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Abstract Background Outbreak investigation is a core function of public health agencies. Suboptimal outbreak investigation endangers both public health and agency reputations. While audits of clinical medical and nursing practice are conducted as part of continuous quality improvement, public health agencies rarely make systematic use of structured audits to ensure best practice for outbreak responses, and there is limited guidance or policy to guide outbreak audit. Methods A framework for prioritising which outbreak investigations to audit, an approach for conducting a successful audit, and a template for audit trigger questions was developed and trialled in four foodborne outbreaks and a respiratory disease outbreak in Australia. Results The following issues were identified across several structured audits: the need for clear definitions of roles and responsibilities both within and between agencies, improved communication between agencies and with external stakeholders involved in outbreaks, and the need for development of performance standards in outbreak investigations - particularly in relation to timeliness of response. Participants considered the audit process and methodology to be clear, useful, and non-threatening. Most audits can be conducted within two to three hours, however, some participants felt this limited the scope of the audit. Conclusion The framework was acceptable to participants, provided an opportunity for clarifying perceptions and enhancing partnership approaches, and provided useful recommendations for approaching future outbreaks. Future challenges include incorporating feedback from broader stakeholder groups, for example those of affected cases, institutions and businesses; assessing the quality of a specific audit; developing training for both participants and facilitators; and building a central capacity to support jurisdictions embarking on an audit. The incorporation of measurable performance criteria or sharing of benchmark performance criteria will assist in the standardisation of outbreak investigation audit and further quality improvement.

Abstract Background A storm-related disaster in New South Wales, Australia in June 2007 caused infrastructure damage, interrupted essential services, and presented major public health risks. We investigated household disaster preparedness and information sources used before and during the disaster. Methods Rapid cluster survey of 320 randomly selected households in Newcastle and Lake Macquarie, New South Wales, Australia. Results 227 households (71%) responded to the survey. By the day before the storm, 48% (95%CI 40–57%) of households were aware of a storm warning, principally through television (67%; 58–75%) and radio (57%; 49–66%) announcements. Storm preparations were made by 42% (28–56%) of these households. Storm information sources included: radio (78%; 68–88%); family, friends, colleagues and neighbours (50%; 40–60%); and television (41%; 30–52%). Radio was considered more useful than television (62%; 51–73% vs. 29%; 18–40%), even in households where electricity supply was uninterrupted (52%; 31–73% vs. 41%; 20–63%). Only 23% (16–30%) of households were aware that the local government-operated radio network has a designated communication role during disasters. A battery-operated household radio and appropriate batteries were available in 42% (34–50%) of households, while only 23% (16–29%) had all of: a torch, battery-operated radio, appropriate batteries, mobile phone, emergency contact list and first aid equipment. Conclusion Broadcast media are important information sources immediately before and during disasters. Health services should promote awareness of broadcast networks' disaster role, especially the role of radio, and encourage general household disaster preparedness. A rapid cluster survey conducted shortly after a natural disaster provided practical, robust information for disaster planning.