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Online J Public Health InformOnline J Public Health InformOJPHIOnline Journal of Public Health Informatics1947-2579University of Illinois at Chicago Library ojphi-10-e13610.5210/ojphi.v10i1.8919ISDS 2018 Conference AbstractsImplementation of a Facility Based County Surveillance System Using
Epi Info Spoto Samantha *
1
Wiese Michael 
1
Lyman Michelle 
 2

 1
1 Epidemiology, Florida Department of
Health in Hillsborough County, Tampa,
FL, USA; 2 University of South
Florida College of Public Health, Tampa, FL,
USA* Samantha Spoto E-mail: samantha.spoto@flhealth.gov30 5 2018 2018 10 1 e136ISDS Annual Conference Proceedings 2018. This is an Open Access
article distributed under the terms of the Creative Commons
Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting
all non-commercial use, distribution, and reproduction in any medium,
provided the original work is properly cited.Keywords 
Syndromic SurveillanceLong Term Care FacilityEpi Info
==== Body
Objective
The Florida Department of Health in Hillsborough County (DOH- Hillsborough) routinely
reviews the ESSENCE-FL system to assess syndromic trends in emergency department
(ED) and urgent care data (UCC). Collection of this type of symptom data from long
term care facilities (LTCFs) and child care centers is of interest in order to
better understand how these illness patterns present in vulnerable populations
outside of the EDs.

Introduction
Surveillance in nursing homes (Enserink et al., 2011) and day care facilities
(Enserink et al., 2012) has been conducted in the Netherlands, but is not commonly
practiced in the United States (Buehler et al., 2008). Outbreaks of illnesses within
these facilities are required to be reported to the Epidemiology Program, however a
small fraction of outbreaks reported come from LTCFs. Without regular communication
between LTCFs and the Epidemiology Program, it is likely that many outbreaks are
going unreported due to lack of awareness of the reporting requirements by facility
staff. To better understand the prevalence of illness in LTCFs and improve
communication between LTCFs and DOH-Hillsborough a weekly surveillance survey was
created using Epi Info web survey.

Methods
The online facility search tool from the Agency for Healthcare Administration (AHCA)
was used to query assisted living facilities and nursing homes in Hillsborough
County in July 2017. The information provided included the number of beds a facility
is licensed to have. Interest in participation was solicited from larger LTCFs
within the county in August 2017 and 23 facilities volunteered to receive weekly
surveys, with a total volume of 3,276 beds. A form was created in Epi Info to
capture weekly information per facility of the number of residents and staff with
new onset of various symptoms. Symptom groups include GI, rash, respiratory, and
those with respiratory symptoms who also have a fever (to assess influenza-like
illness); number of positive flu tests for the week is also asked. Starting with
week 38, an email has been sent once a week to participating facilities with a link
to the Epi Info web survey (Figure 1) and instructions to fill out the information
for the previous week.

Results
To date, 12 weeks of information has successfully been captured in Epi Info and
transferred to Microsoft Excel for graphical visualization of percentage of
residents/staff reported each week in the county with new onset of the above
symptoms. Low levels of illness (<6%/ week of total reported residents/staff)
have been reported for various syndromes each week. Over the 12 week period an
average of 3.9 facilities submit data per week, with a total of 10 of 23 facilities
participating at least once. In week 42 phone calls were made to faclities that had
not submitted any responses in an attempt to elicit more participation and
troubleshoot any problems faclities may have encountered. Prior to week 42, an
average of 3.2 facilties reported per week. After reminder phone calls were
conducted, the average number of responses for weeks 42-48 was 4.4 with the highest
in week 42 (6 responses). Starting in week 42 the survey has also been implemented
for 15 child care facilities, with four participating over the seven weeks with an
average of 2.1 responses per week.

Conclusions
Since implementation, the main limitation with the data collection is lack of regular
participation from facilities. The current goal of the project is to increase the
number of regular responses from both LTCFs and child care facilities. The phone
calls made in week 42 increased the response rate for LTCFs, particularly for that
week. Preliminary results from the first 12 weeks of data indicate that using Epi
Info web survey as a syndromic surveillance tool for local facilities has potential
if regular participation can be acheived.

Figure 1 Screenshot of the Epi Info web survey for long term care facilties, to be
completed on a weekly basis.
==== Refs
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