national resource for infection control (nric) - tackling the challenge of conveying guidance during...
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National Resource for Infection Control (NRIC) - tackling the
challenge of conveying guidance during the Pandemic influenza A(H1N1)
outbreak
City eHealth Research Centre(CeRC) Department of Health (DH)
NRIC - purposeAudience primarily Infection Prevention and Control Professionals but increasingly because infection prevention and control is everybody’s business all healthcare professionals with patient, client contact or contact with the healthcare environmentThe Library contains relevant, up to date, evidence based policy, guidance and information published within the last 5 years where possible, on infection prevention and control and in collaboration with NeLI links to evidence based information on infectious diseases (seminal evidence older than 5 years also included)
A brief chronology of the Swine flu (H1N1) outbreak
18th March – human cases of swine influenza reported in Mexico and certain areas of the united States of America27th April UK Health Secretary made a statement to parliament on the reports of human cases of swine influenza known as the H1N1 infection in some parts of the world and WHO raised its pandemic alert level to Phase 428th April advice if returning from an affected area to the UK29th April WHO raised the Pandemic alert level to Phase 530th April Swine flu information leaflet to every households across the UK24th/30th April daily press statements/press briefings began - HPA, DH, WHO, ECDC11th June WHO raised the Pandemic flu alert level to Phase 62nd July UK moved from containment to a treatment phase
A brief chronology of the Swine flu (H1N1) outbreak
Changes of pandemic flu media updates to weekly, due to change of surveillance information 30th July Weekly GP consultation rates showed a plateau or small decrease in England coinciding with the start of school holidays and the introduction of the National Pandemic Flu ServiceJuly, ECDC issued short term planning assumptions specifically for the first wave, based on those developed by the UK the most affected European country. They represented reasonable worst cases for the 12 months of this pandemic18th September – the experience in temperate Southern hemisphere countries indicates it is inevitable that Europe will be affected by an A(H1N1) 2009 pandemic second wave this autumn and winter
Did NRIC provide the information needed on the new Swine Flu threat
An initial search of NRIC logs from April 1st to 26th May yielded the following: -NRIC did not record a single search for ‘influenza’ on it’s web server logs from 1st until 27th April!And then suddenly on the 29th April increased interest ?panic
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Information from NRIC web server logs
Data Range 1st March – 31st August
Terms used • Pandemic flu• Pandemic Influenza• Influenza• Swine flu • H1N1
Publication dates checked against increased hitsTop 40 most accessed documentsAre we providing what professionals need through a one stop specialist digital library in a timely manner?
Confounding?Monthly NRIC/NeLI eNewsletter – included all new documents added during that month – users may have used links to go straight to publications plus we scored an ‘own goal’ by ECDC link on home pageNew publications/guidelines and more in-depth daily press releases from: -
Health Protection Agency (HPA)Department of Health (DH)World Health Organisation (WHO)European Centre for Disease Prevention and Control (ECDC)
Visitors Geographic Locations other than UK
United Kingdom/United States/Italy/Greece/Canada/Korea, Republic of/Slovenia/Ireland/Hong Kong/Germany/Australia/Portugal/Switzerland/Russian Federation/China/Brazil/France/Philippines/Saudi Arabia/New Zealand/Romania/Europe/
Malaysia/Taiwan/Cyprus/Czech Republic/Netherlands/Mexico/Argentina/Dominican Republic/Kuwait/Vietnam/Nigeria/Austria/Egypt/Turkey/Mongolia/Pakistan/Thailand/Malta/Chile/Norway/Singapore/Sweden/
Swine Flu Searches – Visitors who used the NRIC search facility (PF, Inf, PI)
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Why the peak in August?GP consultation rates peaked in UK in July/August apart from ScotlandECDC Daily Update (16/08/2009) confirmed 38,187 cases of A(H1N1)v including 60 deaths – majority of cases being reported from UK, Netherlands, Greece and Germany. The majority of hospitalised cases reported from the UK specifically EnglandLaunch of National Pandemic Flu Service 23/07/2009
Swine Flu Searches divided into individual terms used (Chart 2)
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"Pandemic Flu"
"pandemic%20influenza""influenza"
“Pandemic Flu – managing demand and capacity in health care organisations (surge)”
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Date/time
Hits
Top 10 document’s visited1. Influenza A(H1N1) virus: how to protect yourself2. Pandemic flu guidance for businesses: risk assessment in
the occupational setting3. Pandemic flu: managing demand and capacity in health care
Organisations (surge)4. Managing influenza-like illness (ILI) in nursing and
residential homes during the current influenza pandemic (WHO Phase 6)
5. Swine flu: preventing spread in the home and community6. Swine flu clinical package7. Pandemic (H1N1) 2009 clinical practice note: Managing
adult critically ill cases8. Human Swine Influenza: advice for the public9. New website section on swine flu10. eBug – topic related to reducing transmission of swine flu in
the community
Top 10 document’s visitedDifficult to be too specific as new documents & guidance added almost dailyGave an initial overview of information health professionals requiredWill be reviewed once epidemic has run it’s course? information useful to demonstrate need?
ConclusionsIncrease in traffic noted – August 2009 ?Dates linked to decreased information from other sourcesHomepage ‘Update’ link to all influenza documents in date order popular – increased hitsMonthly eNewsletter increased awareness of relevant publications and may have increased hits on that months newly published documents
ConclusionsEasy access to daily press releases/information from sources other than NRIC heightened awareness of surveillance data and publicationsInstant access to all influenza publications from an NRIC ‘New Update’ link on the home page increased access and changed search terms usedComparing access to pandemic flu information against numbers of visits to NRIC for other resources April 2009 and May 2009 demonstrated much smaller numbers accessing pandemic flu guidance than other IP&C publications? relevant
Acknowledgements
Thanks to: Dr Patty Kostkova, Ed de Quincey and Gawesh Jawaheer
for the interpretation of the web server logs