doran.s.reynolds@kp.org

Doran began his career over twenty eight years ago at Santa Rosa Memorial Hospital in Food Services. After two years, Doran entered Environmental Services and began working in the field.  In 1988 Doran became the Assistant Manager at American River Hospital in Carmichael, Ca.. Since that time Doran has excelled in his career working in contract management services. He was a Regional Manager over the west coast and enjoyed his role as “Train the Trainer” setting up programs and training employees to clean systematically creating consistent results every time.  In 2007, Doran began his management career with Kaiser Foundation Hospital in South Sacramento and most recently took over the Manager position at the Sacramento Medical Center.  Since joining the Sacramento Team Doran has successfully improved the facilities performance and leads the field as the Chair for the Northern California EVS Peer Group Team.

Our primary topics covered were:

• Safety and Disaster Preparedness
• Reducing Healthcare Associated Infections

Review the following presentations in order to refresh your knowledge of our session’s topics:

Lisa Schenthal – CAL-EMSA: Public Health & Medical Coordination during a Disaster

Craig Hodges -Interline Brands/Clean Source: Supplier’s Role in a Disaster

Mary Ellen Leciejewski – Dignity Health: Getting Greener

Kristina Freas – Dignity Health – Approach to Flood & Water Intrusion

Bill Avery – Stericycle – Emergency Preparedness

SCA – Clean and Green

Michael Cummings – FEMA – Partners in Response

Sonny Fong – State Department of Water Resources

AsepticSure – Mobile Decontamination

Marcy Maxwell – Meeting the Challenge of Mandatory HAI Reporting

Roy Boukidjian RN, CIC – Northridge Hospital – SSI & C.Diff Observations & Analysis

Tracy Robles – Sutter Health Emergency Management System

Take Action to Save Lives!

• Disaster Preparedness

• Reducing Healthcare Associated Infections

Please join us for our 30th lunch and conference at no charge to you.

Date: March 6, 2012

Time: 8:30 am – 3:30 pm

Location: Sacramento State Alumni Center,

6000 J St State University Drive, Sacramento, CA 95819

Safety and Disaster Preparedness

Featured Speaker: Michael Cummings -Private Sector Liaison/EA-FEMA, Region IX

Featured Speaker: Lisa Schoenthal, Chief Disaster Medical Services, Emergency Medical Services Authority (E.M.S.A.)

Featured Presentation:  Disaster Impact on Greater Sacramento - Sonny Fong, State Department of Water Resources

Safety and Disaster Preparedness Experts in Attendance

• Kristina Freas, BSN, RN, MICN, MICP – Director of Emergency Preparedness, Dignity Health
• Cheri Hummel – Vice President, Disaster Preparedness, California Hospital Association
• Tracy Robles, ARM, CHSP, HEM – Director, Environmental Risk, Sutter Health

Reducing Healthcare Acquired Infections

Featured Speaker:  Marcy Maxwell, RN, BSN, PHN – Infection Preventionist, Dignity Health

Other Speakers and Topics Include:

“The Role of the Supplier in a Disaster or Emergency” – Craig Hodges – Vice President, Interline Brands / CleanSource

“Challenges of Pharmaceutical Waste” – Bill Avery – VP, Stericycle, Inc.

“Greening” Healthcare – Sister Mary Ellen Leciejewski – Ecology Program Coordinator, Dignity Health

“Improving HCAHPS scores in Medical Facilities” – Group Discussion

We look forward to seeing you there.

Date:  February 16, 2011

Time:  8:00 am – 2:00 pm

Location:  U.C. Davis Medical Center, M.I.N.D. Institute Auditorium

2825 50th Street, Sacramento, CA 95817

Speakers include:

Marcy Maxwell, RN, BSN, PHN, CIC;  St. John’s Regional Medical Center

Vicki Warnock, RN, ICP CHW Coastal Hospitals

Gloria Hurd, Manager, EVS & Conference Services, UCD Medical Center

AGENDA

8:00   AM – 8:45 AM                    Registration, Refreshments & Exhibit Viewing

8:45   AM – 9:00 AM                    Welcome: Rick Parker, HospAA Founder

9:00   AM – 9:15 AM                    Opening Address: Peggy Styer, CHW Supply Chain Mgt.

9:15   AM – 10:00 AM                  Hospital Cleaning Study Update: Jack McGurk

10:00 AM – 10:30 AM                HAI Reductions Success Story Case #1:  Vicki Warnock

10:30 AM – 11:00 AM                Break – Refreshments & Exhibit Viewing

11:00 AM – 11:30 AM                Maintaining HAI Prevention in a Crisis:  Gloria Hurd

11:30 AM – 12:00 Noon           Greener Waste Handling at Hospitals:   Lisa Vasconcellos, Stericycle

12:00 Noon – 12:45 PM           Lunch – Cleaning Video Review & Exhibit Viewing

12:45 PM – 1:30 PM                  HAI Reductions Success Story Case #2:  Marcy Maxwell

1:30 PM – 2:00 PM                   PANEL: Caring for Rubber Floors

Haim Barnoy & Jon Best – Nora Flooring

Ryan Suarez – Mondo Flooring

2:00 PM -2:30 PM                  Wrap Up and Questions for Speakers

——————————————————————————————-

Date: Wednesday September 1, 2010

Time: 9:00 am – 3:00 pm

Location: California Medical Center, Los Angeles

Speakers:

Vicki Keller, California Department of Public, HAI Program, will be giving an HAI Prevention update.

Jack McGurk, HospAA Executive,  will be reviewing the Detergent-Free Cleaning Study results.

Bill Avery, Stericycle, will be presenting a Medical Waste update.

Amy Kassing, Kimberly-Clark, will be introducing  the new CDF One-step Disinfecting Wipe.

Rick Parker, CEH

The availability of environmental services staff for cleaning environmental surfaces in patient rooms has declined over the past decade.  Chemical manufacturers of cleaning products took note of this trend and in an effort to assist the cleaning process, combined cleaners and disinfectants into one application.  Quaternary ammonium was the disinfectant most often used in these cleaner/disinfectant combinations.  At the same time, the general practice for determining cleanliness of environmental surfaces within patient rooms was based upon visual inspection.  This has all changed with the recent availability of adenosine triphosphate (ATP) bioluminescence monitoring of environmental surfaces.  Cooper and associates assessed the efficacy of visual methods to determine cleanliness in relation to the use of ATP luminometers and microbiological testing in four acute care British hospitals.[i] Their results indicated that visual assessment was an unreliable indicator of both surface cleanliness and assessing the effectiveness of cleaning protocols.  They also were of the opinion that high ATP and microbiological results after cleaning were a result of dirt and/or microorganisms being redistributed by cleaning rather than being removed.

The quick-measure ATP bioluminescense technique was used by the authors of this paper to evaluate cleaning efficacy in several hospitals in the Sacramento, California area.  A 3M Clean-Trace™ luminometer was utilized in the assay process in which a specialized swab was used to sample an approximate four by four inch area of the environmental surface.  The tube was then placed into an ATP bioluminescense reaction tube and agitated for approximately five seconds before being read in a luminometer.  The amount of organic material found on the environmental surface was read in relative light units (RLUs) with the higher the amount of organic matter, the greater the RLU reading.  Measurements of terminal room cleaning efficacy was achieved by evaluating high risk objects (HROs) as outlined by P. C. Carling in his studies within 23 acute care hospitals within the United States.[ii] The Carling group identified the HROs as “high touch” items such as nurse call box, overbed tray, sink, and toilet handle.

Several Sacramento acute care hospitals have achieved outstanding results using the concentrated cleaning process.[iii] The following information focuses on the results achieved at one Sacramento 350 bed hospital that operated at approximately 85 percent occupancy during the study.  Phase I of the study evaluated the 14 HROs as outlined by Carling in his study and provided an assessment of the cleaning efficacy prior to the initiation of the new cleaning process.  The previous cleaning process used a detergent cleaner with quaternary ammonium disinfectant.  Phase II measured the worst five HROs as determined from Phase I sampling in three Sacramento area hospitals.  Measurements during Phase II were conducted after rooms had been terminally cleaned using ChemSpec Oxidizing Cleaner 14000, which contains 218  parts per million (ppm) bleach followed by an immediate application of 1,000 ppm Pure Bright Bleach to the worst five HROs.  The ChemSpec cleaner is detergent-free.  A minimum of 25 terminally cleaned rooms were monitored prior to being reoccupied at the hospital during both phases of the study.  Lewis et al in their study of using ATP measurements for evaluating cleaning of environmental surfaces in hospitals found that a benchmark value for cleaning adequacy of 250 RLU could be achieved in hospital cleaning.[iv]

The mean scores of the worst five HROs from Phases I and II of the study are shown in Table 1.

Table 1

Worst Five HRO Comparison

Previous Cleaning (Phase I) vs. Concentrated Cleaning (Phase II)

Number of Rooms Sampled in Phase I = 25

Number of Rooms Sampled in Phase II = 26

The ATP measurements of the rooms having been cleaned using the concentrated cleaning process found 117 of the 124 (94.4%) readings were below the 250 RLU benchmark.  Additionally, 94 of the 124 (75.8 %) of the HRO measurements were 100 RLU or less.  This showed an improvement over the previous cleaning process measured in Phase I which had 30.8 percent of the measurements below the 250 RLU benchmark for these five HROs and only 9.2 percent below 100 RLU.  As shown on Table 1 there was a marked decline in the overall mean scores for the worst five HRO measurements from a mean for the previous cleaning process of 754 RLU to a mean of 81 RLU achieved by the concentrated cleaning process using ChemSpec Oxidizing 14000 Cleaner and Pure Bright Bleach of 1,000 ppm.  Figure 1 graphically displays the marked improvement achieved through the concentrated cleaning process for the five worst HROs.

Figure 1

Reduction in RLU from Concentrated Cleaning Process

Blue = Previous Cleaning Process

Red = Concentrated Cleaning Process

Figure 2 graphically indicates the improvement achieved using the concentrated cleaning process of ChemSpec Oxidizing 14000 Cleaner and Pure Bright Bleach of 1,000 ppm in Phase II over the use of quaternary ammonium/disinfectant in Phase I.  The percent changes for the various RLU ranges are shown comparing Phase I to Phase II ATP readings.  Using a normal test for statistically significant differences, we compared the success rates (i.e. RLU<250) of the concentrated cleaning process to the standard cleaning approach using quaternary ammonium/disinfectant.  We found that the success rate for concentrated cleaning was 94.4 percent, and the success rate for the standard approach was 30.8 percent, with a p-value well below .01.  Additionally, 75.8 percent of the 124 readings made during Phase II using the concentrated cleaning process were at or less than 100 RLU.  Using the detergent-free cleaner containing bleach applied by a cotton cloth and followed with application of 1,000 ppm bleach by a  clean cotton cloth proved in this process improvement project to be statistically overwhelming in its efficacy when compared to the former cleaning process using quaternary ammonium/disinfectant.

Figure 2

Improvement in RLU Measurements

Previous Cleaning Method (Phase I) vs. Concentrated Cleaning (Phase II)

p-value = < .01

The decline of the mean scores for the worst five HROs using the concentrated cleaning process from 754 RLU to 81 RLU documents the cleaning improvement achieved by the concentrated cleaning process.  Also impressive is the decline in RLU measurements above the 250 RLU benchmark following the implementation of the concentrated cleaning process where 94.4 percent met the benchmark compared with only 30.8 percent under the previous cleaning method.  These data support a need for a paradigm shift to the concentrated cleaning methodology and more hospitals are implementing this new cleaning approach.

[ii] Carling PC, Perry MF, Von Beheren SM. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals, Infection Control and Hospital Epidemiology, January 2008; 29: 2-3.

[iii] McGurk J, Parker R. Environmental surface cleaning in patient rooms, California Journal of Environmental Health; Vol. 24, No. 2, Fall 2009: 31-33.

[iv] Lewis T, Griffith C, Gallo M, Weinbren M; A modified ATP benchmark for evaluating the cleaning of some hospital environmental surfaces, Journal of Hospital Infection, 2008; 69:157.

February 23,  2010

According to a new study, sepsis and pneumonia, two common conditions caused by hospital-acquired infections like MRSA, killed 48,000 Americans in 2006, and cost the nation over 8 billion dollars to treat.

A report on what has been described as the largest nationally representative study to date of deaths due to sepsis and pneumonia, appears in the 22 February issue of Archives of Internal Medicine.

Co-author Dr Ramanan Laxminarayan, who is leading Extending the Cure, an investigation into antibiotic resistance for the Washington DC based think-tank Resources for the Future, told the press that in many cases the conditions could have been avoided with better infection control in the hospitals.

“Infections that are acquired during the course of a hospital stay cost the United States a staggering amount in terms of lives lost and health care costs,” said Laxminarayan.

“Hospitals and other health care providers must act now to protect patients from this growing menace,” he urged.

The researchers said that hospital-acquired infections are caused by “superbugs”, germs that can’t be killed with common antibiotics.

Co-author Dr Anup Malani, a professor at the University of Chicago who is also working on Extending the Cure with Laxminarayan, said:

“These superbugs are increasingly difficult to treat and, in some cases, trigger infections that ultimately cause the body’s organs to shut down.”

Sepsis, a condition where the whole body goes into a state of inflammatory response, and pneumonia, an infection of the lungs and respiratory tract, are two conditions often caused by deadly microbes, including resistant bacteria such as MRSA (methicillin-resistant Staphylococcus aureus). Such infections usually lead to longer stays in hospital and can lead to serious complications and even death.

Laxminarayan and his colleagues examined data from 69 million records of patients discharged from hospitals in 40 states of the US (they used the Nationwide Inpatient Sample database).

The US Centers for Disease Control and Prevention (CDC) estimated in 2002 that 99,000 American deaths a year were linked to hospital-acquired infections. In this study the researchers focused on only the two most serious conditions, sepsis and pneumonia, and calculated deaths resulting directly from infections patients acquired while they were in hospital. Plus they concentrated on infections that they regarded as mostly preventable, such as when they result from a lapse in sterile technique during surgery.

They found that the cost of such infections can be high. For instance, developing sepsis after surgery resulted in an average of 11 extra days in hospital and an additional infection treatment cost of 33,000 dollars per patient.

However, the most alarming finding was that nearly 20 per cent of people who developed sepsis following surgery died as a result of the infection.

Malani, described this finding as a “tragedy” because:”In some cases, relatively healthy people check into the hospital for routine surgery. They develop sepsis because of a lapse in infection control – and they can die.”

When they looked at pneumonia, which can develop when disease-causing germs get into the lungs, for instance via a dirty ventilator tube (a clearly preventable post-surgery infection, as many are, said the authors), they found people who developed the condition after surgery stayed on average an extra 14 days in hospital at an additional treatment cost of 46,000 dollars per person. And in 11 per cent of cases the patient died as a result of the infection-related pneumonia.

Malani said:”The nation urgently needs a comprehensive approach to reduce the risk posed by these deadly infections.”

“Improving infection control is a clear way to both improve patient outcomes and lower health care costs,” he added.

“Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia.”
Michael R. Eber; Ramanan Laxminarayan; Eli N. Perencevich; Anup Malani.
Arch Intern Med, Vol. 170 No. 4, February 22, 2010, pp 347-353.

Source: Burness Communications.

In an editorial published in the September-October 1945 issue of The Sanitarian, Roscoe Davis, Sanitary Inspector with the California State Department of Public Health, proclaimed that June 15, 1945 was a “RED LETTER DAY” for Sanitarians in California.1 For at 3:00 p.m. on that date Governor Earl Warren signed into law Senate Bill 319 which provided for the registration of existing sanitarians and the future examination and registration of sanitarians employed full time in State and local departments of health of the State of California. During the bill signing Governor Warren stated that he was proud to sign such progressive legislation for public health.2

The enactment of this legislation provided examination and registration of sanitarians in California and culminated a struggle of 16 years to gain such recognition for the profession. Legislation to create a registration act in California for sanitarians had been introduced in 1931, 1933 and again in 1935, but none successfully negotiated the legislative process. One of the earliest activities undertaken by the California Association of Sanitarians after its formation in 1930 was to draft two legislative bills to create a registration program. These bills were the ones introduced in 1931. They passed the Senate but failed to gain passage in the Assembly.3 The interest in securing a registration act in California was not diminished when the National Association of Sanitarians replaced the California Association of Sanitarians in 1937. Much of the program at the annual convention of the National Association of Sanitarians held in San Francisco in 1943 was dedicated to the establishment of standards for sanitarians. The Northern California Section of the organization had the task the following year of drafting a bill for registering sanitarians to be presented to the State Legislature.   Melvin J. Olsen, a sanitarian with the Sacramento County Health Department, was elected as Chairman of the Committee on Registration and drafted the proposed legislation.4

The legislation that was adopted in 1945 for examining and registering of sanitarians defined a sanitarian as a person trained in the field of sanitary science and technology who is qualified to carry out educational and inspectional duties and enforce the law in the field of sanitation. The original registration law required the then State Department of Public Health to accept for registration any person who prior to January 1, 1946, the effective date of the registration statute, had been employed as a sanitarian, food and market inspector, sanitary inspector or housing inspector by the State, city, county or local health district of the State or any person who had passed an official civil service examination in any of these classifications by the State, city, county or local health district of the State. This provided a mechanism for those who were currently employed or on a civil service list for these job classifications to become registered. After the effective date of the registration law, the State department was directed to administer examinations in various parts of the state to qualify persons as registered sanitarians who would become employed on a full time basis in health departments of the State or local jurisdictions to enforce State statutes relative to public health, the rules and regulations of the State Board of Public Health and local public health ordinances.5

Thomas McMorrow of the Contra Costa County Health Department was issued the first sanitarian registration certificate. He was very proud of being R.S. Number 1. He confided to the author that he had achieved the status of being the first person registered by volunteering his wife to type the registration certificates, and in doing so he had her type his as the first one. However, a review of archived materials from the earliest days of the registration program found a letter from Mr. McMorrow dated August 18, 1945 to Mr. C. G. Gillespie, Chief of the Bureau of Sanitary Engineering for the State Department of Public Health, providing verification of his test results for a sanitary inspector that would qualify him for registration. In the letter, Mr. McMorrow stated: “I do hope that my prompt submission of this card will place me in that enviable position of being No. 1 man on the registration list.”6 Mr. McMorrow served as the Director of Sanitation for Contra Costa County and often delighted in asking new sanitarians interviewing for positions with the county if they knew their registration number. When they proudly told him their number, he would respond by saying that he still knew his number, and then he would show them his registration certificate with Number 1 on it.

In a paper presented October 13, 1945 at the ninth Annual Conference of the National Association of Sanitarians held in El Centro, California Charles L. Senn, Director of Sanitation with the Los Angeles City Health Department, spoke about the positive feeling that was in the air at the conference. The reasons for this positive spirit among the attendees were several fold. First, World War II had ended and relatives, friends and co-workers were returning from battle. Second, the feeling now was that improvements in sanitation would be able to be accomplished in the everyday work performed by sanitarians.  For too long the excuse that “there was a war on” had been used to hamper corrections and improvements in sanitation, construction and housing. There now seemed to be optimism that sanitarians would be able to achieve accomplishments in their field of work. A more important reason for celebrating, he commented, was the passage of the Sanitarian Registration Act.7

Some health officers at the time thought that the work of nurses was more important than the work of sanitarians. This, Mr. Senn analyzed, was due to the fact that sanitarians were too focused on writing notices to bring about compliance with the law, and the health officers were receiving complaints regarding such actions. Nurses, on the other hand, took an educational approach in implementing their programs and spent time informing civic organizations about their accomplishments. His presentation went on to stress the need for training for sanitarians so that they could change from being sanitary inspectors focused strictly on code enforcement to becoming educators. He called for local training of new staff to instill in them a spirit of public health so that they could do a good job. He also recognized that all practicing sanitarians should keep abreast of modern developments through in-service training and university courses. He hoped that the registered sanitarians would be as proud
of their registration as were the other public health professionals.8 The California Department of Public Health issued registration certificate number 1000 on June 13, 1947 to Desmond W. Coffelt. Mr. Coffelt was a Lieutenant (j.g.), Hospital Corps in the United Sates Navy at the time he received his registration.9 Nearly 20 years later registration certificate number 3000 was issued to Robert L. Cushing on January 27, 1967 who still works for the City of San Jose. It took nearly 25 more years for the number of registrations to double when on December 1, 1991 registration certificate number 6000 was issued to Erick M. Mirabella. The California Department of Health Services has just recently issued registered environmental health specialist certificate number 7000 to Peter Z. Keshishian in January 2001.    A dozen years after California had passed the first Sanitarian Registration Act, only five other states had passed similar statutes. By that time California had registered 1850 sanitarians from the 2100 applications for registration it had received. During the period from 1951 to 1957, approximately 85 percent of the sanitarians registered in California had college degrees. This fact prompted the State Board of Public Health to initiate a change in the education requirements to include a bachelor’s degree for sanitarian registration. The elevation of educational standards was perceived as placing the burden of preparation on the applicant and relieving governmental units from training expenses.10 An important improvement to the registration act was made through legislation in 1983 that regulated the practice of sanitarians in both the public and private sectors and defined the scope of practice for the profession.11 The legislation also allowed the Department to deny, suspend, refuse to renew or revoke a
sanitarian registration certificate for acts of deceit, misrepresentation, violation of contract, fraud, negligence, professional incompetence or unethical practice.12 Using this power, the Department has taken disciplinary actions that have resulted in the revocation of registration certificates. To be recognized as a legitimate profession there must be a mechanism for enacting disciplinary action.   Amending the registration act helped to secure this status.   The Sanitarian Registration Act was amended again during the 1986 legislative session to create a new classification category for retired sanitarians and a reduced biennial fee for them of $25.00. This legislation became effective on January 1, 1987. It allowed retired sanitarians not working in a job requiring registration who were at least 50 years old or collecting retirement benefits and had worked as Registered Sanitarians for at least 10 years in California, or received an on-the-job disability before the 10 year period of time had elapsed, to renew their registration in this classification.13 The Department’s Office of Legal Services reviewed the regulations governing education requirements for the Sanitarian Registration Act and issued an opinion stating that a bachelor’s degree and all education requirements had to be completed before a person could be employed as a sanitarian trainee. The opinion further stated that only work experience completed after a person met all the education requirements would be acceptable in determining eligibility to take the registration examination. It was felt that these requirements were too restrictive. The Sanitarian Registration Certification Committee held two workshops, one in Los Angeles and the other in Hayward, to receive input on this and other concerns related to the Sanitarian Registration Act. Comments received during the workshops led to new legislation that would allow experience gained prior to completing all education requirements to count towards fulfilling requirements for the examination and upgrading the registration examination.14 Comments received during the workshops also led to a name change. The terms “sanitarian” and “registered sanitarian” were changed to “registered environmental health specialist” through legislation carried by Assemblyman Trice Harvey in 1988.15 This was done with the support of the California Environmental Health Association to more correctly reflect the changing nature of the profession from sanitation to encompassing the total field of environmental health. Too often the public had viewed the term sanitarian with sanitation or janitorial worker and the name change was seen as a positive image enhancement. The change in the name to environmental health specialist was consistent with the similar change in the professional organization from California Association of Sanitarians to California Environmental Health Association that had occurred in 1970. It is interesting to note that Assemblyman Harvey was a registered sanitarian (registration number 2346) and had worked for the Kern County Health Department. He enthusiastically supported the change of name to registered environmental health specialist. Following passage of this legislation, new certificates of registration as environmental health specialists were sent to all former registered sanitarians. The author recalls visiting Assemblyman Harvey’s office at the Capitol on several occasions and observed his registration certificate displayed on the wall for all of his constituents and visitors to see.
The provisions for investigating complaints made against registered environmental health specialists has also provided an additional benefit to those found innocent of the charges brought against them. In several cases the fact that the Department conducted a thorough investigation into the allegations made against the registered environmental health specialist and found the charges to be unfounded, saved the expense of the environmental health specialist fighting a lawsuit.   Since its inception in 1946, the registration program has issued over 7000 certificates of registration. There are currently 3465 active environmental health specialists registered in California. Many of the early registrants have passed away or have retired and let their registration lapse. The earliest registered person currently on file is Edwin S. Doyle who holds registration number 17. Mr. Doyle was born in December 1913 and is retired from the National Canners Association. The next earliest registration belongs to Mr. Olsen who holds registration number 508. Mr. Olsen was born in June 1912 and, as mentioned earlier in this paper, played a critical role in getting the original registration act adopted.   The registration program is in the process of developing a new strategic plan. As part of this planning process, a questionnaire was sent to all active registered environmental health specialists on November 6, 2000. A response rate of approximately 30 percent was achieved, and the information obtained from the questionnaire is being tabulated and will be utilized in developing the multi-year strategic plan for shaping the future of the program. A request was also made to the California Conference of Directors of Environmental Health and the California Environmental Health Association to have the officers complete a consensus questionnaire to provide input from each of their organizations. A preliminary review of the responses indicates that some of the issues and concerns that have been noted in this historical review of the program continue to this day. The new strategic plan will need to deal with these issues as the profession moves into the 21st Century.

1 Davis, Roscoe C., R.S., “Editorial, California Sanitarians Arrive!” The Sanitarian, Vol. 8,
September-October, 1945, p. 60.
2 Olsen, Melvin J., R.S., “Registered Sanitarians’ Bill Passed By California Legislature,” The
Sanitarian, Vol. 8, July-August, 1945, p. 15.
3 Mangold, Walter S., R.S., “Coming of Age,” The Sanitarian, Vol. 20, September-October, 1957, p.70.
4 Olsen, “Registered Sanitarians’ Bill Passed By California Legislature,” loc. cit., p. 16.
5 Olsen, loc. cit., pp. 15-16.
6 McMorrow, Thomas M. letter to Bureau of Sanitary Engineering, State Department of Public
Health requesting registration as a sanitarian, August 18, 1945.
7 Senn, Charles L., “Value Of Registration Of Sanitarians To Public Health And The National
Welfare,” The Sanitarian, Vol.8, January-February, 1946, p. 157.
8 Ibid. pp.157-162.

9 Sampson, W. W., “The Thousandth Registered Sanitarian,” The Sanitarian, Vol. 10, January-February, 1948, p.167.
10 Mangold, Walter S., R.S., “Coming of Age,” The Sanitarian, Vol. 20, September-October, 1957,  p.73.
11 Lassiter, Marcia and Eastman, Diane, “Proposed Sanitarian Registration Act,” memorandum sent to all California Registered Sanitarians, February 18, 1983.
12 California Health and Safety Code, Section 106715, Chapter 1271, Statutes of 1983, amended by Chapter 415 (reorganization of Health and Safety Code), Statutes of 1995.
13 California Health and Safety Code, Sections 106695 and 106700, created by Chapter 340, Statutes of 1986, amended by Chapter 415, Statutes of 1995.
14 McGurk, Jack S., R.S., Turner, Douglas E., R.S., and Winston, Martin, R.S., “Sanitarian Registration Program Update,” memorandum sent to all California Registered Sanitarians, May 27, 1987.
15 California Health and Safety Code, Section 106600, Chapter 773, Statutes of 1988, amended by Chapter 415, Statutes of 1995.