certified inspectors to run its environmental health section.  Programs include state mandated inspections for compliance with the Connecticut Public Health Code, as well as education related to program specific topics.  Inspections are conducted in the following areas:

·         Food service establishments:  restaurants, food stores, school cafeterias, nursing homes, churches, vendors

·         Cosmetology establishments including Nail and Beauty Salons and Barber Shops

·         Child Day Care Centers and Group Day Care Homes

·         Public Swimming Pools

·         Public Bathing Beaches

·         Response to general nuisance complaints

·         Housing:  landlord-tenant issues related to minimum housing standards

·         Private water supplies permitting, testing and maintenance

·         On-site sewage disposal site evaluations, plan reviews, installations, alterations and repairs.

Inspection activity (not all inclusive) during the 2012-2013 fiscal year (July 1 to June 30) included:


                                309        Food establishment inspections

                                55          Cosmetology inspections 

                                9            Day care inspections

                                15          Public pool inspections    

                                148        Beach/bathing water samples taken and tested

                                19          New well permits were issued

                                13          Permits were issued for new septic systems

                                41          Engineer designed septic system plans were reviewed and approved

                                306        Permits were issued to repair an existing septic system

                                236        Properties were tested for suitability for a septic system

        63          Complaints:  including general nuisances, animals, housing, sewage, etc.

        302        Applications were reviewed for health code compliance for proposed building activities                      including building expansions, additions to homes, in-ground and above ground                             pools, accessory apartments, garages, decks, etc.

In June of 2013, the board of directors for CRAHD adopted a local ordinance requiring the registration and inspection of all overnight stay facilities within the district. Overnight stay facilities include but are not limited to: hotels, motels, inns, and bed and breakfast establishments. The district will be seeking compliance of these facilities in minimum sanitation standards for common areas as well as individual rooms. This new program will become effective July 1, 2013 and will be carried out in the next fiscal year and annually thereafter.

Public Health Nursing:

CRAHD is responsible for Tuberculosis case medication management and has utilized local VNA’s to conduct follow up visits to ensure treatment compliance. 

 Our Public Health Nurse, under the guidance of the Director of Health, conducts active surveillance of all mandatory reportable diseases identified by the CT Department of Public Health.  In addition, the Public Health Nurse conducts follow up investigations of selected illnesses reported to control the spread of these diseases in the community.

The Public Health Nurse works closely with all three school districts to conduct surveillance for flu like illness, to assist in the control of illness in the school settings, and to support health education activities.  

 During the course of the year, the role of the Public Health Nurse has been further defined as a key person in the planning and execution of public health preparedness, and is the district’s preparedness coordinator. 


Health Education and Promotion:

CRAHD has assisted with in-school flu clinics offered at Morgan High School in Clinton.  In coordination with the VNA of Southeastern CT, CRAHD has also assisted with clinics in Old Saybrook at the three schools, the town hall, the firehouse for emergency personnel and at the CRAHD office.  The benefits of this concept have been presented to the three district towns.

The district continued to be involved in the promotion of good oral health for the un/under- insured through the Old Saybrook Dental Initiative Group. 

Our Public Health Nurse attended Science Day at the Goodwin Elementary School Program and the Old Saybrook Middle School Health Day to educate on the importance of good hand washing and personal hygiene using Mr. Glow Germ Kits.  She also mentored two different groups of Junior and Senior High School groups to assist with this education to the schools.  Student assistants were Honors Biology Students interested in the Medical Field.

CRAHD attended an English as a Second Language Adult Education Class at Clinton High School and educated about the Seasonal Flu and the importance of vaccination and hand washing in the prevention of getting and spreading the Flu.

Our Director of Health and Pubic Health Nurse were core participants in the development of the Middlesex County Coalition on Community Wellness, an outgrowth of the county’s CDC Community Transformation Grant, by collecting data for a county wide wellness assessment, including Change Tool completion, Key Informant interviews,  and further data collection toward the submission of a proposal to the CDC requesting funding for implementation of programs geared toward creating positive change in the areas of physical activity, healthy eating and management of chronic disease.

Through a Preventative Health Block Grant, CRAHD created and presented an educational program to at risk town employees and others in the prevention of Skin Cancer.  Municipal and park and recreation staff, as well as elderly, were educated on the dangers of sun exposure, provided pamphlets and literature on prevention of sun exposure, including Tanning Beds.  At the end of each education session, each participant received his or her own sunscreen lotion.


Public Health Preparedness:

CRAHD is the lead health department in Mass Dispensing Area #39, which includes the 3 health district towns as well as Westbrook, Chester, Essex and Killingworth.  We continued work to improve operationalizing our mass dispensing plan and pandemic influenza plan.  These plans direct how medication will be dispensed to large segments of the population in a very short time period, and public health actions needed in a mass dispensing scenario.  Working in cooperation withthe Department of Public Health, local Emergency Management Directors, Health Directors, and town leaders in all 7 towns, we have placed an emphasis on volunteer recruitment and training, and creation of more closed PODs or points of dispensing.  We also worked with our colleagues in public health preparedness Region 2 to complete a regional Technical Assistance Review (TAR) and Project Public Health Ready; two assessment tools designed to identify areas to improve our capacity to prepare for and respond to public health emergencies.  Our Public Health Emergency Staff and Volunteers attended an Incident Command ICS 100 class to better prepare them as volunteers to work under a command structure in an emergency situation. CRAHD has been meeting with each town from MDA #39 to review the mass dispensing plan and to encourage them to include the plan in their respective all hazards plan for their town.

 Lastly, CRAHD has been working on a Quality Improvement (QI) project to improve its Health Alert Network (HAN) capacity and usefulness.  Our Public Health Nurse was an active participant in a statewide work group for the revision and vetting of a new Head of Household Form which would be used in a mass dispensing scenario.  The form is developed from a medical model and is more user-friendly. 


Waste Water Management Activities:

The Connecticut River Area Health District continues to be an integral part of its constituent towns Water Pollution Control Agency planning and/or plan implementation.  In Old Saybrook,CRAHD plays an integral part in the Water Pollution Control Authority’s Waste Water Management District (WWMD) program.  The Health District Staff works closely with the Water Pollution Control Authority (WPCA) to ensure implementation of its upgrade ordinance.  CRAHD is responsible for ensuring that all on-site conventional sewage disposal system upgrades meet the requirements of the CT Public Health Code and the Ordinance’s Upgrade Standards.  Approximately 120 out of 1900 on-site septic systems have been upgraded under the program.

 In addition, the health district has been assisting the Clinton Water Pollution Control Commission in its planning for its own waste water management plan. 


Disease Tracking and Prevention:

The Health District’s Director of Health and Public Health Nurse perform active surveillance and provide control follow up for diseases and health conditions that are reportable to the local director of health by law.  Follow up was provided for illnesses that had the potential of being spread person to person or through a medium such as food or water.  Outreach and education is continuously provided for diseases of importance such as Hepatitis A, B and C, elevated childhood lead levels, Lyme Disease and other vector borne diseases.The district also manages the mosquito control activities in the towns that participate in control and monitors for mosquito borne diseases.