Improving Birth Dose Hepatitis B Vaccination Rates: A Quality Improvement Intervention

Abstract

BACKGROUND: There are 43 000 new cases of hepatitis B virus infection and 1000 cases of perinatally acquired infection each year in the United States. National recommendations are to administer hepatitis B (HepB) vaccine to all stable newborns .2000 g within 24 hours of birth. Our primary objective was to increase institutional vaccination rates from a baseline of 52% to goal .85% before hospital discharge. METHODS:In February 2017, we instituted a multidisciplinary quality improvement project aimed at increasing HepB vaccination birth dose rates. Interventions included (1) standardizing the process of offering HepB vaccine via scripting and timing, (2) engaging and educating parents, and (3) educating physicians and nurses regarding the importance of HepB vaccination and strategies to discuss HepB vaccination with vaccine-hesitant parents. The main outcome measure was the percentage of newborns receiving HepB vaccination by discharge. The secondary outcome was the percentage of newborns receiving HepB vaccination by 12 hours of life per New York State Department of Health recommendation. Data were analyzed by using statistical process control P-charts.RESULTS: A total of 21 108 newborns were included between July 2015 and April 2019. In addition to several upward centerline shifts, implementation of interventions resulted in increased and sustained HepB vaccination rates by hospital discharge from a baseline of 52.4% to 72.5%. Rates by 12 hours of life increased from 21.5% to 42.5%. CONCLUSIONS:Multidisciplinary collaboration, scripting, and provider and staff education regarding the risks of hepatitis B virus, benefits of HepB vaccine, and strategies to discuss HepB vaccination with parents significantly increased vaccination rates. Further efforts to improve vaccination rates to within 12 hours are preferable.

Hepatitis B Vaccination of Low Birth Weight Infants in Washington State

“…Given these data, strategies to increase administration during hospitalization are needed. Recent quality improvement studies using approaches such as standardization of HepB vaccination processes and greater education of parents, nurses, and providers, markedly improved HepB vaccination of healthy newborns ≥2,000 g before hospital discharge 32 33 ; similar interventions could be considered for these high-risk infants under 2,000 g.…”

Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people: a scoping review

“…Pharmacy involvement was frequently identified as essential to ensuring that vaccines were consistently available and dispensed quickly, with pharmacy staff involved in the leadership and delivery of several interventions 41 54 57 61 67. Gattis et al described a pharmacy-led intervention for influenza vaccination of solid organ transplant recipients whereby pharmacists were responsible for screening patients, assessing appropriateness, recommending vaccination to providers, educating patients/family and verifying and dispensing vaccines 55.…”

Pregnancy and Hepatitis B Immunization: A Commentary on Maternal Knowledge and Vertical Transmission Risks

“…Vaccination rates by 12 hours of life increased from 21.5% to 42.5%, and vaccination rates by hospital discharge increased from 52.4% to 72.5% [44].…”