Gaps in Hospital Policies and Practices to Prevent Perinatal Transmission of Hepatitis B Virus

Abstract

WHAT'S KNOWN ON THIS SUBJECT:In the United States, an estimated 1.4 million people have chronic HBV infection, causing 2000 to 4000 deaths annually. Newborn HepB administration is a key intervention to prevent perinatal HBV transmission and morbidity and mortality caused by chronic HBV infection. WHAT THIS STUDY ADDS:This study examined how well national recommendations for perinatal HBV prevention advocated by the CDC and the ACIP are implemented by hospitals. It also reveals considerable gaps in hospital policies and practices that need to be addressed. abstract OBJECTIVE: The objective of this study was to examine hospital policies and practices to prevent perinatal transmission of hepatitis B virus (HBV) in the United States and to and identify gaps. METHODS: In March 2006, a nationally representative sample of 242 delivery hospitals in the 50 states, District of Columbia, and Puerto Rico (with at least 100 annual births) were surveyed about hospital perinatal hepatitis B prevention policies and asked to review paired maternal-infant medical records for 25 consecutive live births. Main outcome measures were hospital policies related to the prevention of perinatal transmission of hepatitis B and the proportion of infants who received recommended care. RESULTS: A total of 190 of 242 hospitals responded to the survey and completed medical record reviews for 4762 mothers and 4786 infants. The proportion of hospitals that reported each of the 6 policies examined ranged from 63.0% to 80.6%. Among infants who were born to the 18 hepatitis B surface antigen (HBsAg)-positive women with documented prenatal test results, 62.1% received both hepatitis B vaccine and hepatitis B immunoglobulin within 12 hours, but 13.7% were unvaccinated and 19.7% did not receive hepatitis B immunoglobulin before hospital discharge. Among infants who were born to the 320 women with unknown HBsAg status, only 52.4% were vaccinated within 12 hours of birth and 20.1% were unvaccinated before discharge. Among infants who were born to HBsAg-negative mothers, 69.1% received the hepatitis B vaccine before hospital discharge. The strongest predictor of vaccine administration was having a written hospital policy for newborn hepatitis B vaccination. CONCLUSIONS: These findings indicate that significant gaps persist in hospital policies and practices to prevent perinatal HBV transmission in the United States. Efforts to avoid medical errors through appropriate implementation and monitoring of hospital practices are needed to eliminate perinatal HBV transmission.

Effect of Revised Nursery Orders on Newborn Preventive Services

“…Therefore, the 83% vaccination rate, though improved, was not as high as the 87.2% rate reported by hospitals with universal vaccination rates that were included in the survey. 6 In addition, in our hospital, vaccination rates were lower for infants with two white parents. The newborn nursery committee received feedback from many physicians that they did not recommend the vaccine to the parents because of the low disease incidence in their primarily white patients.…”

“…5 In a March 2006 survey of a nationally representative sample of delivery hospitals in the United States, 69.1% of infants born to hepatitis B surface antigen-negative mothers received the vaccine before hospital discharge. 6 The percentage of infants who received the vaccine did not vary significantly by maternal race or ethnicity. The strongest predictor of vaccine administration was having a written hos- (7) 9 (7) LOS Ͼ72 hours n ϭ 90 n ϭ 81…”

Using data to guide policy: Next steps for preventing perinatal hepatitis B virus transmission in Cambodia

“…Other assessments have shown that having a written hospital policy or standing orders for newborn hepatitis B vaccination is associated with having higher vaccination coverage in facilities [13,14]. Therefore, in addition to strengthening national guidance, hospitals should have policies in place to provide on-site birth dose vaccination.…”

Review of the Prevention of the Hepatitis B Virus Infection Transmission From Mother to Child During Pregnancy

“…When a pregnant woman refers for the first prenatal visit, the physician will give her a series of routine blood tests, including one test for the presence of the hepatitis B surface antigen (HBsAg), which can cause severe liver damage and hepatocellular carcinoma when the child becomes infected during infancy. If the mother is infected, the physician will recommend a dose of hepatitis B immunoglobulin (HBIG) for her baby immediately after birth to protect her child from infection in the short term (1,2,(11)(12)(13)(14)(15)(16). Neonates should also receive the first dose of the HBV vaccine within 12 hours of birth so as for them to be able to receive the second and third doses of this vaccine at a regular time.…”

“…There are many reports about the rate of the transmission of the HBV infection during pregnancy and also understanding of the mechanisms of the transmission of the infection from mother to child. All these studies have sought to implement policies on maternal screening and infant follow-up as well as mechanisms to minimize the transmission rate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Here, we aimed to review the ways for the prevention of this infection from mother to child and research the new guidelines.…”