1. Improvements in Perinatal Hepatitis B Prevention Practices, Chicago Birthing Hospitals, 2002 and 2006 Patricia Hoskins-Saffold, RN, MSN Steven Terrell-Perica Chicago Department of Public Health

2. Chicago Population size: 2,896,016 * Number of birthing hospitals: 24 Number of live births: 47,958 * Expected HBsAg births: 286 † Identified HBsAg births : 141 ‡ * US Census, 2000 † CDC, 2004 ‡ CDPH, 2004

3. Chicago Birthing Hospitals N=24

4. Birthing Hospital Perinatal Hepatitis B Assessment & Feedback, 2002 Maternal & infant chart audits: 18 (75%) hospitals –Assessed prenatal HBsAg screening practices –Assessed HepB vaccination practices Feedback Sessions: 18 (75%) hospitals –Provided summary of results and recommendations for improved practices

5. Recommendations for Hospitals Create standing orders: –Screening when no/unknown prenatal HBsAg screening results –Universal hepatitis B vaccine birth dose Document HBsAg status in maternal & infant charts: –Progress notes –ACOG forms (2-ply, 2nd copy in infant record) –Actual laboratory results be attached to record

6. National Immunization Survey Hepatitis B Immunizations (Ages 0-2 days)

7. Birthing Hospital Perinatal Hepatitis B Assessment & Feedback, 2006 Maternal & infant chart audits: 24 hospitals –To assess changes in prenatal HBsAg screening & documentation practices –To assess infant hep B vaccination & documentation practices Survey: 24 hospitals –Implementation of standing orders & policies for screening & vaccination

8. Chart Audits, March-August 2006 Maternal Records Review (60 charts/hospital) : Documented prenatal/admission HBsAg test results (ante partum & ACOG forms, lab reports & progress notes) Infant Records Review (60charts/hospital) : Documented vaccination date, time, & dose (medication sheets, informed consents & progress notes). Documented mother’s HBsAg results in infant charts Total mother/infant chart pairs audited: 1,453

9. Percentage of Women with Prenatal HBsAg Screening Documented, 2002 vs 2006 Per Hospital Range, 2006: 40% to 98%

10. Percentage of Women without Prenatal HBsAg Screen who were Screened Upon Admission, 2002 vs 2006 Per Hospital Range, 2006: 33% to 100%

11. Percentage of Women Screened in the First or Second Trimester Who Were Screened Upon Admission *, 2002 vs 2006 * Risk factors for hepatitis B infection not assessed

12. Percentage of Mother’s HBsAg Status Documented in Infant Chart, 2002 vs 2006 Per Hospital Range, 2006: 40% to 100%

13. Percentage of Infants Receiving Hepatitis B Vaccine Before Discharge, 2002 vs 2006 Per Hospital Range, 2006: 37% to 100%

14. Hospital Survey Results, 2006 Maternal PolicyStanding Order Review HBsAg status on admission67%42% Screen on admission if no prenatal screening67%50% Repeat HBsAg screening for high risk mothers25%0% Infant Document maternal HBsAg status in infant chart63%0% Universal birth dose79%83% HBsAg-positive, HBIG/HepB, within 12 hrs79%83% HBsAg-unknown, HBIG/HepB, within 12 hrs67% 24 hospitals surveyed

15. Hospital Feedback Sessions, 2006 Attendees: Chiefs of Obstetrics & Pediatrics, Obstetric & Nursery Managers, Infection Control Practitioner, Quality Assurance Manager, Pharmacy Manager, Staff Nurse Educator Reviewed results of chart audit –Comparison of participating hospitals’ results Recommendations –Re-screening of high-risk mothers –Encouraged use of standing orders & policies for prenatal/admission screening & vaccination –Encouraged enrollment in VFC program Provided certificate for participation

16. Exchange of Information, 2007 Regional meetings –Review of recommended practice –Hospitals to share successful interventions Hospital pharmacies enrolling in VFC program Implementation of standing orders Awards for improved/sustained high performance

17. Conclusions From 2002 to 2006, prenatal hepatitis B screening and vaccination practices improved at Chicago birthing hospitals The 2002 chart audits and feedback sessions may have contributed to the improvements CDPH will coordinate opportunities for hospitals to share successes and challenges in order to facilitate additional improvements

18. Chicago Department of Public Health Perinatal Hepatitis B Program West Side Center for Disease Control 2160 West Ogden Ave. Chicago, Illinois, 60612 312-746-5375 hoskins-saffold_pat@cdph.org