Application of a return of investment analysis for public health training by case study.

BACKGROUND: Local health departments require assurance of competence of their workforce to prevent and mitigate outbreaks by supporting the implementation of evidence-based actions in clinical practice, medical procedures and infection control practices. Too often outdated policies or reduction in budgets prevent the appropriate training strategies or resources to recruit, retain or support this capability. DESIGN AND METHODS: In this 2018 case study analysis, we coupled the Phillip's Return on Investment model with a standard financial proforma model to make a business case that investing in training, specifically the Certification in Infection Control (CIC), was worthwhile for cost reduction, improved knowledge, skills and abilities (KSA's) and improved employee retention. RESULTS: Our model demonstrated that our initial investment (USD $1,840) was profitable based on the internal rate of return (IRR = 130%, Year. 5), payback period (0.71 years), Benefit Cost Ratio (BCR = 1.41) and Return of Investment (ROI = 41%), if an epidemiologist worked a minimum of 3 healthcare associated infection outbreaks per year. Data from 4 local epidemiologists demonstrated that the application of KSA's reduced investigation hours by 10%-25% for all types of outbreaks with payback periods of less than 6 months and positive ROIs for staff with retention greater than 1 year. Our model demonstrated that at the highest end of our investment costs (US $2940) with an investigation improve efficiency of 25%, the IRR was 85% after year 5 with a payback period of 1.13 years if the epidemiologist worked on 3 HAI outbreaks per year over the 5 years. CONCLUSIONS: Our results validate the profitability of investment into the CIC for local epidemiologists if they could be retained longer than the payback period. The model provides a method for managers to leverage training opportunities for employee retention while ensuring competencies in the workforce.

An occurrence of neurotoxic shellfish poisoning by consumption of gastropods contaminated with brevetoxins.

Brevetoxins were confirmed in urine specimens from patients diagnosed with neurotoxic shellfish poisoning (NSP) after consumption of gastropods that were recreationally harvested from an area previously affected by a Karenia brevis bloom. Several species of gastropods (Triplofusus giganteus, Sinistrofulgur sinistrum, Cinctura hunteria, Strombus alatus, Fulguropsis spirata) and one clam (Macrocallista nimbosa) from the NSP implicated gastropod collection area (Jewfish Key, Sarasota Bay, Florida) were examined for brevetoxins using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and enzyme-linked immunosorbent assay (ELISA). All gastropods and the clam were contaminated with brevetoxins. Composite B-type toxin concentrations in gastropods ranged from 1.1 to 198 µg BTX-3 equiv./g by ELISA, levels likely capable of causing NSP in consumers. Several brevetoxin metabolites previously characterized in molluscan shellfish were identified in these gastropods. Brevetoxin analog profiles by ELISA were similar in the gastropod species examined. This work documents the occurrence of NSP through consumption of a type of seafood not typically monitored in Florida to protect human health, demonstrating the need to better assess and communicate the risk of NSP to gastropod harvesters in Karenia brevis endemic areas.