BACKGROUND: In 2016, the incidence of acute hepatitis C virus infection was 1.0 per 100,000 persons in the United States and 6.2 per 100,000 persons in Massachusetts. Hepatitis C virus infection among pregnant women in the United States increased by 89% from 2009 to 2014. The risk of a mother with hepatitis C virus infection transmitting the infection to her infant is approximately 4% to 7%. The Infectious Disease Society of America and the American Association for the Study of Liver Diseases recommend universal hepatitis C virus screening in pregnancy, whereas the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend risk-based screening. OBJECTIVE: The objective of this quality improvement project was to assess the hepatitis C virus screening practices of obstetricians and gynecologists at a tertiary care center located in a high endemic area for hepatitis C virus infection. STUDY DESIGN: An electronic 10-question survey was reviewed by the Tufts Medical Center Institutional Review Board and found to be exempt from institutional review board approval. The survey was emailed to resident and attending physicians who provide obstetrical care. RESULTS: Of a total of 41 respondents, 38 (92.6%) provided responses; of these 38 respondents, 17 (44.7%) were attending physicians, 4 (10.5%) were fellows, and 17 (44.7%) were resident physicians. In addition, 16 of 37 (43.2%) respondents answered that all pregnant women should be screened for hepatitis C virus, whereas 20 of 37 (54.1%) respondents thought only pregnant women with risk factors for hepatitis C virus infection should be screened. Furthermore, only 13 of 31 (41.9%) respondents correctly identified all of the recommended risk factors that should prompt screening for hepatitis C virus. When asked about their clinical practice, 5 of 36 (13.9%) respondents indicated that they screen all pregnant patients, whereas 28 of 36 (77.8%) respondents indicated that they screen patients based on their risk factors for hepatitis C virus infection. CONCLUSION: Our survey showed that risk-based screening for hepatitis C virus may be less effective than universal screening because healthcare providers are not consistent in identifying risk factors for hepatitis C virus infection. Universal screening could decrease the amount of hepatitis C virus infections that go undiagnosed in pregnancy.

Concerns persist regarding possible false negative results that may compromise COVID-19 containment. While obtaining a true false negative rate is infeasible, using real world observation these data suggest a possible false negative rate to be approximately 2.3%. Use of a sensitive, amplified RNA platform should reassure healthcare systems.

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Background With appropriate turnaround time (TAT), cerebrospinal fluid (CSF) Gram stains can provide rapid, clinically actionable information in patients with meningitis. Monitoring CSF Gram stain TAT at our institution revealed workflow gaps that were causing result reporting delays. We then implemented a new quality management program to improve TAT. Methods We reviewed the TAT of all CSF specimens submitted for bacterial culture received between August 1, 2016, and July 31, 2020, and began prospectively monitoring CSF Gram stain TAT in January 2019. We then implemented the following changes in April 2019: (i) monthly reviews of TAT with staff, (ii) hand-off sheets for shift transitions, and (iii) pre- and post-shift walk throughs including centrifuge checks. Results A total of 6913 samples were included in the analysis. CSF samples with TAT > 60 min decreased from 27.3% to 9.89% (P < 0.0001), and median TAT decreased by 9 min (P < 0.0001) with significantly reduced variability. These changes were sustained throughout the follow-up period across all shifts and shift transitions. Conclusions A new monthly quality metric allowed us to track CSF Gram stain TAT, identify barriers to TAT goals, and implement workflow changes that significantly improved TAT without the need for costly interventions.

INTRODUCTION: Hepatitis C Virus (HCV) infection among pregnant women in the US increased 89% from 2009 to 2014. The risk of a HCV infected mother transmitting the infection to her infant is approximately 4-7% per pregnancy. Infectious Disease Society of America (IDSA) and American Association for the Study of Liver Diseases (AASLD) recommend universal HCV screening in pregnancy whereas the American College of Obstetricians and Gynecologists (ACOG) recommends risk-based screening. The objective of this study was to assess the opinions and clinical practice of OBGYN providers in a tertiary care center. METHODS: An electronic 10 question survey was approved by the Tufts Medical Center Institutional Review Board and emailed to providers. RESULTS: 38/41 (92.6%) provided responses and 17/38 (44.7%) were attendings, 4/38 (10.5%) were fellows, and 17/38 (44.7%) were residents. 16/37 (43.2%) of respondents agreed all pregnant women should be screened for HCV whereas 20/37 (54.1%) agreed that only pregnant women with risk factors for HCV should be screened. When asked about their clinical practice, 3/36 (8.3%) of respondents stated they do not screen pregnant patients for HCV, 5/36 (13.9%) screen all pregnant patients, and 28/36 (77.8%) screen patients based on their risk factors for HCV. CONCLUSION: Divergent guidelines, provider opinions, and clinical practice necessitate further research into universal HCV screening in pregnant patients. Future plans include an educational intervention on HCV for providers in the department followed by a chart review to determine the HCV detection rate before and after a change in practice to universal screening for HCV.