Table 2 Characteristics and key issues identified using the structured audit methodology in Australia.

Multi-state outbreak of Salmonella Mbandaka associated with contaminated peanut butter, Australia,1995[7, 8]

State and territory communicable disease and laboratory heads.

Need for national coordination of outbreaks and clarification of national and jurisdictional roles.

Need for national laboratory network to provide rapid subtyping of isolates.

Development of performance standards for timeliness of outbreak response.

Influenza outbreaks in aged-care facilities, New South Wales, 2005 [13].

Regional health protection staff and Federal health department aged-care accreditation staff

Identify a coordinator to facilitate communication between all stakeholders - facilities, state and federal agencies.

Develop standard surveillance case definitions, notification triggers, and national guidelines for influenza control in aged-care facilities.

Clarify roles of general practitioners in outbreaks.

Promotion of influenza immunisation in aged-care staff and residents.

Need for broadcast facsimile capacity to aged-care facilities.

Need for daily communication with affected families during quarantine.

Prophylaxis of contacts of food handler with hepatitis A to prevent an outbreak, NSW, 2006.**

Regional health protection staff

Promote early notification of hepatitis from laboratories and general practitioners.

Need for coordination of communication and liaison with other agencies e.g. schools and food safety authority.

Ensure roles of all staff are clear and documented in rapidly evolving outbreak responses.

Development of fact sheets and mass vaccination procedures.

Salmonella outbreak in an aged-care facility, NSW, 2008.**

Regional health protection staff and food safety authority

Develop guidelines for appropriate investigation timelines and share them between agencies.

Document roles of each agency and agree on and share communicated advice in each outbreak setting.

Salmonella outbreak in a restaurant, NSW, 2008.**

Regional health protection staff and food safety authority

Develop protocols for joint health and food authority investigations with clarification of roles and legal status.

Need for rapid sharing of new epidemiological or environmental investigation information.

Interagency governance procedures identified for reporting and implementing recommendations from structured outbreak audits.