MPH 610 Week 1 Practice Site Proposal Post Example

Week 1 Discussion: Initial Post

An Animal Bite Program Run From One Desk: The Applied Practice Experience I Have Proposed at the Kessler County Health Department

Initial Post

The site in two lines. My applied practice experience is with the environmental health division of the Kessler County Health Department, a composite county health department serving about 180,000 people. The division's rabies prevention program receives every animal bite report in the county, arranges observation of the biting animal and advises callers and clinicians on whether rabies postexposure prophylaxis is needed.

A problem the site already has. The program is run from one desk. One environmental health technician handles about 600 bite reports a year, most from dogs, entered into a spreadsheet. The division manager told me at our first meeting that advice to emergency department clinicians about prophylaxis is inconsistent: it depends on who answers the phone and whether they remember the last case like it. She also said she cannot answer a simple question from the board of health, such as how many bites in a year came from unvaccinated dogs, without someone going through the spreadsheet by hand.

The Products, Named

I have proposed two products. The first is a two-page risk assessment and consultation protocol for staff and emergency clinicians, setting out the questions to ask about the animal, the exposure and the local rabies situation, and the recommendation each set of answers leads to, aligned with the national recommendations for postexposure prophylaxis (Rupprecht et al., 2010). The second is a quarterly bite surveillance report with rates per 100,000 residents by species, month and area, and the share of biting dogs and cats with known vaccination, built from a cleaned version of the existing spreadsheet.

The protocol matters because prophylaxis decisions are often wrong in both directions. In a study of 2,030 animal exposures treated in 11 urban emergency departments, prophylaxis was judged inappropriate in 40% of the cases in which it was given, often because the animal was available for observation, and inappropriately withheld in about 6% of cases in which it was not given (Moran et al., 2000).

Competencies Tied to Them

The protocol evidences the competency on communicating public health content to an audience, since it is written for busy clinicians, and the competency on working in interprofessional teams, since it must be agreed with the emergency department. The surveillance report evidences the competencies on applying epidemiological methods and interpreting data for practice.

What Stays Yours and What Stays Theirs

The products are mine to draft and the division's to adopt. The protocol will not take effect until the health officer approves it, and the site's own forms, records and supervisor evaluations are not part of what I write or submit here.

A Question for the Group

Has anyone else's site asked for a product that needs approval by someone you will rarely meet? I am wondering how to plan for a health officer's review when my preceptor is not the one who signs off.

Reply to Brianna

Brianna, your site's need for a Spanish-language prenatal class schedule is concrete, and I like that the clinic manager raised it. You describe the product as "materials." Could you name the finished object, such as a one-page schedule and a script for front-desk staff, so your work plan can say when each is done?

Reply to Theo

Theo, a literature review on youth vaping for a school district could be useful, but did anyone at the district ask for one? If the district's problem is that it has no policy for vaping on buses, a draft policy with a short evidence summary might serve them better and give you a product to hold.

References

Moran, G. J., Talan, D. A., Mower, W., Newdow, M., Ong, S., Nakase, J. Y., Pinner, R. W., & Childs, J. E. (2000). Appropriateness of rabies postexposure prophylaxis treatment for animal exposures. JAMA, 284(8), 1001-1007. https://doi.org/10.1001/jama.284.8.1001

Rupprecht, C. E., Briggs, D., Brown, C. M., Franka, R., Katz, S. L., Kerr, H. D., Lett, S. M., Levis, R., Meltzer, M. I., Schaffner, W., & Cieslak, P. R. (2010). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations and Reports, 59(RR-2), 1-9.