Newborn Hepatitis B Vaccination Policy in Hospital Nurseries

Abstract

ABSTRACT. Objective. Hepatitis B vaccination (HBV) is unlike any other immunization series because it can be initiated in the hospital nursery. The objective of this study was to describe how hospital nurseries develop HBV policies and to describe the sources of information used for learning about national HBV recommendations.Methods. A cross-sectional telephone survey was conducted on a national random sample of nursery medical directors of 290 hospital nurseries representing all 50 states. The outcomes measured were methods used by hospital nurseries to develop HBV policy and sources of information used by nursery directors to learn about national HBV recommendations.Results. Directors at 207 (71%) of 290 eligible nurseries responded. Of the 184 nurseries that have considered developing an HBV policy, the most common method was through a formal committee (43%). In 104 (57%) of these nurseries a nurse was involved in policy development, and in 15 (8%) the nurse manager initiated the process. The most common source of initial information about the July 1999 announcement to suspend the nursery dose of HBV was the American Academy of Pediatrics. The most common initial source of information about the availability of thimerosal-free HBV was pharmaceutical companies. Physician, nurse, and pharmacist colleagues were cited as sources of information with similar frequency (12, 11, and 20 cases, respectively).Conclusions. Physicians are not the sole initiators and developers of HBV policy in the newborn nursery. Although almost all nurseries designate a physician as a nursery director, in many cases (55% of cases) the position is "rotating" or as part of another administrative position (63% of cases). Many hospital nurseries involve nurses and pharmacists in key roles to stay current with HBV recommendations and to develop subsequent policy. Using nonphysician national organizations as additional channels of information might expedite dissemination about changes in HBV recommendations and, as a result, improve nursery awareness and adoption of national HBV guidelines. T he hepatitis B vaccination (HBV) series is unlike other pediatric vaccinations because it can be routinely initiated in an inpatient settingthe hospital nursery. The newborn nursery represents the first opportunity to immunize children and establish immunization practices and attitudes at the family and individual levels. The newborn period may be a time when parents are especially receptive to information about immunizations, because HBV at birth is associated with timely receipt of other vaccines. 1 In addition, a nursery's immunization policy can greatly influence the adoption of vaccination recommendations by individual health care providers in the same community. 2 In July 1999, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) instituted changes in HBV recommendations for low-risk infants-those born to mothers who test negative for hepatitis B surface antigen. 3 Because of the potential risk of thimer...