A large urban university medical center used a unique set of strategies in preparation for its triennial survey conducted by the Joint Commission on Accreditation of Healthcare Organizations. Although the medical center had experienced many Joint Commission surveys, this particular survey was the first to include associated physician offices in multiple diverse settings. To address these challenges, the hospital developed a structure and process that engaged all levels of staff and ensured a successful survey outcome.

Antenatal vaccination is usually delivered in primary care, yet a recent survey highlighted that many UK GPs are not confident discussing vaccination with pregnant women, and would value concise guidelines. 1 HOW DOES ANTENATAL VACCINATION WORK? Antenatal vaccination boosts maternal antibody levels and therefore the amount of antibody transferred to the fetus. RATIONALE AND EFFECTIVENESS OF ANTENATAL VACCINATION Pertussis (whooping cough) Recommendation: between 16-32 weeks of gestation. The UK antenatal pertussis vaccination programme was introduced following the 2012 pertussis outbreak, when >9000 individuals were infected and 14 infants died. 2 Although numbers of cases have since reduced, rates of pertussis remain significantly higher than prior to 2012. A similar trend has been observed globally, and at least 14 countries have implemented similar recommendations. 2 Pertussis disproportionately affects young infants, who have the highest rates of disease, and are at highest risk of severe disease and death. Most cases occur in early childhood before completion of primary immunisation, and therefore antenatal vaccination provides effective protection during this 'windowperiod' of vulnerability. Pertussis vaccination is <90% effective at protecting infants up to 2 months of age, and is 95% effective at preventing infant death from pertussis. 2 The only deaths among infants born to vaccinated women have been in cases where the mother was vaccinated <10 days before delivery (leaving insufficient time for effective antibody transfer). Pertussis is currently only available as a combination vaccine (Boostrix ®-IPV [GlaxoSmithKline UK] in the UK) that also protects against tetanus, diphtheria, and polio, which are safe to be given in pregnancy. 3