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National Resource for Infection Control (NRIC) - tackling the challenge of conveying guidance during the Pandemic influenza A(H1N1) outbreak

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Title: National Resource for Infection Control (NRIC) - tackling the challenge of conveying guidance during the Pandemic influenza A(H1N1) outbreak


1
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)

2
NRIC - purpose
  • Audience primarily Infection Prevention and
    Control Professionals but increasingly because
    infection prevention and control is everybodys
    business all healthcare professionals with
    patient, client contact or contact with the
    healthcare environment
  • The 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)

3
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 America
  • 27th 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 4
  • 28th April advice if returning from an affected
    area to the UK
  • 29th April WHO raised the Pandemic alert level to
    Phase 5
  • 30th April Swine flu information leaflet to every
    households across the UK
  • 24th/30th April daily press statements/press
    briefings began - HPA, DH, WHO, ECDC
  • 11th June WHO raised the Pandemic flu alert level
    to Phase 6
  • 2nd July UK moved from containment to a treatment
    phase

4
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 Service
  • July, 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 pandemic
  • 18th 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

5
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 its web server logs from 1st
    until 27th April!
  • And then suddenly on the 29th April increased
    interest ?panic

6
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 hits
  • Top 40 most accessed documents
  • Are we providing what professionals need through
    a one stop specialist digital library in a timely
    manner?

7
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
    page
  • New 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)

8
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/
  • Malaysia/
  • Taiwan/
  • Cyprus/
  • Czech Republic/
  • Netherlands/
  • Mexico/
  • Argentina/
  • Dominican Republic/
  • Kuwait/
  • Vietnam/
  • Nigeria/
  • Austria/
  • Egypt/
  • Turkey/
  • Mongolia/
  • Pakistan/
  • Thailand/
  • Malta/
  • Chile/

9
Swine Flu Searches Visitors who used the NRIC
search facility (PF, Inf, PI)
10
All resources reference swine flu added
together - Pages viewed and Dates
11
Why the peak in August?
  • GP consultation rates peaked in UK in July/August
    apart from Scotland
  • ECDC 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 England
  • Launch of National Pandemic Flu Service
    23/07/2009

12
Swine Flu Searches divided into individual terms
used (Chart 2)
13
Pandemic Flu managing demand and capacity in
health care organisations (surge)
14
Top 10 documents visited
  1. Influenza A(H1N1) virus how to protect yourself
  2. Pandemic flu guidance for businesses risk
    assessment in the occupational setting
  3. 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
    community
  6. Swine flu clinical package
  7. Pandemic (H1N1) 2009 clinical practice note
    Managing adult critically ill cases
  8. Human Swine Influenza advice for the public
  9. New website section on swine flu
  10. eBug topic related to reducing transmission of
    swine flu in the community

15
Top 10 documents visited
  • Difficult to be too specific as new documents
    guidance added almost daily
  • Gave an initial overview of information health
    professionals required
  • Will be reviewed once epidemic has run its
    course? information useful to demonstrate need?

16
Conclusions
  • Increase in traffic noted August 2009 ?Dates
    linked to decreased information from other
    sources
  • Homepage Update link to all influenza documents
    in date order popular increased hits
  • Monthly eNewsletter increased awareness of
    relevant publications and may have increased hits
    on that months newly published documents

17
Conclusions
  • Easy access to daily press releases/information
    from sources other than NRIC heightened awareness
    of surveillance data and publications
  • Instant access to all influenza publications from
    an NRIC New Update link on the home page
    increased access and changed search terms used
  • Comparing 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 IPC publications? relevant

18
Acknowledgements
  • Thanks to
  • Dr Patty Kostkova,
  • Ed de Quincey and Gawesh Jawaheer for the
    interpretation of the web server logs
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