May 08, 2009

A public health nurse checks a woman's blood pressure during field work.

A public health nurse checks a woman’s blood pressure during field work.

Last summer, “Attack of the Killer Tomatoes” became more than a science fiction spoof. In June 2008, tomatoes were blamed for a nationwide outbreak of Salmonella Saintpaul, a bacterial infection that caused serious illness in more than 1,400 people in 43 states, including North Carolina.

While it is vital for local public health professionals to be able to investigate disease outbreaks, they often have limited training in field investigation. Fortunately, in North Carolina, training in outbreak investigation has been available to public health nurses since 2004 through a partnership between the N.C. Division of Public Health and the N.C. Center for Public Health Preparedness. The Center is part of the North Carolina Institute for Public Health, the service and outreach arm of the UNC Gillings School of Global Public Health.

“We knew there was a need for a more formal training program,” says Kathy Dail, RN, MEd, a nurse epidemiologist with the N.C. Division’s communicable diseases branch. “There were no conferences or workshops. Each local health department was on its own” to report and investigate suspected outbreaks.

The N.C. Center for Public Health Preparedness had what Dail describes as a “vision of partnership.” Center staff saw a good match between Dail’s need to train local public health nurses and the Center’s mission to train public health workers.

Does NCCPHP’s online course in field investigation make a difference? The nurses who have completed it think so.

Dail’s group and the Center’s staff focused on the goals of teaching nurses to recognize a threat, gather data quickly and accurately, and provide the state with timely, quality surveillance and investigation. Given the challenges of training nurses across the state and the need for nurses to become more comfortable using the Internet, an online course was developed.

The result was “Introduction to Communicable Disease Surveillance and Investigation in N.C.,” a 14-week, online course with a two-day, face-to-face skills demonstration. Topics include a history of epidemiology, threats to global public health, communicable disease laws and regulations, and steps to conduct an outbreak investigation and communicate findings to the public.

In 2006, the course became required for N.C. public health nurses who spend more than 75 percent of their time on communicable disease issues. To date, more than 300 public health nurses in more than 80 local health departments have completed the 60-hour training course.

Does the course make a difference? The nurses who have completed it think so – 99 percent say they would recommend it to a co-worker; 100 percent say they plan to implement on the job what they had learned.

Dail agrees. “This has been the most positive educational venture of my 25-plus years of teaching in public health settings,” she says.

— Bev Holt

Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit