Hand washing for swine flu

In my analysis of the Australian Government's Swine Flu web site I suggested the instructions for handwashing could be improved. The instructions are contained in a 24 kbyte GIF file on the "Individuals and households" page. Here I have separated the four steps into individual images, reduced to 32 colours, and removed text from the images. The result is four files, each of 4 kbytes.

To wash your hands properly:

1. Wet your hands, then apply soap.

   

2. Lather vigorously for 15 to 20 seconds.

   

3. Rinse with water.

   

4. Dry your hands afterwards with a clean towel.

   

Some points to note: I replaced the dash in "15-20 seconds" with the word "to". This is more understandable if the text is converted to synthetic speech by an assisted technology device for the blind. Otherwise the text will be read as "fifteen dash twenty seconds".

Reducing the complexity of the images by removing the shading to make them pictograms would reduce them to 1 kbyte each and also make them easier to understand. A simple animation also could be made from the images.

Mobile phones for combating pandemics

Dr Robert Fitzgerald from University of Canberra talked about e-learning at ANU a few weeks ago. After that he invited me over to UoC to discuss the use of mobile phones in aid projects, before travelling to Cambodia to work on some. He has posted some messages on the projects. The on is SMS Monitoring Systems - Geochat from InSTEDD. In this he describes a Short Message System (SMS) based system called Geochat, used for tracking a pandemic. This takes information sent in an SMS message and maps it with Google Maps. This has been used for an Avian Influenza simulation exercise and has obvious application in Australia with the current swine flu pandemic.

Australian Government Swine Flu Outbreak Web Information

There are some technical faults in the Australian Government's "Swine Flu Outbreak" web page. Below are some suggestions to fix the faults, improve the site and a general approach to improve the provision of such information online.

In a major emergency, such as a pandemic, all that the authorities can provide to the community is advice. There are not sufficient resources to provide each individual with material assistance. It is therefore important that useful advice is provided. The web would be a useful way to provide such advice, if we could to learn to use it effectively.

The Australian Government has provided some useful information online, but the formatting and arrangement of that information could be improved. Better use could be made of the web to distribute and present information. The PDF versions of information brochures could be replaced with easier to read web pages. Simple animations which demonstrate techniques such as hand washing could be created. These could be displayed on web pages and also be suitable for use on smart phones, iPods and on digital signage in schools, offices and workplaces.

The Australian Government home page provides a link for "Swine Flu Outbreak" as the second feature, after the Economic Stimulus Plan. This appears to be an appropriate level of priority. Unfortunately the link is to a web page with the vague title of "Heath Emergency" and subtitle of "H1N1 09 Outbreaks" <http://www.healthemergency.gov.au/>. Many readers are likely to stop at this point, think they are in the wrong place. The page should have a title like that of the home page "Swine Flu Outbreak".

The web address for the page is generic, referring to "Heath Emergency", however there appears to be no provision for more than one health emergency, nor of distinguishing between them. There is also no provision for government information on other forms of emergencies. The Australian Government should establish a web address for emergencies and include health under that.

The information on the "Heath Emergency" page is not intended for the general public and is not suitable for them. The page is intended for health professionals, school administrators and business people. The page lists information for individuals and households last in a menu of seven items. It is unlikely that many people will even notice this menu item. This should be changed to put the information for individuals on top of the home page.

The "Individuals and households" has a menu at the top which lists "Personal protective equipment" as he first item. However, this is not the most important way to combat flu, which is good personal hygiene, and so should be the first item. Many people will click on "Personal protective equipment" and thus miss the first section "Protecting yourself and others".

The web address for the page contains upper and lower case text. It works with all lower case text. The mixed case will cause confusion and should be replaced. The web address is too long and should be made one third the current length.

The page has been formatted to omit the left menu when printed and prints well. The bottom of the page contains details of where to get further information. However, there is no link to state and territory health departments. There should be a link to the corresponding health department pages.

The web page failed a TAW automated web accessibility test, TAW 3.0 (6/8/09 12:51 AM) Validation conform to WAI guidelines, W3C Recommendation 5 May: 1999. There was one Priority one problem, 12 priority two and 1 priority three problems. There is a ALT text tag missing from one image on the page, which should be added. It would also be useful to offer audio and video versions of the information and in other languages.

The page scored 79/100 with the W3C mobileOK Checker, which is a good result.

The page is 53KB, with 34KB for the images. The text of the page is 16 kbytes, indicating that there is not an excessive amount of formatting used. However, the page might usefully be split into two smaller pages.

The image providing advice on hand washing is relevant and useful but should be optimised for online use.

The image is a 24 kbyte GIF file. It contains text which makes the image file unnecessarily larger and is not accessible by those using assistive technology. The image contains 203 colours, which is more than needed for a simple line drawing. If reduced to 8 colors, the image size decreases to 6 kbytes. Consideration could be given to reducing the complexity of the images, making them simple pictograms.

The web page lacks keywords, description and other metadata in the HEAD. This should be added and the irrelevant "powered by IBM Lotus Workplace Web Content Management(r) 2.0" removed.

The web page failed validation, due to the missing "ALT" on an image.

The validation also noted that:

"The character encoding specified in the HTTP header (utf-8) is different from the value in the <meta> element (iso-8859-1). I will use the value from the HTTP header (utf-8) for this validation. "

The missing ALT should be added and the character set mismatch corrected. Consideration should be given for using a later version of HTML than HTML 4.01 Transitional, for the document.

The web page contains a link to flu posters and information brochures. However, most of these are not relevant for individuals and could cause confusion and panic, with mention of protective gloves, gowns and respirators. The items on this page should be reordered to place those relevant to the general public, such as how to wash and dry hands, first and the ones for professionals lower down.

To assist the community, I had the Australian National University COMP2410 students undertake their web design assignment on a swine flu advice web site for Australia. That experience is now available, if needed.

Dealing with a pandemic in an educational institution

An international conference was run from Hong Kong in 2003 on how to deal with the SARS outbreak in university and other educational institutions ("Educational Narratives and Reflections in the time of SARS"). The papers from the conference are available online and would be of value for schools, vocational institutions and universities now considering how to deal with a flu pandemic. Assuming institutions will simply shut down is a dangerous assumption to make.

Paper Title	Description	Sent in by	Date
VITLE classes: HKBU library supporting e-learning during SARS outbreak	On how the VITLE system at HK Baptist University was used to deliver general courses to schools and the public and on a library-run course on searching. (Ref: 76)	SOUL System Admin	30-MAY-2003 10:15:29
IT Learning meeting notes of 16 April 2003	Notes of a meeting of a small group of senior staff commenting on how HKU coped with teaching during SARS. (Ref: 74)	SOUL System Admin	30-MAY-2003 10:12:56
Does your library disaster preparedness plan have a section on epidemics?	A revised draft written for a library magazine (Ref: 73)	SOUL System Admin	30-MAY-2003 10:11:48
"Mind the Gap"	A school principal's frustrations. How have others felt? (Ref: 72)	McNaught, Carmel	26-MAY-2003 13:27:47

From: Educational Nattitives and Reflections in the time of SARS, Hong Kong Web Symposium Consortium, 19-31 May 2003.

Influenza Pandemic Business Continuity Guide

The Australian Government released a Influenza Pandemic Business Continuity Guide for Australian Businesses in July 2006. This is available as a 340 KByte, 68 page PDF file. Unfortunately the document is not available as an easy to read and download web pages. It suggests use the telephone, video conferencing and the internet to conduct business as as a way to avoid meeting people face to face, even when participants are in the same building. However, it points out that demand for services may be impacted by a pandemic, for example demand for internet access may increase. It suggests checking the business has an adequate infrastructure, including computer networks and internet presence.

Unfortunately the guide does not explicitly mention teleworking as a strategy, even though the same government department which produced the guide also funds Telework Australia to promote online working.

Also available is an Influenza Pandemic Kit for Small Businesses withm materials both as web pages and downloadable in PDF:

1. Booklet: Being prepared for an influenza pandemic:
   1. Help Protect Your Staff And Customers From Getting Sick
   2. Plan Now To Keep Your Business In Business
   3. Ten Steps You Can Take To Be Better Prepared For A Pandemic
   4. What Is A Human Influenza Pandemic?
   5. Where Can I Find More Information?
2. Reference sheets
1. Pandemic Phases
2. Workplace Cleaning Products
3. What if employees become ill at work during a pandemic?
4. Pandemic planning checklist for small businesses
3. Health posters:
1. COUGH ETIQUETTE AND RESPIRATORY HYGIENE
2. HOW TO CLEAN HANDS USING AN ALCOHOL-BASED LIQUID OR HAND RUB
3. HOW TO FIT AND REMOVE A P2 RESPIRATOR
4. HOW TO FIT AND REMOVE A PROTECTIVE GOWN
5. HOW TO FIT AND REMOVE A SURGICAL MASK
6. HOW TO FIT AND REMOVE PERSONAL PROTECTIVE EQUIPMENT IN THE CORRECT ORDER
   
7. HOW TO FIT AND REMOVE PROTECTIVE EYEWEAR
8. HOW TO FIT AND REMOVE PROTECTIVE GLOVES
9. HOW TO WASH AND DRY HANDS
10. STAFF INFLUENZA NOTICE
11. TRAVEL HEALTH

Table of Contents
1. Introduction and purpose of this guide 1
2. What is avian influenza and pandemic influenza? 3
H5N1 (avian influenza or bird flu) 4
Human Influenza 5
Prevention and Treatment 6
3. What is the Government doing? 9
Government Support 10
Australian Health Management Plan 10
Containment 12
Maintaining society’s functions 13
National Action Plan for Human Influenza Pandemic 13
State and territory government activities 13
4. How might pandemic influenza affect my business? 15
Characteristics of a pandemic 16
Staff absenteeism 16
Other immediate effects 17
Financial implications 17
5. How can I minimise the impact of a pandemic on my business? 21
Preparation 22
Business continuity planning 23
Step 1: Identify your business’ core people and skills 23
Step 2: Establish a pandemic planning team 23
Step 3: Plan for staff absences 24
Step 4: Consider the effects of supply shortages on operations 25
Step 5: Establish and maintain two-way communication 25
Step 6: Consider human resource issues 26
Step 7: Test your plan and know when to activate it 29
6. How can we help protect staff from getting sick? 31
Basic precautions 32
Practice good personal hygiene 32
Workplace cleaning 33
Air conditioning 34
Personal protective equipment 35
Social distancing—reducing contact with others 35
Restricting staff travel 36
Restricting workplace entry 37
Annual influenza injections 37
Screening workers and managing staff who become ill at work 37
iv
7. How do I manage my customers and stakeholders? 39
Communication 40
Duty of care to your customers 40
8. What other tools are available? (Appendices A–D) 41
Online Resources 42
Hotline 42
A. Pandemic planning checklist 43
B. Planning scenarios 50
C. Background on previous pandemics 54
D. Frequently Asked Questions 56
Health information posters are located inside the back pocket of this guide

From: Influenza Pandemic Business Continuity Guide for Australian Businesses, Department of Innovation, Industry, Science and Research, July 2006

Maintaining services online during a flu pandemic

The Australian National University has released a revised ANU Pandemic Response Plan. Like many such plans, this envisages a progressive reduction of organisation activities with all but essential activities being stopped. However, this is based on the assumption that educational activities require gatherings of people. Instead, education and many administrative services, can be maintained using telecommunications, while avoiding face-to-face gatherings of people. Most staff and students can stay at home, but maintain many educational and research activities online.

Some simple steps would be required, such as checking that procedures allow for distribution of electronic documents in place of paper ones. Some procedures for example may refer to requiring "signatures". This requirement can usually be met with an email message with the person's name typed on it, but where a higher level of authentication is required, submission via a password protected system might be needed . Staff may need to be issued with additional equipment at home and trained in its use. Students may need advice on what to get. Online courses would need to be checked to make sure they work on slower home links and ones overseas. Servers would need to be checked for capacity.

In addition to telephone and Internet services, educators can make use of broadcast and cable TV services, including in Canberra Transact, to provide content. In the event of a pandemic, is likely that a significant proportion of the Canberra population will be at home and looking for something to keep them stimulated. The universities and schools might make some materials available for this purpose.

ps: The ANU COMP2410 students have completed their assignment on designing a swine flu advice web site for Australia. This expertise is now available, if needed.

Lack of useful Swine Influenza Information online from Australian Government

Senator Lundy posted an item to her new web site on 29 April, pointing out that the Department of Health and Ageing (DHA) established a website to provide information on Swine Influenza. That got me thinking about what information was available for the public. I was unable to find any clear and coordinated information for the public from Australian Governments. Instead there are an assortment of web reference to detailed information to officials and cross references which will lead the reader around in circles.

The DHA appears to be for medical practitioners, not the general public. It refers people to DHA's "Health Emergency" web page. This has a paragraph about swine flu and then a link to "Swine Influenza Outbreaks", which contains the equivalent of five pages of text and then links to detailed documents about the number of cases reported so far. All this material appears to be intended for officials, not the public:

National tally of people being tested for Swine Influenza as at 6 am,
30th April 2009

Australia
AUS Phase DELAY

Table 1: Current Australian Cases Under Investigation
0600 AEST 30/04/2009

Jurisdictions	Suspect Cases	Probable	Confirmed
ACT	1	0	0
NSW	51	0	0
Vic	24	0	0
Tas	1	0	0
Qld	27	0	0
SA	11	0	0
NT	1	0	0
WA	12	0	0
Total	128	0	0

Source: CDNA

From: Swine Influenza Update Bulletin,Department of Health and Ageing, 6am, 30 April 2009

The World Health Organization (WHO) has a Swine influenza - Epidemic and Pandemic Alert and Response (EPR) but this is intended for national public health officials. The Australian Capital Territory Department of Health has a Swine Influenza page, but this refers to the DHA and WHO pages.

healthdirect Australia, a joint initiative of the Australian, ACT, NSW, NT, Tasmania, SA and WA governments has a "health alert" on its home page, but this just links to DHA.

The Centers for Disease Control and Prevention (CDC)has videos on YouTube, showing the correct way to wear a face mask.