New Jersey Administrative Code
Title 8 - HEALTH
Chapter 52 - PUBLIC HEALTH PRACTICE STANDARDS OF PERFORMANCE FOR LOCAL BOARDS OF HEALTH IN NEW JERSEY
Appendix - APPENDIX
PROGRAMMATIC GUIDELINES FOR BEST PRACTICES
I. Environmental Health Activities
Recreational Bathing
(a) The local board of health shall:
1. Conduct a sanitation and safety program at public bathing places (that is, swimming pools, lakes, rivers and ocean bathing places), based upon the current "Recreational Bathing" regulations contained in the State Sanitary Code (see N.J.A.C. 8:26);
2. Inspect, using an inspection form designed by the Department of Health and Senior Services, each public bathing place at least twice during the operating season, make follow-up inspections when deficiencies are found, and take necessary enforcement actions;
3. Assure sanitary surveys of natural bathing areas as indicated by bacterial counts and/or epidemiological evidence;
4. Inspect public spas and/or whirlpools at least yearly in accordance with the provisions of the Recreational Bathing regulations (N.J.A.C. 8:26); and
5. Conduct investigations within 24 hours of all deaths and serious injuries and report such occurrences as outlined in the Recreational Bathing Regulations (N.J.A.C. 8:26) on a form developed by the Department of Health and Senior Services.
Campgrounds
(a) The local board of health shall:
1. Conduct a sanitation and safety program for campgrounds based upon State law and Chapter II of the State Sanitary Code (N.J.A.C. 8:22-1 ); and
2. Inspect each campground at least annually to insure compliance; conduct follow-up inspections and initiate enforcement action as necessary.
Youth camps
(a) The local board of health shall conduct a youth camp sanitation and safety program (N.J.A.C. 8:25) and shall:
1. Inspect each youth camp once prior to opening; and
2. Perform necessary follow-up inspections at the request of Consumer and Environmental Health Services; and
3. Submit copies of each inspection to Consumer and Environmental Health Services, Department of Health and Senior Services.
Food surveillance
(a) The local board of health shall maintain surveillance of retail food establishments, food and beverage vending machines and shall:
1. Conduct a retail food establishment program based upon State laws and regulations, including Chapter 12 of the State Sanitary Code and local ordinances, if applicable (N.J.A.C. 8:24);
2. Inspect retail food establishments using forms approved by the Department of Health and Senior Services at least once a year, inspect vending machines dispensing potentially hazardous foods at least once a year and those dispensing non-potentially hazardous foods on a complaint basis or as required by local ordinance;
3. Initiate appropriate enforcement action to secure compliance with State law and local ordinance; collect and prepare evidence for legal action; follow a protocol for taking appropriate enforcement actions to secure compliance (such as abatement letters, administrative hearings, summons, court actions and condemnations);
4. Maintain food establishment and vending machines files at the local health agency office containing inspection reports, food sample reports, and reports of enforcement actions taken and other pertinent data associated with the program;
5. Provide for, or conduct training courses for food service supervisors using curricula approved by the Department of Health and Senior Services such as the Food Manager's Certification Program;
6. Collect samples and provide for laboratory analyses of any food suspected of being associated with a foodborne illness or, as necessary, any food suspected of being adulterated, misbranded or unwholesome;
7. Embargo all food known or suspected of being adulterated, misbranded, unwholesome or associated with foodborne illness within the meaning of local ordinance or State law;
8. Assist the Department of Health and Senior Services upon request in conducting recalls and recall effectiveness checks of foods found to be contaminated, adulterated or misbranded; and
9. Condemn and supervise the destruction or otherwise dispose of food which is adulterated, misbranded, unwholesome or associated with foodborne illness within the provisions of local ordinance or State law.
Occupational health (operative January 1, 1989)
(a) The local board of health shall conduct an occupational health program operative January 1, 1989; and shall:
1. Maintain a comprehensive profile of all employers in each designated four digit Standard Industrial Classification (SIC) operating in local jurisdiction. This profile should utilize Department of Labor and Right to Know data filed (see N.J.A.C. 8:59) and include for each employer:
Name of company, SIC Code
Address of company,
Number of employees,
Major product or service,
Right to Know Data--DEP/DOH,
History of emergency calls,
History of complaints;
2. Maintain a list of all information and/or agency occupational health resources and make appropriate referrals in response to requests for information or complaints;
3. Train or obtain at least one staff person in Occupational Health and Industrial Hygiene through a continuing education program provided or made available by the Occupational Health Services of the Department of Health and Senior Services;
4. Conduct initial and follow-up interviews, utilizing standardized procedures and forms developed by the Department of Health and Senior Services, upon receipt of reports of occupational disease cases (8:57-1.13 ); and
5. Conduct preliminary surveys in response to reported occupational diseases or referrals from the Department of Health and Senior Services, using standardized forms provided by the Department of Health and Senior Services to record observations and collect information. (These standardized forms shall be forwarded to the Department of Health and Senior Services' Occupational Health Services for follow-up).
Public health nuisances
(a) The local board of health shall conduct a public health nuisance program to include the following:
1.Investigations of public health nuisances including, but not limited to, noxious weeds, housing, solid waste, and insect and rodents, which shall be conducted in accordance with applicable State laws and local ordinances, which are at least equivalent to the "Weed Control Code of New Jersey," the "Solid Waste Code of New Jersey," and the "Public Health Nuisance Code of New Jersey (1953)," exclusive of Section 2.1 (a) and (b) (which are model codes available from the Department of Health);
2. Conduct complaint investigations and surveys to identify nuisances, and through appropriate follow-up, ensure abatement in accordance with State law and local ordinances;
3. Maintain and make available educational information on the prevention and abatement of public health nuisances; and
4. Maintain current files on all public health nuisances which shall include the investigation, follow-up, abatement and enforcement action taken in each instance.
II. Communicable Disease Activities
Reportable diseases
(a) The local board of health shall conduct a program for the surveillance, investigation and control of reportable diseases and shall:
1. Document episodes of reportable diseases including occupational diseases and/or incidents and transmit the information to the State and other agencies as required by chapter 2, Reportable Diseases (N.J.A.C. 8:57-1 ) of the State Sanitary Code and N.J.S.A. 26:4;
2. Conduct prompt investigations of reportable illnesses as well as unusual manifestations of disease not listed as reportable in chapter 2 of the State Sanitary Code (N.J.A.C. 8:57-1 ) and institute appropriate control measures and promptly report all findings to the Department of Health and Senior Services;
3. Disseminate and exchange information relative to outbreaks of disease with physicians, hospitals, boards of education, and other responsible health agencies as appropriate; and
4. Analyze reported data to provide a basis upon which to plan and evaluate an effective program for the prevention and control of infectious diseases.
Immunization
(a) The local board of health shall promote and provide immunizations for protection against childhood vaccine-preventable diseases and shall:
1. Promote and provide primary and booster immunizations to preschool and school age children for protection against diseases in accordance with current recommendations of the Department of Health and Senior Services;
2. Assist all schools, with an emphasis on preschool facilities, in implementing and enforcing the immunization requirements contained in Chapter 14, of the State Sanitary Code (N.J.A.C. 8:57-4 ) by providing immunization services and conducting periodic surveys and representative record audits every year;
3. Secure prompt reporting of vaccine-preventable disease as required by chapter 2 of the State Sanitary Code (8:57-1.2 ); and
4. Utilize vaccine information statement forms and maintain related documentation for individuals receiving State-issued vaccines according to State Directives and in compliance with Federal law.
Rabies and zoonosis control
(a) The local board of health shall conduct a program for the control of rabies and other zoonoses and shall:
1. Require rabies vaccination of dogs to comply with current rabies statutory requirements and encourage the vaccination of cats, and provide for rabies vaccination clinics at least once a year;
2. Ensure that a report of an annual canvass of all dogs owned, kept, or harbored within the limits of the respective municipality is received by the local board of health by September 1 of each year.
3. Inspect kennels, pet shops, shelters and pounds, to ensure compliance with the State laws and regulations prescribed by the Department of Health and Senior Services, and ensure that licenses issued to these facilities are in compliance with existing laws;
4. Report and investigate animal bites, ensure that persons bitten are advised to see a physician, quarantine biting animals as indicated and report immediately to the Department of Health and Senior Services clinically suspicious cases of rabies in animals as determined by a veterinarian, ensure availability of impounding facility where biting animals may be appropriately quarantined and observed for rabies;
5. Ensure that heads of animals that have died within 10 days after biting a person are delivered immediately to the Department of Health and Senior Services' Public Health and Environmental Laboratories for examination (Unwanted dogs or cats or any another animal which has bitten a human may be sacrificed immediately and the head promptly delivered to the Public Health and Environmental Laboratories for examination);
6. Provide an organized program for control of stray dogs and other animals;
7. Inspect annually, or more often if necessary, records of dealers in psittacine birds as required by chapter 3 of the State Sanitary Code (N.J.A.C. 8:23); and
8. Initiate appropriate enforcement actions to secure compliance with the State rabies statutes, collect and prepare evidence for legal action.
Tuberculosis control
(a) The local board of health shall control the spread of tuberculosis and shall:
1. Ensure that all of the tuberculosis control services or services elements listed in the "Guidelines for Ambulatory or Outpatient Tuberculosis Control" (available at the New Jersey Department of Health and Senior Services) are available and accessible to all persons living within the jurisdiction of the local agency;
2. Secure prompt reporting of tuberculosis and transmit reports as required by the State Sanitary Code (8:57-1.2 ) and encourage the reporting of suspects;
3. Ensure effective treatment and continuing medical supervision of suspect and diagnosed cases of tuberculosis;
4. Ensure that contracts are identified and brought to examination, diagnostic conclusion, and treatment in accordance with the policy of the Department of Health and Senior Services;
5. Ensure the provision of preventive therapy in accordance with current recommendations of the Department of Health and Senior Services;
6. Ensure reporting of the current status of diagnosed cases of tuberculosis in accordance with the policy of the Department of Health and Senior Services using forms provided by the State;
7. Provide for the discharge from tuberculosis supervision of patients whose treatment has been completed in accordance with current recommendations by the Department of Health and Senior Services;
8. Provide for testing using currently approved intradermal tuberculin tests, of pupils, teachers, employees, and volunteers in the non-public schools, and for follow-up of those in both the public and non-public schools as recommended in the current edition of "School Tuberculin Testing in New Jersey," published by the Department of Health and Senior Services; and
9. Analyze data to provide a basis upon which to plan and evaluate an effective program for the prevention and control of tuberculosis.
Sexually transmitted diseases
(a) The local board of health shall control sexually transmitted diseases and shall:
1. Provide for medical services for all persons seeking medical care for Sexually Transmitted Disease (STD);
2. Secure prompt reporting of any case of STD and forward reports immediately to the Department of Health and Senior Services, Communicable Disease Field Program, as required by chapter 2 of the State Sanitary Code (8:57-1.2 );
3. Provide interview and investigation services to priority STD cases in accordance with the policy established by the Department of Health and Senior Services and report results of these services on appropriate forms provided by the Department;
4. Provide counseling to all patients infected with STD and treated at public health department STD clinics, to include, but not be limited to, disease prevention, sex partner referral, need for follow-up testing, and appropriate action to take when symptoms appear;
5. Provide public education services to the community or target population; and
6. Analyze reported data and provide a basis upon which to plan and evaluate an effective program for the prevention and control of sexually transmitted diseases.
Human Immunodeficiency Virus (HIV) infection
(a) The local board of health shall administer a planned program to prevent and control HIV infection and shall:
1. Utilizing seroprevalence and case reporting data provided by the Department of Health and Senior Services, identify ways to reach persons at high risk within the community and develop and implement a strategy to disseminate HIV prevention and control information to these groups;
2. Maintain supplies of educational materials to meet information requests on the transmission, prevention and control of HIV;
3. Provide or arrange for other suitable local health education resources (for example, Planned Parenthood, Red Cross) to conduct education programs addressing the epidemiology, prevention and control of HIV to civic and community organizations and occupationally at risk groups utilizing State prepared or equivalent curricula;
4. Provide or arrange for in-service training addressing the epidemiology, prevention and control of HIV to all local health department personnel;
5. Develop and implement a protocol to refer individuals concerned about their HIV status to counseling and testing sites and other health care providers;
6. Refer HIV infected persons and their families seeking services to appropriate provider agencies such as mental health, drug treatment and other social service agencies; and
7. Participate in the planning, development and implementation of a county or regional program to control HIV infection and the progression to AIDS.
III. Maternal and Child Health Activities
Infants and preschool children
(a) The local board of health shall provide health supervision for infants and preschool children and shall:
1. Provide child health conferences for comprehensive preventive health care of infants and preschool children, with particular emphasis on the medically indigent, based upon the current Department of Health and Senior Services publication, "Guidelines For the Child Health Conference";
2. Prepare a Child Health Service Report CH-7 or subsequent form number for each session, and submit promptly on at least a quarterly basis to the Maternal and Child Health Program in the New Jersey Department of Health and Senior Services;
3. Maintain an informational and outreach service to encourage physicians, hospitals and social agencies to refer families to the child health conference, women, infants and children supplemental Food Program (WIC) and the public health nursing agency; and
4. Provide for information and guidance on physical, emotional, nutritional, and cognitive development of infants and preschool children through child health conferences and home nursing visits.
Childhood lead poisoning
(a) The local board of health shall provide for the prevention and control of lead poisoning in young children and shall:
1. Conduct a program, the major components of which shall include:
i. Case identification;
ii. Medical management;
iii. Environmental surveillance; and
iv. Education in conformance with 24:14A-1 et seq. and chapter 13 of the State Sanitary Code (N.J.A.C. 8:51-7.7 ). (Also, a current issue of "Preventing Lead Poisoning in Children, a statement by the Centers for Disease Control" and findings of the New Jersey Physician Task Force on Lead Poisoning shall be used as guidelines for program delivery as appropriate.)
2. Develop a program plan based on elements in (a)1 above and on the degree of risk in the community as identified through the "Community Health Profile" and "Community Hazard Score for Lead Poisoning in Children" issued by the Department of Health and Senior Services;
3. Conduct case finding efforts among children one through five years of age by annual blood testing in accordance with approved collection techniques in such settings as child health conferences, WIC clinics, day care centers, nursery schools and door-to-door in high risk neighborhoods, with testing priority given to children at higher risk including:
i. Those one through three years of age;
ii. Those residing in or frequenting housing units or other sites where lead-based paint may be present;
iii. Those whose parents or other household members may be occupationally or otherwise exposed to lead sources;
iv. Those at increased risk of exposure to lead sources for whatever reason;
v. Those with a history of pica or increased lead absorption; and
vi. Those who are siblings of a child with increased lead absorption;
4. Assure that confirmed positive test results based on current risk classification standards is immediately referred to medical supervision and that a child so referred shall receive on-going, medical management as appropriate;
5. Conduct environmental surveillance among patient cases identified; and
i. Provide staff capable of conducting environmental investigations;
ii. Assure that, simultaneous with referral for medical attention, an environmental investigation will be initiated to identify the probable source(s) of lead exposure and to ensure the expedient and safe removal of the lead hazard(s);
iii. Assure that along with the owner of the property wherein the child resides, the parent or guardian of the child shall be notified in writing and kept abreast as to the findings of the environmental investigation and subsequent surveillance;
iv. Ensure that during periods when actual renovation work is underway, the affected child or children are removed from the premises; and
6. Provide a program of education directed toward parents, the general public, physicians and other health personnel regarding lead intoxication, sources of lead in the environment and control measures; and
i. Assure the provision of appropriate counseling and instruction to parents of lead intoxicated children and to parents of children at risk by trained professional personnel; and
ii. Assure the provision of adequate in-service training and continuing education of program personnel.
Improved pregnancy outcome
(a) The local board of health shall reduce infant mortality by improving access to prenatal care and related services in accordance with guidelines established by the Department of Health and Senior Services and shall:
1. Maintain an information and referral system for those requesting family planning, or prenatal and WIC services, to include:
i. A file of all providers of such services in the jurisdiction; and
ii. An active referral file;
2. Maintain a liaison with prenatal clinic services, family planning clinics, WIC school nurses, school health educators, and others;
3. Provide public health nursing services as requested by agencies for prenatal follow-up to high risk women who are determined to be medically indigent, to include, at a minimum:
i. Pregnancy counseling;
ii. Prenatal information;
iii. Follow-up of all referred positive pregnancy tests to promote initiation of prenatal care in the first trimester as requested by agencies;
iv. Nursing support and education through prenatal and postpartum home nursing visits as needed; and
v. Referrals as appropriate to WIC or other nutrition services, social services, and family planning services;
4. Establish and maintain a community outreach and education program targeting high risk women including adolescents to encourage and facilitate early entrance into prenatal care; and
5. Cooperate with the Department of Health and Senior Services, Newborn Biochemical Screening Program to locate and secure repeat specimens from infants when the sample cannot be obtained through the normal channels of a hospital and/or physician.
IV. Adult Health Services Activities
Cancer services
(a) The local board of health shall provide cancer prevention for populations at high risk according to criteria outlined in the Department of Health and Senior Services' publication "Adult Health Services Guidelines" and as identified through the Community Health Profile and shall:
1. Provide screening personnel to meet the criteria for staffing as specified in the "Adult Health Services Guidelines";
2. Establish a coordinated plan for counseling, referral and follow-up of all persons with non-negative screening results;
3. Provide screening services yearly for three percent of women ages 15 to 34 and the three percent of women ages 35 to 64 who are at high risk for cervical cancer;
4. Provide education services yearly for five percent of women ages 15 to 34 and five percent of women 35 and older to receive instruction in these particular areas;
i. The risk factors for cervical cancer and breast cancer;
ii. The importance of the Pap Smear in the early detection of cervical cancer (in accordance with the American Cancer Society Guidelines on cervical cancer screening);
iii. The importance of comprehensive breast cancer screening which include mammography at intervals specified by the American Cancer Society Guidelines and a physical breast examination by a health care professional;
iv. Breast self examination as one component in a total health care awareness program; and
v. Dietary and lifestyle modifications to reduce the risks of breast and cervical cancer.
5. Provide yearly instruction to three percent of individuals over age 40 in these particular areas:
i. The risk factors for colon/rectal cancer;
ii. The importance of compliance with the guidelines on colon/rectal cancer prescribed in Department of Health and Senior Services' Adult Health Services Guidelines; and
iii. The dietary and lifestyle modification to reduce the risk of colon/rectal cancer;
6. Provide annual reports to the State on the demographic characteristics of populations receiving screening and/or education services and the results of these screening programs;
7. Serve as a community resource to disseminate information available from the State on types of screening services available;
8. Provide for cancer-related continuing education for nursing and other program personnel at least once every three years. Include current cancer-related information in the orientation of all newly-hired cancer program staff to be involved in Cancer Services; and
9. Offer smoking prevention and cessation programs as defined in the "Adult Health Services Guidelines" (N.J.A.C. 8:52-6 ).
Diabetes services
(a) The local board of health shall provide for diabetes education services per the Department of Health and Senior Services' "Adult Health Services Guidelines" and shall:
1. Conduct public education related to diabetes and its risk factors such as age, obesity and family history;
2. Conduct diabetes risk assessment on all adult clients who utilize clinical or hypertension or cancer screening services, and counsel, refer, and follow-up clients where appropriate;
3. Educate or appropriately refer known diabetics to available diabetes-related education and other community resources (such as ophthalmologist, podiatrist, etc.); and
4. Provide for diabetes-related continuing education for nursing and other program staff at least once every three years, and include current diabetes-related information in the orientation of all newly-hired staff to be involved in Diabetes Services.
Cardiovascular disease services
(a) The local board of health shall provide cardiovascular disease control services according to the Department of Health and Senior Services "Adult Health Services Guidelines" and shall:
1. Provide hypertension screening services yearly to one percent of the high risk population;
2. Provide cardiovascular risk factor assessment and counseling on all individuals screened for hypertension and include the following areas:
i. Family history of cardiovascular disease;
ii. Smoking;
iii. Excessive cholesterol intake;
iv. Obesity;
v. Diabetes; and
vi. Exercise, and counsel, refer and follow-up clients where appropriate;
3. Provide cardiovascular health education programs for the general public;
4. Provide cardiovascular health education programs for hypertensive individuals; and
5. Provide for cardiovascular-related continuing education for nursing and other program staff at least once every three years, and include current cardiovascular-related information in the orientation of all newly-hired staff to be involved in cardiovascular disease services.
Health services for older adults
(a) The local board of health shall provide for a health program at locations selected by the health department which identifies the health needs of adults age 65 and older, and shall:
1. Provide a health needs assessment yearly on one percent of the non-institutionalized elderly in accordance with "Guidelines for Health Services for Older Adults" contained in the Adult Health Services Guidelines (available at the New Jersey Department of Health and Senior Services);
2. Provide education on alcohol abuse and medication management;
3. Follow-up and make referrals as appropriate for abnormal screening results or for needs identified in the individual's history and/or intake;
4. Assure participation at service sites through advance notification (for example: publicity);
5. Provide for gerontology related continuing education for staff at least once every three years, and include current gerontology related information in the orientation program for all new staff providing these services; and
6. Provide immunizations (for example, influenza and pneumococcal vaccines) at the discretion of the local health agency in accordance with the Immunization Practices Advisory Committee of the U.S. Public Health Service.
V. Health Education/Health Promotion
(a) A structured program shall be provided by the Health Educator or Field Representative, Health Education, in accordance with community health education needs, which shall include health components for Alcohol Abuse Control, Drug Abuse Control, Smoking Prevention and Cessation, Nutrition, Injury Control, and Physical Fitness and Exercise and shall include the following:
1. An assessment of health education needs and identification of target population based on information from the New Jersey Department of Health and Senior Services Community Health Profile and other relevant health related data;
2. Written health education program plans with measurable objectives for the six components in (a) above, based on the Health Promotion Guidelines, contained in the Adult Health Services Guidelines and other identified health education needs;
3. Identification and involvement of local leadership in the planning, implementation, and maintenance of needed health education services and programs to include collaboration with other agencies serving the community where such opportunities exist, and consultation with content specialists in the six required components in (a) above; and other areas as needed;
4. Application of appropriate health education interventions to provide for the effective implementation of health education programs (that is, community development, skill development, simulation, peer group discussion, behavior modification, lecture, media awareness, programmed learning, individual instruction, etc.);
5. Integration of a health education component into health department programs and services, covering the six required promotion topics in (a) above;
6. Consultation and training in the application of health education techniques for the professional staff of the health department;
7. Evaluation and report of the degree of success in achieving predetermined health education objectives; and
8. The health educator or Field Representative, Health Education shall serve as a community health information resource.
Public health nursing
(a) Provision of public health nursing services shall include the following:
1. The services of a public health nurse director or supervisor to assess, plan, implement and evaluate public health nursing services in accordance with community health needs;
2. Up-to-date written objectives, policies and procedures developed in cooperation with the health officer, for each activity in which there is nursing participation which relate to the overall goals of the local health agency;
3. The maintenance and use of individual, family and other service records according to current professional standards;
4. Orientation in-service and continuing education programs for nursing staff;
5. Annual reports of services rendered which include pertinent statistics and descriptive narrative as related to objectives; and
6. Integration, in conjunction with the health educator, of the relevant components of the health promotion program into all activities involving public health nursing services.
