1. A Survey of Hepatitis B Disease Prevention Practices in Delivery Hospitals in Mississippi
Sandor Feldman MD
Immunization Consultant
And
Joyce Booth RN, MSN
Nurse Consultant
Division of Immunization
MS State Department of Health 1

2. Objectives
Determine MS’s delivery hospitals’ (N=50) policies for screening pregnant women for hepatitis B surface antigen (HBsAg)
Determine MS’s delivery hospitals policies for administering hepatitis B vaccine (HBvax) to newborns (NB) prior to discharge
Determine compliance with hospitals’ policies for screening of pregnant women
Determine compliance with hospitals’ policies for administering HBvax to NBs prior to discharge 2

3. Methods Definitions Screening of pregnant women
HBsAg documented in hospital record
HBsAg testing before or at delivery
Immunization of NB with HBvax prior to discharge
Documented in hospital record
Informational letter
Hepatitis B virus (HBV) infection in NB
Availability of thimerosal-free HBvax
ACIP, AAP, AAFP and MSDH (MS State Dept. of Health) preference for birth dose of HBvax
Rationale for birth dose 3

4. Methods Survey (questionnaire) Maternal screening for HBsAg
Policies: HBvax for NBs
Routine, physician order only, or no policy
Standardized Maternal and NB record review
Modified from CDC’s Screening Assessment Tally Sheet for HBV (1999)
Maternal and NB records; 30 each per hospital
If available, maternal-infant pairs 4

5. Methods Initial letter and questionnaire-Nov. 2001
F/u letter-Jan. 2002
F/u telephone contact for hospitals not responding to above
Letter requesting review of maternal and NB records-Feb. 2002
Appointment made via telephone
Completed record review, 9/2002
Births between 7/1/01-12/31/01 5

6. Survey Results
*Telephone call back was required for 40% (N=20) of the surveys to clarify responses 6

7. Survey Results 7

8. Record Review Results OVERALL- 96% MATERNAL SCREENING FOR HBsAg8
* Forty-six hospitals had >90% documentation of HBsAg in maternal records

9. Survey Results
38%
28%
34% 9

10. Survey Results Obstacles to routine HBvax for NBs
No knowledge of AAP/AAFP/ACIP preference
Do not see cases of HBV in mothers/infants
Did not give in past, do not want to start now
HBvax only for NBs of infected mothers
Birth dose complicates schedule
HBvax not thimerosal-free
Medical-legal
Cost/reimbursement
Increased personnel time/paper work
Administering vaccine, reporting to immunization registry, etc 10

11. Survey Results 11

12. Results of Record Review Compliance with Newborn HBvax Policies
No. Hospitals
No. Records
%Compliance with policy
Policy
Routine 19
580
96%†
MD order
12*
333
6%‡
None
15*
440
3%§
1353
44%
Overall 46
Overall 48% of NBs receive HBvax at birth
† 15/19 hospitals, >93% compliance
* 4 hospitals, no NB records available for review
‡ 6 hospitals, 0%; 1 hospital, 47%; remainder, <6%
§ 10 hospitals, 0%; remainder 3-13% 12

13. Post-Survey Changes in NB HBvax Policies
Changed from MD order to Routine HBvax
7 hospitals; 6330 NBs
Changed from No Policy to Routine HBvax
8 hospitals; 4895 NBs
MS hospitals as of Nov 30, 2002
34 hospitals, 74% of birth cohort (~31,000) have routine NB HBvax
Before survey/intervention, 47% were born at hospitals with routine HBvax
Based on 96% compliance with routine HBvax policy, 29,697 or 71% of MS’s NB will now receive HBvax at birth
49/50 (one added) hospitals screen for maternal HBsAg, >95% compliance 13

14. VFC Coverage of Newborns for HBvax Impact of Survey/Intervention
No. Hospitals
(%)
No. Births
% Birth cohort
12405
30%
8 (16%)
7625
18%
VFC, after intervention
13 (26%)
Total
21 (42%)
20030
48% 14

15. Goals and Post-survey Interventions
100% maternal screening, routine NB HBvax and VFC coverage of NB for HBvax
Continue to address obstacles to routine HBvax for NBs
telephone contact, face-face meetings with or presentations to key physicians and/or hospital nursery personnel
Publication of Survey findings
MS Morbidity Report, Healthy Baby Update, MS AAP chapter newsletter
F/U letter with results of survey to all 50 delivery hospitals and MS Hospital Association for distribution to all Hospital Administrators 15

16. Summary/Conclusions/Recommendations
HBsAg screening of pregnant women was 96%
Initially 47% of birth cohort born in hospitals with routine HBvax
Post-survey/intervention, increased to 74%
Overall compliance with policy of routine HBvax for NBs was 96% (individual hospitals, range %)
Hospitals with MD orders or no policy for HBvax poorly vaccinated NBs
Increased VFC coverage of birth cohort for birth dose from 30% to 48%, post-survey/intervention
Addressing individual hospital obstacles to routine birth HBvax increased by over 50%, NBs born at hospitals routinely administering birth dose 16