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 - purpose Audience 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 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)

A brief chronology of the Swine flu (H1N1) outbreak 18 th March – human cases of swine influenza reported in Mexico and certain areas of the united States of America 27 th 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 28 th April advice if returning from an affected area to the UK 29 th April WHO raised the Pandemic alert level to Phase 5 30 th April Swine flu information leaflet to every households across the UK 24 th /30 th April daily press statements/press briefings began - HPA, DH, WHO, ECDC 11 th June WHO raised the Pandemic flu alert level to Phase 6 2 nd 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 30 th 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 18 th 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 1 st to 26 th May yielded the following: - NRIC did not record a single search for ‘ influenza ’ on it ’ s web server logs from 1 st until 27 th April! And then suddenly on the 29 th April increased interest ?panic

Information from NRIC web server logs Data Range 1 st March – 31 st 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?

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)

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)

All resources reference ‘swine flu’ added together - Pages viewed and Dates

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

Swine Flu Searches divided into individual terms used (Chart 2)

“Pandemic Flu – managing demand and capacity in health care organisations (surge)”

Top 10 document’s 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

Top 10 document’s 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 it ’ s course? information useful to demonstrate need?

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

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 IP&C publications? relevant

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