Presented by Dr. Drew Harris, UMDNJ in cooperation with Rutgers University, University of Medicine and Dentistry of NJ Supported by the NJ Department of Health and Senior Services

Practice standards

Set the performance standards for the local, regional and county boards of health

Pertinent sections

• Emergency Response (8:52-12.2)
  • 24/7 communications
  • Coordinate preparedness plan w/ HAN/LINCS
  • Exercises at least annually
• Surveillance (8:52-12.3)

These are NJDHSS regulations promulgated that outline what is expected of local and county health departments. Under other laws, the state has the power to take over or otherwise intervene if a local entity fails to live up to the standards. Note the pertinent sections.

Reporting

• Certain communicable diseases must be reported if “suspect” or “confirmed”.
• Includes: anthrax, rabies, smallpox, etc.
• Applies to all health care providers, labs, hospital CEOs, day care directors, etc.
• “Outbreaks” –actual or suspected
• Suspected bioterrorism
• Should call local health officer STDs and TB reported direct to NJDHSS

NJAC 8:57, 1.1 – 1.12

The NJDHSS regularly issues regulations defining which diseases--suspected or confirmed — or syndromes must be reported and to whom. As new diseases such as SARS emerge, the regulations are amended. It is important to keep up-to-date with this list. The obligation to report applies to several categories of professionals and organizations such as: physicians, other health care providers, laboratories and directors/executives of nursing home, prisons, schools, day care centers, and colleges.

Health officers have additional obligations

• If notified of any reportable disease he/she must report case to NJDHSS
• If case from another jurisdiction, must notify other HO
• Begin investigation
• Initiate appropriate disease control measures (food embargo, PPE, Isolation and Quarantine)

8:57, 1.8-1.9

Health Officers act on behalf of Boards of Health which have responsibility for assuring compliance with appropriate state laws and regulations and whose power is derived from the state. They, too, must report diseases and outbreaks as required, as well as notify the health officer in the home community. They must initiate the investigation and embargo, quarantine and other public health measures as necessary.

Quarantine and isolation

Courtesy of the Library of Congress and the National Digital Library: Corbis/Bettmann

Isolation – restriction of infected person Quarantine – restriction of exposed person Photo on left: "Infantile Paralysis ... KEEP OFF THIS STREET." Placards were typically pasted on tenements and multi-family dwellings by the health department to enforce quarantine rules.

Upon report of communicable disease, a health officer or NJDHSS may upon written notice:

• Establish isolation or other restrictive measures to prevent or control disease
• Remove people to hospital
• Restrict exposed people for incubation period
• Most compliance is voluntary
• Use the least restrictive means necessary

It is important to note that most orders of quarantine or isolation are voluntarily complied with. We can expect legal challenges only in unusual and difficult cases, especially if public health officials are careful to explain the need for the action, procedures and provide assurances of safety and care. Effective and ongoing communication with all concerned is crucial.

The quarantine or isolation must be achieved by the least restrictive means necessary. During the SARS outbreak in Toronto, exposed but asymptomatic hospital workers were allowed to go to work. However, they couldn't’t take public transportation or visit other public places. Services to provide for their family’s needs were made available.

Download SARS Preparedness and Response Plan: NJDHSS

Download Influenza Pandemic Plan: NJDHSS