HONOLULU (AP) — The Hawaii Department of Health had breakdowns in communication and inconsistencies in practices in its response to three disease outbreaks in 2015 and 2016, according to a state audit.

The state auditor's report made public Thursday indicates that the department failed to properly communicate with its own divisions, other agencies and the public during the outbreaks of dengue fever, hepatitis A and salmonella.

The audit points specifically to the department's Disease Outbreak Control Division, which did not have established guidelines in distributing information to the public and other agencies.

"The confusion and at times, discord, may have been avoided if DOH had established and followed a full communications plan," State Auditor Les Kondo said in the report.

The division did not follow its own investigation policies, and it had inconsistent practices for record keeping, making it unable to provide a full account of its response, according to the report.

"These deficiencies result in limited accountability to the public and could also result in missed investigation steps and possible delays and/or replication of efforts during an outbreak response," Kondo said.

The department has been addressing the concerns listed in the report and aims to make it more effective, said Virginia Pressler, director of the department. In a letter to the auditor, she said the department has been developing guidelines and reorganizing.

"The Department of Health understands that during an outbreak, communication within our department, with other response agencies and the public is essential," Pressler said in the letter. "Protecting the health of Hawaii's people is our top priority. As a publicly funded entity, this is a responsibility the Department of Health takes very seriously."