Wisconsin Division of Public Health

Improving Healthcare Workers Safety

Wisconsin Division of Public Health – Bureau of Communicable Diseases and Emergency Response
Madison, WI

United States healthcare facilities continue to struggle to raise employee influenza vaccination rates among healthcare workers – despite the known benefit to patient safety. But an innovative project launched by the Wisconsin Division of Public Health (DPH) in 2005 has dramatically raised employee influenza vaccination rates among the state’s 140 hospitals and 400 nursing homes.

Gwen Borlaug, CIC, MPH, infection control epidemiologist with the DPH Bureau of Communicable Diseases and Emergency Response (BCDER), created a team comprised of State Epidemiologist Dr. Jeffrey P. Davis; Bureau Director Sandra Breitborde; Immunization Program Director Dan Hopfensperger; Communicable Diseases Epidemiology Section Chief Richard Heffernan; data entry staff member Jean Druckenmiller, CIC, BSM, (NRM); and statistician Marisa Stanley.

Originally contemplating asking the legislature for a mandate, the team instead determined which National Foundation for Infectious Diseases recommendations were used by Wisconsin hospitals and nursing homes to boost compliance, and what their rates were. They learned most facilities provided free shots, convenient locations, and education to promote employee influenza vaccination rates. But that strategy “wasn’t getting rates into the 80-100 percent range,” said Borlaug.

Only 14 percent followed a recommendation from the Society for Healthcare Epidemiology of America: using individual declination forms requiring decliners to acknowledge they are putting their patients at risk. Facilities using the forms had much higher median vaccination rates. “The declination form is the only consistent thing that is statistically shown to improve the compliance rate,” Borlaug said.

The team set a goal of getting all Wisconsin hospitals and nursing homes to boost their employee influenza vaccination rates to at least 80 percent. Public recognition of success– including mention in DPH newsletters and a certificate for display – was used as an incentive. The state agency tracks rates, provides results feedback to facilities, and makes recommendations for improvement.

Since the project’s start, facilities using the forms jumped from 14 percent to 72 percent. The median employee influenza vaccination rates rose from 58 percent to 71 percent in hospitals, and from 50 percent to 66 percent in nursing homes. Hospitals reaching the targeted 80 percent employee influenza vaccination rates jumped from 5 to 40; the number of nursing homes skyrocketed from 27 to 113. Last year, the team added reminder telephone calls and a webcast to its arsenal.

The team is delighted with the “huge improvement” seen to date, said Borlaug. “In Wisconsin, we prefer to do things voluntarily. We want healthcare workers to do this because it’s the right thing, and so far, it’s working.”