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A lab's outreach for healthier school kids.

Every hospital needs to be the center of wellness in its community. Several years ago, the lab of our nonprofit, 111-bed hospital made a commitment to become more active in the health care of our local area -- rural Chowan County, N.C. As part of that effort, we belong to a hospital-wide speakers bureau reaching local service clubs. We also offer educational programs for the school systems and counseling for clients. Among our lab's outreach efforts are:

* Running a QC program for home glucose monitors[1]

* Teaching high school health career students basic laboratory techniques

* Representing lab professionals on career days

* Providing cholesterol screening on a regular basis

* Disseminating information about the future role of the laboratory and hospital in our community

Recent intervention

Seldom does a lab program influence the outcome of a community's health as did ours. It all began with author France's personal involvement in her child's school, located in adjacent Perquimans County. In the course of her participation in school life, she noted the bathrooms lacked soap, paper towels, and warm water, and hygiene was not being monitored by teachers. Because the task of monitoring student hygiene seemed impossible for the staff members, she presented an in-depth hand-washing program that helped convince the children to avoid illness by taking necessary hygienic precautions.

The health risk France noted was unknown to the majority of parents as well as unrecognized by the general public. The local school fit into an extremely unfortunate pattern: The children didn't use the school bathrooms because these facilities were dirty and lacking in supplies.

Wet workshop

In the spring of 1993, France presented a two-day "wet workshop" to students in kindergarten through fifth grade and their teachers at her child's school. On the first day, she made a 30-minute presentation that included the answers to:

* What is a medical technologist?

* What are microorganisms?

* How can they help or hurt us?

* What tools are used in the laboratory to study bacteria?

* How do germs get into people's bodies?

* Why is it so important to wash your hands?

* What is the proper technique to use in washing your hands?

Each student used an unwashed finger in order to inoculate a blood agar plate. France also let each person use a microscope to see a prepared, mixed-field Gram stain. The second day follow-up included an inspection of the organisms that grew overnight on the "dirty hands" cultures. This display effectively demonstrated the truth of the first day's lecture. She gave a short quiz and created fun activities -- a word puzzle (Figure 1) and a maze (Figure 2), for example -- both of which emphasized to the young students the need to wash their hands before meals and after using the bathroom facilities.

The reception by teachers and children was overwhelmingly positive. Community neighbors and friends commended France on her active role in promoting healthy choices for children. The school soon became active in providing soap, paper towels, and monitoring to reemphasize the need for proper hand-washing.

The local newspaper carried a story on the laboratory's interaction with the school. The publicity provided us with good public relations and demonstrated the hospital's dedication to improving the health of people in our service area.

Summer epidemic

Chowan County provides year-round school for children in kindergarten through third grade. Not long after the summer session began in July 1993, an outbreak of Shigelia species developed. Most of the 68 cases were school-age children; a few were family members of the children first diagnosed.

According to the state, 46 cases of shigellosis also were reported in the late spring and summer of 1993 in Pasquotank County. That region is geographically separated from us by Perquimans County, in which France ran the hand-washing program; that county registered only 12 cases of shigellosis during the same time period. Parents and children in Chowan reported soap and towels were seldom available and there was never warm water in the school bathrooms. Teachers were not always able to directly monitor the younger children in the bathrooms and enforce proper hand-washing. During the outbreak of bacterial gastroenteritis, public health departments, doctors, and local health officials received calls from parents asking what could be done to prevent further cases. Parents only became aware of inadequate bathroom supplies through the explanation of the transmission of the disease.

Offer of help

This prompted Whalen to contact a local elementary school principal to offer the children services in hand-washing instruction. Her call was referred to the school nurse who, at first, was reluctant to add more to the busy schedules of the teaching staff. Whalen emphasized state reports showing the outbreak in Chowan County followed reported cases in Pasquotank County. Perquimans County, between the two, had been spared. She speculated the hand-washing campaign offered by France in the spring of 1993 at the Perquimans schools might have made the difference.

Within a week, the Chowan school nurse called back to request our help in providing an educational program to the two local elementary schools in that county. France, the program's developer, made scheduling a cooperative effort with the teachers. She covered 43 classes at both schools in an eight-day period. Nearly 1,200 students and 43 teachers were involved. She resented the workshop, "Are Your Hands Clean?" to pre-kindergarten through fifth grade classes. She adjusted the delivery of the information to match each grade.

Forty-eight cents

The hours spent preparing lectures and doing on-site presentations were the most costly part of the program. In all, France spent about four hours in preparation and 36 hours in the schools. In addition to giving her the paid time to run the program, the lab reimbursed her for some travel. Materials included handouts for each student and some 120 blood agar plates for culturing dirty fingers.

The cost was about $580, which made the cost per student $0.48. Given a $100 cost per person to diagnose and treat GI pathogens in this community, our investment of 48 cents per child to promote wellness far outweighed the potential expense of treating an epidemic. We chose prevention over cure.

Vital part of care

The success of any public service program can only be measured by future outcomes. Demonstrated reduction in the spread of the bacterial pathogens certainly might have occurred even without our clinical laboratory's direct participation in the school education process. During a recent visit to a local elementary school, one of the teachers was observed standing at the entrance to the bathroom, dispensing soap into the hands of the children, as well as supplying paper towels to every student.

The positive reception by the teaching staff at the schools, the active participation of the children involved, and the resultant public awareness certainly give credibility to the clinical laboratory's role in promoting wellness through education. A hospital engenders positive community attitude by presenting the laboratory as a vital part of health care service. The public then increasingly views the hospital as a group of diverse professionals who truly care about the local population.


[1.] Whalen F. An outreach program for home glucose monitoring. MLO. July 1994; 26(7): 44-46.
COPYRIGHT 1996 Nelson Publishing
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Copyright 1996 Gale, Cengage Learning. All rights reserved.

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Title Annotation:hospital laboratories
Author:Whalen, Frances L.
Publication:Medical Laboratory Observer
Date:Jan 1, 1996
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