MSIPC Fundamentals: Interaction
between IPs and Local and State
Health Departments
www.michigan.gov/hai
October 29, 2014
Joyce Lai, MPH– Michigan Department of Community Health
Noreen Mollon, MS– Michigan Department of Community Health
Outline


MDCH Organization
Communicable Disease Surveillance


Reportable Diseases
Michigan Surveillance Data Systems
MDSS
 MSSS
 Sentinel Surveillance for ILI


SHARP
Outbreak Response
 Surveillance and Reporting
 Prevention Initiatives


Other MDCH Entities that frequently interact with IPs
MDCH Mission Statement

MDCH will protect, preserve, and promote the
health and safety of the people of Michigan with
particular attention to providing for the needs of
vulnerable and under-served populations
MDCH Organization
DIRECTOR
Chief Operating
Officer
Offices of Services
To the Aging
Office of
Inspector General
Operations
Administration
Medical Services
Administration
Behavioral Health &
Developmental
Disabilities
Administration
Public Health
Administration
MDCH Organization
Public Health Administration
Bureau of Local Health
& Administrative Services
Bureau of Disease Control,
Prevention, and Epidemiology
Bureau of Laboratories
Bureau of Family, Maternal
And Child Health
Office of Public Health
Preparedness
Division of Health Wellness
And Disease Control
MDCH Organization
Bureau of Disease Control,
Prevention, and Epidemiology
Division of Genomics, Perinatal
Health, and Chronic Disease
Division of Environmental Health
Division of Communicable Disease
Division of Immunization
Surveillance Section
Communicable Disease Surveillance

Communicable disease reporting is required by
Michigan law:
 Michigan
Public Health Act No. 368 Communicable
Disease Rules: R 325.171-3, 333.5111
 Rule revision allows the State the right to periodically
update the list of reportable diseases
 This reporting is expressly allowed under HIPAA
Hepatitis C Virus
Neisseria meningitidis
Histoplasma capsulatum
Bordetella pertussis
Why Communicable Disease
Surveillance is Important






To identify outbreaks
To assure treatment, preventive treatment and/or
education
To evaluate prevention and control programs
To help target prevention resources
To facilitate epidemiologic research
To assist national and global surveillance efforts
Chlamydia trachomatis
Influenza Virus
Mycobacterium tuberculosis
Salmonella sp.
Public Health Depends on
Collaboration
Healthcare
Providers
Clinical
Laboratories
Local Health
Department
State Health
Department
Centers for Disease
Control and Prevention
Isolates and specimens
sent to State Lab for
additional testing
Communicable Disease Reporting
Entities








Physicians*
Laboratories*
Hospital ICP
Private citizens
School systems*
Pharmacists
Veterinarians
Medical Examiners
*Required to report




Hospitals*
Child care facilities
Long-term care
facilities*
Pre-hospital
emergency services
 Police
 Fire
 EMS
Communicable Disease “Brick Book”

The current 2014 version
(electric crimson), provides
a good summary of the
communicable disease
rules, requirements, and
responsibilities
Michigan Reportable
Diseases

~90 disease/conditions are
reportable in Michigan

Also reportable are ‘unusual
occurrences’, outbreaks and
epidemics of any disease or
condition (including
healthcare-associated
infections)

Specific reporting rules and
definitions can be found at
www.michigan.gov/cdinfo
Case Rules and Definitions

Example of
Streptococcus
pneumoniae
reporting
algorithm
Case Rules and Definitions

Acute /
Chronic
Hepatitis C
Reporting
Flowchart
Timeliness and Completeness of
Communicable Disease Reports

In general, all reportable diseases are required to
be reported within 24 hours of confirmation

Report contents
 Demographic
info – name, date of birth, sex, race
 Contact info – address, phone number
 Disease details – onset date, lab results

Surveillance is only as good as the data received
 The
timeliness and effectiveness of public health
responses are dependent on prompt and accurate
surveillance reporting
Authority of State and Local HDs

Michigan is a “home rule” state, meaning local HDs have
autonomy within their jurisdiction

The MDCH operates independently from the local HDs

The primary role of the MDCH in communicable disease
control is to provide:
expert consultation
 reference level diagnostics laboratory services
 childhood vaccines
 support local HDs upon their request
 Maintenance and administration of the MDSS


All communicable disease reports should be reported to
your local HDs
Map of Michigan Local HDs
Public Health Investigative Authority

State and local HD personnel are authorized to
investigate reported diseases, including:
 Contacting
health providers
 Conducting additional case-finding
 Conducting epidemiological studies
 Conducting specimen collection
 Gathering information on medical history, lab results,
diagnostic procedures, treatment, and health outcomes

The MDCH works collaboratively with the local HDs
and participates in investigations when requested
Confidentiality, HIPAA, and PHI

Disclosure of protected health information (PHI) to
health authorities without individual consent or
authorization is permitted when disclosure is
required by law or is authorized by law for a public
health purpose (www.hhs.gov/ocr/hipaa/)

All information provided to public health
authorities is kept confidential
Helpful Links

www.michigan.gov/mdch
 Click
on ‘Providers’ and then ‘Chronic and
Communicable Diseases’

www.michigan.gov/hivstd - HIV/STD/Viral Hepatitis

www.michigan.gov/cdinfo - Communicable Disease
resources, forms, links, reports, and publications
www.michigan.gov/mdss - Michigan Disease
Surveillance System (MDSS)
www.michigan.gov/hai- Healthcare-Associated
Infection Surveillance & Prevention


Michigan Surveillance Systems

Michigan Disease Surveillance System (MDSS)

Michigan (Emergency Department) Syndromic
Surveillance System (MSSS)

Sentinel Surveillance for Influenza-Like Illness
Disease Detection/Reporting Timeline
Exposure
Symptom
Onset
Seeking of
Medical Care
Reported
to Local HD
Reported
to State HD
Diagnosis
Time
ED Syndromic
Surveillance
Michigan Disease
Surveillance System
Michigan Disease
Surveillance System




Web-based communicable disease surveillance system
Disease can be reported 24/7 from your computer
Used to facilitate coordination between local, State,
and federal public health agencies
Streamlines disease reporting; more efficient and
closer to real-time
 Allows
for more timely public health interventions
 Reduces delays in public health follow-up by grouping
disease based on county of patient residence
Michigan Disease
Surveillance System

Data in the MDSS can be accessed and edited by
multiple parties which facilitates the sharing of
information without requiring multiple phone calls

Allows for instantaneous retrieval of summary reports
 MDCH
Weekly Surveillance Report
(www.michigan.gov/cdinfo)
 Data sent to CDC National Notifiable Disease Surveillance
System (NNDSS – www.cdc.gov/nndss) for Morbidity and
Mortality Weekly Reports (MMWR – www.cdc.gov/mmwr)
MDSS Reporting Pathways
Community
Physicians
Infection
Preventionists
Hospital Labs
Local Health Department
MDSS
CDC
•
•
National Notifiable
Disease Surveillance
System (NNDSS)
Morbidity and Mortality
Weekly Report (MMWR)
• Case Follow-up
• Local Surveillance
• Electronic Reports
MDCH
• Statewide Surveillance
• Weekly Surveillance Reports (WSR)
Adding/Editing Cases in MDSS
Searching Records in MDSS
Pulling MDSS Data
Pulling MDSS Data
MDSS Statistics
Individual
Case Reports
77,686
Transactions
400,000
Unique
User
Log Ins
----
Year
2007
Referrals
83,876
2008
136,057
104,616
429,848
783
2009
160,326
119,843
618,731
893
2010
158,225
113,765
697,258
906
2011
213,639
159,185
803,092
982
2012
211,150
146,069
1,018,304
1,126
2013
185,362
126,812
1,059,023
1,155
MDSS Electronic Reporting
LABORATORY
2006
2007
2008
2009
2010
2011
2012
2013
MDCH REGIONAL LAB - LANSING
16,407
7,039
13,589
20,723
16,245
18,567
22,305
20,905
DETROIT MEDICAL CENTER LAB
1,167
8,652
8,758
8,882
9,816
10,147
8,981
7523
MDCH REGIONAL LAB - DETROIT
1,206
1,323
2,040
1,596
1,662
1,714
369
12
ARUP LABORATORIES
2,100
3,656
2,678
3,314
3,498
3,209
5,680
5621
GARCIA LABORATORIES
--
--
483
--
--
HURLEY HOSPITAL LAB (3/09)
--
--
--
3,024
3,792
5,031
4,448
2874
MAYO CLINICAL LABS (8/09)
1,548
6,668
3,985
4,317
3375
LABCORP (9/09)
1,226
3,375
4,225
4,957
5149
MDCH REGIONAL LAB – OAKLAND (9/09)
863
MDCH REGIONAL LAB - OAKLAND CO LAB - PONTIAC
2,823
2,552
2,188
2106
MDCH REGIONAL LAB - OAKLAND CO LAB - SOUTHFIELD
425
676
552
758
MDCH REGIONAL LAB - KALAMAZOO
340
1,359
127
123
MDCH REGIONAL LAB - UPPER PENINSULA
57
0
0
0
MDCH REGIONAL LAB - KENT COUNTY
412
1,757
268
204
MDCH REGIONAL LAB - SAGINAW COUNTY
308
1,632
3,189
2288
SPARROW LABS (2/11)
1,735
2,281
2161
SPARROW LABS – ST LAWRENCE LAB (2/11)
2,104
2,712
2965
QUEST DIAGNOSTIC – AUBURN HILLS (8/11)
4,969
12,510
16420
8
McLAREN OAKLAND HOSPITAL
16
McLAREN CENTRAL MI HOSPITAL
5
McLAREN MACOMB HOSPITAL
27
McLAREN FLINT HOSPITAL
27
McLAREN BAY HOSPITAL
26
McLAREN GREATER LANSING HOSPITAL
7
Total
20,880
20,670
27,548
41,176
49,421
63,662
74,884
72600
More Info on the MDSS

Contact:
 Your Local Health Department Communicable
Disease Program
 Your Regional Epidemiologist
 Edward Hartwick, MS, MDSS Coordinator
 HartwickE@michigan.gov
http://www.michigan.gov/mdss
(517) 335-8165
Michigan (Emergency Department)
Syndromic Surveillance (MSSS)

A surveillance system that detects and tracks the
chief complaints of ED patients throughout the state

Chief complaints are classified into syndromic
categories that could indicate a possible public
health emergency

Web-based application displays the data in real-time

Alerts are automatically sent when rates of a given
syndrome are detected to be higher than the
predicted norm
MSSS

# of facilities: 95

# of users: 173

# of referrals per day,
Statewide: 12,343

# of referrals per day,
per facility: 130
MSSS Data

Each message sent to the MSSS consists of:
 Demographics:
date of birth, sex
 Residence: home zip code
 Visit Info: date, time, class (e.g. urgent care, ER)
 Chief Complaint
MSSS Chief Complaints

Chief complaints are classified into the
following syndromes:
 Gastrointestinal
 Constitutional
 Respiratory
 Rash
Hemorrhagic
 Botulinic
 Neurological
 Other
 Default

MSSS Classification Examples
Chief Complaint
“slurred speech”
“general weakness”
“stomach pain”
“difficulty breathing”
“nose bleed”
“headache”
“hives and itching”
“right foot injury”
“med refill”
Syndrome
Botulinic
Constitutional
Gastrointestinal
Respiratory
Hemorrhagic
Neurological
Rash
Other
Default
MSSS Alerts

A detection algorithm monitors the data hourly

An e-mail alert is sent to State and regional
epidemiologists if an aberration is detected
 If
the actual value of a syndrome exceeds the predicted
value for a given syndrome in a geographic area

Users can view the data in charts, graphs, or maps
Use of MSS Data


Early detection of outbreaks
Enhanced surveillance during high-profile events:
 World
Series
 Super Bowl
 MLB All-Star Game
 Final Four
 Detroit Auto Show


Seasonal influenza monitoring
Situational awareness
Sentinel Provider Surveillance for
Influenza-Like Illness (ILI)



Michigan component of the CDC U.S. Outpatient
Influenza-like Illness Surveillance Network
Influenza sentinel reports provide data on over
12,000 outpatient office visits per week and are an
important part of influenza surveillance in
Michigan
Contact Stefanie DeVita at 517-335-9104 or
DevitaS1@michigan.gov for more information
Michigan Influenza Sentinel
Hospital Network

MDCH is working to establish a network of sentinel
hospitals that report influenza-associated
hospitalizations

Hospitals that agree to participate would be asked to
provide:
Weekly report consisting of the number of influenzaassociated hospitalizations in each of five age categories
 Total number of admissions during that time frame
 Contact:
 Sally Bidol (bidols@michigan.gov)

Surveillance for Healthcare-Associated
and Resistant Pathogens (SHARP) Unit

Objectives of the SHARP Unit:
 Coordinate
activities related to HAI surveillance and
prevention in Michigan
 Improve surveillance and detection of antimicrobialresistant pathogens and HAIs
 Identify and respond to disease outbreaks
 Use collected data to monitor trends
 Educate healthcare providers, state and
local public health partners, and the
public on HAIs
www.michigan.gov/hai
SHARP Activities
www.michigan.gov/hai




Outbreak Response
Surveillance and Reporting
MDRO Prevention Initiatives
Consulting/Education
Staphylococcus aureus
Klebsiella pneumoniae
Clostridium difficile
Outbreak Response
www.michigan.gov/hai

The MDCH SHARP staff are available to offer our
services and expertise in healthcare-associated
outbreak investigations
Acinetobacter baumannii

MDCH can help facilities coordinate molecular
testing with the MDCH Bureau of Laboratories to
identify genetic-relatedness between patient
isolates (at no cost)
Surveillance and Reporting
www.michigan.gov/hai

Vancomycin-Intermediate Staphylococcus aureus
(VISA) and Vancomycin-Resistant Staphylococcus
aureus (VRSA) are required to be reported according
to the communicable disease rules

Unusual occurrences and outbreaks of HAIs are also
mandated by law to be reported

However, individual HAIs (like a CLABSI), are not
required to be reported to state or local health
departments
Surveillance and Reporting
www.michigan.gov/hai

33 states have laws requiring HAIs to be reported to state health
departments, the majority of which publically release hospital
HAI rates (http://www.jstor.org/stable/10.1086/663204)
Surveillance and Reporting
www.michigan.gov/hai


In Michigan, hospitals can voluntarily report HAIs to
MDCH SHARP via the National Healthcare Safety
Network (NHSN)
NHSN is a web-based surveillance program designed
by CDC:
 Uses
standardized HAI surveillance definitions
 Users can enter and analyze HAI data

The data sent to SHARP from Michigan hospitals are
de-identified and the numbers aggregated for the
purposes of producing state-wide HAI surveillance
reports
Surveillance and Reporting
www.michigan.gov/hai

HAIs tracked by MDCH SHARP surveillance:
•
•
•
•
•
•
•
Central Line-Associated Blood Stream Infection (CLABSI)
Surgical Site Infection (SSI)
Catheter-Associated Urinary Tract Infection (CAUTI)
Ventilator-Associated Pneumonia (VAP)
Clostridium difficile LabID surveillance
MRSA LabID surveillance
Antimicrobial resistance in select pathogens
HAI Surveillance
SSI
CLABSI
Surgical incision showing signs of infection
Subclavian central venous line
VAP
CAUTI
Foley catheter insertion kit
Mechanical ventilator
CDI LabID
MRSA LabID
Staphylococcus aureus
Clostridium difficile
SHARP Surveillance
www.michigan.gov/hai
Currently there are 97 Michigan hospitals sharing HAI data with SHARP, with all 97 hospitals
releasing their data to the Michigan Health and Hospital Association MHA Keystone Center, and 14
hospitals releasing their NICU data to the Vermont Oxford Network (updated 9-17-14).
Number of Acute Care Hospitals that have Signed a Data Use
Agreement with MDCH SHARP
120
Master Agreement
MHA Data Release
VON Data Release
100
Number of Hospitals

80
60
40
20
0
2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013 2014 2014 2014
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
SHARP Reports
www.michigan.gov/hai

SHARP releases state-wide HAI reports quarterly,
semiannually, and annually which are posted at
www.michigan.gov/hai
 All
hospital data are de-identified and aggregated
 Individual hospital data is not made public

SHARP also compiles hospital specific HAI reports
which are only shared with those individual hospitals
SHARP HAI Data
www.michigan.gov/hai
Michigan MRSA LabID Rates
6
MI MRSA LabID
MI MRSA Bld LabID
MRSA LabID Rate per 1,000 Patient Days
5
4
3
2
1
0
2011 Q1
2011 Q2
2011 Q3
2011 Q4
2012 Q1
2012 Q2
2012 Q3
2012 Q4
2013 Q1
2013 Q2
2013 Q3
2013 Q4
SHARP HAI Data
www.michigan.gov/hai
Inpatient MRSA LabID Onset Distribution
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2013 Q1
CO Bacteremia
2013 Q2
Community-Onset (CO)
2013 Q3
HO Bacteremia
2013 Q4
Healthcare Facility-Onset (HO)
SHARP HAI Data
www.michigan.gov/hai
Michigan C. diff LabID Rates
24
22
C. diff LabID Rate per 10,000 Patient Days
20
18
16
14
12
10
8
6
4
2
0
2011 Q1 2011 Q2 2011 Q3 2011 Q4 2012 Q1 2012 Q2 2012 Q3 2012 Q4 2013 Q1 2013 Q2 2013 Q3 2013 Q4
SHARP HAI Data
www.michigan.gov/hai
Inpatient CDI LabID Onset Distribution
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2013 Q1
Community-Onset
2013 Q2
2013 Q3
Community-Onset, Healthcare Facility-Associated
2013 Q4
Healthcare Facility-Onset
SHARP HAI Data
Standardized Infection Ratios (SIR)
Type of Infection
CAUTI6
CLABSI7
CLABSI ICU8
CLABSI NICU9
SSI10
SSI COLO11
SSI HYST12
MRSA Bac LabID13
C.diff LabID14
Michigan Data
1Observed:
Number of
Hospitals
87
84
84
17
81
80
74
85
85
US Data
Procedures Done Device Days or
Patient Days
N/A
100,676 DD
N/A
91,900 DD
N/A
82,973 DD
N/A
8,927
13,514
N/A
2400
N/A
2162
N/A
N/A
1,189,685 PD
N/A
1,109,626 PD
Observed1
Predicted2
www.michigan.gov/hai
MI SIR3
MI p-value4
MI 95% CI5
274
86
77
9
239
117
48
79
219.2497
192.9266
170.4866
22.4400
309.5430
143.9260
40.7430
89.4367
1.250
0.446
0.452
0.401
0.772↓
0.813↓
1.178
0.883
0.0004
<0.0001
<0.0001
0.0016
<0.0001
0.0237
0.2595
0.2685
1.108, 1.404
0.359, 0.561
0.359, 0.561
0.196, 0.736
0.679, 0.875
0.675, 0.971
0.878, 1.549
0.704, 1.095
834
926.2102
0.900
0.0022
0.841, 0.963
Number of infections (CAUTI, CLABSIs or SSIs) reported during the time frame.
The number of CAUTIs or CLABSIs predicted based on the type of hospital unit(s) under surveillance, or the number of SSIs predicted based upon 2009 national SSI rates by
procedure type.
3SIR: Standardized Infection Ratio: Ratio of observed events compared to the number of predicted events, accounting for unit type or procedure. An SIR of 1 can be interpreted as
having the same number of events that were predicted. An SIR that is between 0 and 1 represents fewer events than predicted, while an SIR of greater than 1 represents more events
than expected.
4P-value: An SIR p-value of <0.05 is considered significantly different than expected. It can be either significantly worse (if the SIR is greater than 1 and the p-value is <0.05) or
significantly better (if the SIR is less than 1 and the p-value is <0.05).
595% CI: 95% confidence interval around the SIR estimate. A 95% CI indicates that 95% of the time, the actual SIR will fall within this interval.
6CAUTI: Catheter-Associated Urinary Tract Infection. CAUTIs are defined using symptomatic urinary tract infection (SUTI) criteria or Asymptomatic Bacteremic UTI (ABUTI) criteria. UTIs
must be catheter-associated (i.e. patient had an indwelling urinary catheter at the time of or within 48 hours before onset of the event).
7CLABSI: Central Line-Associated Blood Stream Infection. CLABSIs are laboratory-confirmed bloodstream infections (LCBI) that are not secondary to a community-acquired infection, or
an HAI meeting CDC/NHSN criteria at another body site. BSIs must be central line associated (i.e., a central line or umbilical catheter was in place at the time of, or within 48 hours
before, onset of the event).
8CLABSI ICU: CLABSIs from ICU locations only
9CLABSI NICU: CLABSIs from NICU locations only 10SSI: Surgical Site Infection. Includes any superficial incisional, deep incisional, or organ/space SSI. 11SSI COLO: Inpatient Colon
surgeries 12SSI HYST: Inpatient Abdominal Hysterectomies 13MRSA Bacteremia LabID: Inpatient facility-wide MRSA bacteremia Laboratory-identified Event
14Clostridium difficile LabID: Inpatient facility-wide Clostridium difficile Laboratory-identified Event
↓ or Indicates statistically significantly lower or higher than previous quarter (respectively). Green Text or Red Text indicates significantly fewer or greater infections than expected .
2Predicted:
SHARP HAI Data
www.michigan.gov/hai
CAUTI Standardized Infection Ratios
1.6
1.4
CAUTI SIR
1.2
1
0.8
0.6
0.4
0.2
0
2013 Q1*
*=Significantly different from 1
**=Significantly different from previous month
2013 Q2*
2013 Q3*
Time Period
2013 Q4*
SHARP HAI Data
www.michigan.gov/hai
CLABSI Standardized Infection Ratios
1.2
1
CLABSI SIR
0.8
0.6
0.4
0.2
0
2013 Q1*
*=Significantly different from 1
**=Significantly different from previous month
2013 Q2*
Time Period
2013 Q3*
2013 Q4*
SHARP HAI Data
www.michigan.gov/hai
SSI Standardized Infection Ratios
1.4
1.2
SSI SIR
1
0.8
0.6
0.4
0.2
0
2013 Q1*
*=Significantly different from 1
**=Significantly different from previous month
2013 Q2**
2013 Q3
Time Period
2013 Q4* **
SHARP HAI Data
www.michigan.gov/hai
SSI COLO Standardized Infection Ratios
1.4
1.2
SSI COLO SIR
1
0.8
0.6
0.4
0.2
0
2013 Q1*
*=Significantly different from 1
**=Significantly different from previous month
2013 Q2
2013 Q3
Time Period
2013 Q4* **
SHARP HAI Data
www.michigan.gov/hai
SSI HYST Standardized Infection Ratios
1.8
1.6
1.4
SSI HYST SIR
1.2
1
0.8
0.6
0.4
0.2
0
2013 Q1
*=Significantly different from 1
**=Significantly different from previous month
2013 Q2
2013 Q3
Time Period
2013 Q4
SHARP HAI Data
www.michigan.gov/hai
MRSA Bac LabID SIRs
1.6
1.4
MRSA Bac LabID SIR
1.2
1
0.8
0.6
0.4
0.2
0
2013 Q1*
2013 Q2
2013 Q3
Time Period
2013 Q4
SHARP HAI Data
www.michigan.gov/hai
CDI LabID SIR
1.2
CDI LabID SIR
1
0.8
0.6
0.4
0.2
0
2013 Q1*
2013 Q2*,**
2013 Q3*
Time Period
2013 Q4*
MDRO Prevention Initiatives
Staphylococcus aureus

SHARP also has started two prevention initiatives aimed to
reduce the incidence and prevalence of MDROs in healthcare
facilities in Michigan:

Clostridium difficile (CDI) surveillance and prevention
initiative

Carbapenem-Resistant Enterobacteriaceae (CRE)
surveillance and prevention initiative
Citrobacter freundii
Escherichia coli
Klebsiella pneumoniae
Enterobacter cloacae
MDRO Prevention Initiatives
www.michigan.gov/hai

SHARP recruited facilities into the two initiatives

Both will measure the baseline prevalence and
incidence of their respective organisms

Then there will be a period of measurement during
which facilities are encouraged to begin
implementing infection prevention interventions
to reduce the transmission of these organisms
Planning Stage
Baseline Stage
Intervention Stage
Education and Consulting
www.michigan.gov/hai

Another primary focus of the SHARP unit is increasing
awareness of HAIs, answering FAQs, and disseminating
best-practice and evidence-based recommendations
and guidelines

Examples of entities/persons that ask for our guidance:
 IPs
 Gyms
 Local
 Correctional
HDs
 Healthcare workers
 Schools
 Students
 Public
Facilities
Special Collaboration
www.michigan.gov/hai

SHARP collaborates with the MDCH Viral Hepatitis
Unit:
 Investigating
potentially healthcare-related viral
hepatitis infections (e.g. David Kwiatkowski)
 Works jointly on injection safety-related educational
campaigns (e.g. One and Only campaign)

Contact information
 (517)335-8165

www.michigan.gov/hivstd (click on the hepatitis link)
SHARP Unit Contacts
(517) 335-8165
www.michigan.gov/hai
www.michigan.gov/hai
o Jennie Finks, DVM, MVPH – HAI Coordinator and Unit Manager
finksj@michigan.gov
o Jennifer Beggs, MPH – Infectious Disease and Preparedness Epidemiologist
beggsj@michigan.gov
o Allison Murad, MPH – National Healthcare Safety Network (NHSN)
Epidemiologist murada@michigan.gov
o Noreen Mollon, MS – Infection Prevention Consultant
mollonn@michigan.gov
o Gail Denkins, RN – CDI Prevention Initiative Coordinator
denkinsg@michigan.gov
o Brenda Brennan, MSPH – CRE Prevention Initiative Coordinator
brennanb@michigan.gov
Other MDCH Entities that Interact with IPs



Bureau of Labs (BOL)
Office of Public Health Preparedness (OPHP)
Licensing and Regulatory Affairs (LARA)
 Michigan
Occupational Safety and Health
Administration (MIOSHA)
 Healthcare Facility Engineering

Michigan Care Improvement Registry (MCIR)
MDCH Bureau of Labs (BOL)

Main Phone: (517) 335-8063

Tours available quarterly, to
schedule call (517) 335-9654
MDCH BOL Testing
www.michigan.gov/mdchlab
List of Tests performed
By MDCH BOL
Forms required to
Request testing
Regional Reference Labs

Report Suspected Bioterrorism:
 Lansing:
(517) 335-8063
 Kalamazoo: (269) 373-5360
 Grand Rapids: (616) 632-7210
 Saginaw: (989) 758-3825
 Oakland County: (248) 858-1310
Office of Public Health Preparedness
(OPHP)

Purpose of OPHP is to establish strategic
leadership, direction, assessment, and
coordination of activities to ensure statewide
readiness and interagency collaboration to
respond to public health emergencies.
Michigan Emergency Management
System
President of US
Governor
www.fema.gov/nims
Michigan State Police
State Director of Emergency Management
DHS / FEMA
All emergencies and
disasters are local
Emergency Management
Division (EMD)
MDCH
EMD District
Coordinators
Health Preparedness
Regions
Local Emergency
Management
Local Health
Departments
Emergency Preparedness Collaboration
Industry /
Private Sector
Public
Works
Transportation
Law
Enforcement
Hospitals
EMS
Utilities
Emergency
Management
Public
Health
Fire &
Rescue
www.fema.gov/nims
Emergency Preparedness Training
MI-TRAIN (http://mi.train.org)
Emergency Preparedness Communication

Statewide communication capabilities:
 Michigan
Statewide Comprehensive Interoperable
Communication Plan
 Public
Health Safety Communication System
(800Mhz radios)
 Health
Alert Network (HAN)
MI HAN
(https://michiganhan.org)
Emergency Preparedness Regions

8 Michigan Emergency
Preparedness Regions:
 Modeled
after State Police
Regions
 Encompass 45 Local HD
Emergency Preparedness
Centers
 Each Region contains:
 Medical
Director
 Hospital Bioterrorism
Coordinator
 Epidemiologist
Strategic National Stockpile



Able to distribute large quantities of
pharmaceuticals and medical supplies during an
emergency
Local HDs and hospitals are prepared to receive
MISNS assets
MISNS is capable of delivering assets via ground or
air transport
OPHP Contacts

Linda Scott – Hospital Preparedness Coordinator
 (517)
335-8150
 scottl12@michigan.gov

Mary Macqueen – Public Health Preparedness
Coordinator
 (517)
335-8150
 macqueenm@michigan.gov
MIOSHA – Michigan Occupational
Safety and Health Administration


MIOSHA operates under Licensing and Regulatory
Affairs (LARA)
For healthcare inquiries contact MSIPC’s MIOSHA
liaison Eric Zaban:
 (517)

For general consultation and/or training contact:
 (517)

882-1022
322-1809
www.michigan.gov/miosha
LARA- Health Facilities Engineering

Provide enforcement and interpretation of the
minimum healthcare facility design standards to
reduce the risk of transmission

Kasra Zarbinian
 (517)

241-3422
www.michigan.gov/hfes
Michigan Care Improvement
Registry (MCIR) www.mcir.org




Web-based system created in 1998
to collect children’s immunization
information
Expanded in 2006 to include adults (lifespan registry)
Consolidates immunization information from
multiple data sources and provides immediate, realtime, patient immunization history
Assists with all-hazard preparedness by tracking
vaccines and medications during a public health
emergency
MCIR Activity

9 million records

Over 83 million shot records

29,000 registered users

5,500 active provider sites
The Benefits of MCIR




High healthcare provider participation (90%)
Reports indicate ‘pockets of need’
Flexibility, allowing linkages with other public health
systems
Types of information available in MCIR:
Patient Immunization status at time of visit
 Reminders/recall letters
 Coverage level reports
 High risk influenza
 Newborn screening
 Lead results
 Early hearing detection and intervention (EHDI)

Immunization Information

Annual Fall Conferences – www.michigan.gov/immunize

AIM Kits – www.aimtoolkit.org

Influenza information “FluBytes”– www.michigan.gov/flu

Quarterly Newsletters – send an e-mail with SUBSCRIBE
in the subject line to franklinr@michigan.gov

Beatrice Salada, State MCIR Coordinator
 saladab@michigan.gov
 www.mcir.org
Thanks!

Questions or comments?

Joyce Lai
 (734)
727-7204
 LaiJ@michigan.gov

Noreen Mollon
 (517)
335-6582
 MollonN@michigan.gov