During the Council of State and Territorial Epidemiologists (CSTE) annual meeting, NACCHO hosted a roundtable session titled, “Local Health Department Roles and Activities to Improve Infection Control, Preparedness and Response to Infectious Disease Threats.” The roundtable featured local health departments’ (LHDs’) experiences and lessons learned through the LINC Initiative and NACCHO’s Healthcare-Associated Infection (HAI) demonstration site project. Conversation focused on tools, resources, and lessons learned in preventing and addressing healthcare-associated infections, particularly within the broader context of infection control and prevention in response to emerging infectious diseases.

The roundtable allowed participants an opportunity to share some of the resources they utilized or developed through the LINC Initiative, which then served as examples for other attendees and as a preview of the compiled sample resources NACCHO anticipates collecting, organizing, and providing to LHDs across the country. The resources shared included a carbapenemase-producing Carbapenem-resistant Enterobacteriaceae (CP-CRE) facility investigation tool from Clark County Public Health in Washington, as well as a survey tool developed by St. Louis City Department of Health for use with regional urgent care centers, retail walk-in clinics, and federally qualified health centers (FQHCs) to gauge emergency preparedness readiness related to infection prevention and control issues. Several flyers developed for healthcare providers were also presented, including a quick reference for CRE from Marion County Public Health Department and important information to include when transferring patients from a West Michigan collaborative. The session reinforced the value of sharing these documents to inspire and guide other LHDs and save the effort of starting from scratch, and NACCHO intends to disseminate these and similar resources from the LINC demonstration sites.

Tabletop Exercises
A significant portion of the roundtable session was dedicated to discussing tabletop exercises and the lessons learned from those experiences. Participants agreed on the value of testing plans, which often highlighted gaps and areas of improvement for protocols, coordination, and communication. In addition to this intended goal of tabletop exercises, discussion also illuminated how important preparedness exercises are in terms of establishing and strengthening relationships. These sessions typically involve health departments, hospitals, Emergency Medical Service (EMS) agencies, and long-term care facilities, as well as police and fire personnel and other response partners. Having the opportunity to meaningfully engage face-to-face is incredibly useful for relationship-building. As session moderator Dr. Robert Kim-Farley, Director of Communicable Disease Control and Prevention for the Los Angeles County Department of Public Health, noted, “In preparedness, there is a saying that the worst time to exchange business cards is during an emergency and the same is true here.”

These exercises also serve to establish and build trust as community partners come to view LHDs as allies in combating infectious disease threats, rather than institutions solely responsible for punitive measures. Participants also noted specific examples of how tabletop exercises created opportunities for partners to connect with one another. In one instance, hospitals with high levels of training and preparedness advised and mentored urgent care and walk-in clinics with less training and experience. In another example, in Pasco County, Florida, the tabletop exercise was used as a drill for testing an emergency notification system, which built enthusiasm and support for the system.

Communicating Outbreaks
Another theme that arose during the roundtable session was the challenge of communication around HAIs and the role of LHDs given the sensitive nature of the topic. It became clear there can be tension between wanting to communicate news of an outbreak to slow the spread of HAIs across facilities, and wanting to maintain the trust and privacy of the reporting facility to not negatively impact them and dissuade future reporting. Some states have reporting systems that make data available to other facilities, allowing them to directly communicate about potential or confirmed outbreaks. Other participants noted the latest Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) cooperative agreement, developed by the Centers for Disease Control and Prevention (CDC), included a requirement on communication and the role of the health department in notifying hospitals or healthcare facilities, but expressed reticence to subsume that role for fear of the perception they would be broadcasting that information or shaming a facility. One participant suggested focusing on the potential impact on the community emphasizing preparation and vigilance, rather than naming specific facilities. Even with that strategy, however, participants acknowledged a “rumor mill” may develop between facilities, undermining a controlled message that communicates up-to-date, accurate information.

In general, the session reinforced a strong desire by LHDs to be involved in doing work around HAI prevention and response, as well as the value they contribute and the amount of work yet to be done in this area. One participant reflected this sentiment, commenting, “All the feedback we are getting from partners is ‘We want more, we want more!’ Public health now has a role in HAIs and that needs to be sustained.” There are many challenges and opportunities for LHDs in this area; platforms for LHDs to connect with one another and share their stories and lessons will be critical in providing support for them to provide leadership, coordination, and participation in HAI prevention and response efforts.