BACKGROUND: This abstract describes North Carolina’s Hospital-Based Public Health Epidemiologist (PHE) Program and its effect on infectious disease surveillance and public health threats response. The PHE program began in 2003. With increased funding through the Public Health Preparedness and Response for Bioterrorism cooperative agreement with the Centers for Disease Control and Prevention, the North Carolina Division of Public Health (NC DPH) developed a program that places public health epidemiologists in the state’s largest hospital systems in order to increase surveillance for potential bioterrorist or infectious disease events. Hospital selection was designed to offer the greatest reach in geopolitical location, emergency department volume and hospital bed size.
METHODS: Core activities within the PHE program include surveillance (active and syndromic), investigation, outreach, education, special studies, and collaboration with local health departments (LHDs). In addition, PHEs have been involved in areas outside the core activities including service on hospital and local health department committees (e.g. Epi Teams) and emergency/disaster management (e.g. pandemic influenza planning). Hospital-based PHEs generally operate under the guidance of hospital infection control managers (ICs) and communicate directly with NC DPH. PHEs use two state electronic surveillance systems – NC DETECT (North Carolina's syndromic surveillance database) and NC EDSS (North Carolina's Electronic Disease Surveillance System) – and hospital systems to daily monitor data for reportable disease incidence and conduct case investigations. PHEs share findings with the hospital IC, NC DPH and LHDs.
RESULTS: Recent Program Outcomes, 2015:
- More than 5,070 communicable disease cases reported to LHDs
- Daily monitoring of acute respiratory hospital admissions and positive respiratory laboratory results
- Weekly report of hospital-based surveillance to NC DPH
- Scabies, long-term-care facilities
- Norovirus
- Listeriosis
- Mercury exposure
- Influenza
- Tularemia
- MRSA endocarditis with intravenous drug use
- NC Carbapenum-resistant Enterobacteriaceae (CRE)
- Syphilis with ocular symptoms
- Infections in injection drug users
- La Crosse encephalitis in pediatric patients, Western NC
CONCLUSIONS: Public health epidemiologists effectively connect public health agencies and hospitals to enhance communicable disease surveillance, management and investigation. The hospital-based PHE program has been innovative in improving North Carolina’s ability to prepare and respond to public health threats through improved communication and collaboration between health departments and local hospitals. These benefits also serve a greater goal of improving the general public health infrastructure of North Carolina.