To describe and report the progress of a provider-initiated approach to increase influenza immunization rates for healthcare workers.

Observational study.

The State of Iowa.

Acute care hospitals in Iowa.

Hospitals reported rates of employee influenza vaccination to a provider-based collaborative during 2 influenza seasons (2006-2007 and 2007-2008). Hospital characteristics related to higher vaccination rates were examined.

One hundred (87.0%) of 115 Iowa hospitals and/or health systems participated in season 1; individual hospital vaccination rates ranged from 43.5% to 99.2% (mean, 72.4%; median, 73.1%). In season 2, 115 (100%) of 115 Iowa hospitals and/or health systems participated. Individual hospital vaccination rates ranged from 53.6% to 100% (mean, 79.5%; median, 82.0%). In both seasons, urban and large hospitals had vaccination rates that were 6.3% to 7.6% lower than those of hospitals in other locations. Hospitals that used declination statements had influenza vaccination rates 12.6% higher than hospitals that did not use declination statements in season 2.

The initial vaccination rates were high for healthcare workers in Iowa, especially in smaller rural hospitals, and rates increased during season 2. The successful voluntary approach for reporting influenza vaccination rates that we describe provides an efficient platform for collecting and disseminating other statewide measures of healthcare quality.

To determine the effect of a pandemic influenza preparedness drill on the rate of influenza vaccination among healthcare workers (HCWs).

Before-after intervention trial.

The University of Iowa Hospitals and Clinics (UIHC), a large, academic medical center, during 2005.

Staff members at UIHC.

UIHC conducted a pandemic influenza preparedness drill that included a goal of vaccinating a large number of HCWs in 6 days without disrupting patient care. Peer vaccination and mobile vaccination teams were used to vaccinate HCWs, educational tools were distributed to encourage HCWs to be vaccinated, and resources were allocated on the basis of daily vaccination reports. Logit models were used to compare vaccination rates achieved during the 2005 vaccination drill with the vaccination rates achieved during the 2003 vaccination campaign.

UIHC vaccinated 54% of HCWs (2,934 of 5,467) who provided direct patient care in 6 days. In 2 additional weeks, this rate increased to 66% (3,625 of 5,467). Overall, 66% of resident physicians (311 of 470) and 63% of nursing staff (1,429 of 2,255) were vaccinated. Vaccination rates in 2005 were significantly higher than the hospitalwide rate of 41% (5,741 of 14, 086) in 2003.

UIHC dramatically increased the influenza vaccination rate among HCWs by conducting a pandemic influenza preparedness drill. Additionally, the drill allowed us to conduct a bioemergency drill in a realistic scenario, use innovative methods for vaccine delivery, and secure administrative support for future influenza vaccination campaigns. Our study demonstrates how a drill can be used to improve vaccination rates significantly.

To describe the molecular epidemiology of Legionella pneumophila infections in the University of Iowa Hospitals and Clinics (UIHC).

Molecular epidemiological study using pulsed-field gel electrophoresis (PFGE).

A large university teaching hospital.

All surviving isolates obtained from culture-proven nosocomial L pneumophila infections and all surviving isolates obtained from the University of Iowa Hospital and Clinics' water supply between 1981 and 1993.

Thirty-three isolates from culture-proven nosocomial cases of L pneumophila pneumonia were available for typing. PFGE of genomic DNA from the clinical isolates identified six different strains. However, only strain C (16 cases) and strain D (13 cases) caused more than 1 case. Strain C caused clusters of nosocomial infection in 1981, 1986, and 1993 and also caused 4 sporadic cases. Strain D caused a cluster in 1987 and 1988 plus 4 sporadic cases. Of the six strains causing clinical infections, only strains C and D were identified in water samples. PFGE identified three strains in the water supply, of which strains C and D caused clinical disease and also persisted in the water supply during most of the study period.

Specific strains of L pneumophila can colonize hospital water supplies and cause nosocomial infections over long periods of time.