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Hepatitis B

PEDIATRICS Vol. 109 No. 2 February 2002, pp. e21

ELECTRONIC ARTICLE

Newborn Hepatitis B Vaccination Policy in Hospital Nurseries

Michael D. Cabana, MD, MPH, Kimberly D. Aiken, MD, PhD and Sarah J. Clark, MPH

From the Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Health System, Ann Arbor, Michigan

--> Objective. Hepatitis B vaccination (HBV) is unlike any other immunization series because it can be initiated in the hospital nursery. The objective of this study was to describe how hospital nurseries develop HBV policies and to describe the sources of information used for learning about national HBV recommendations.

Methods. A cross-sectional telephone survey was conducted on a national random sample of nursery medical directors of 290 hospital nurseries representing all 50 states. The outcomes measured were methods used by hospital nurseries to develop HBV policy and sources of information used by nursery directors to learn about national HBV recommendations.

Results. Directors at 207 (71%) of 290 eligible nurseries responded. Of the 184 nurseries that have considered developing an HBV policy, the most common method was through a formal committee (43%). In 104 (57%) of these nurseries a nurse was involved in policy development, and in 15 (8%) the nurse manager initiated the process. The most common source of initial information about the July 1999 announcement to suspend the nursery dose of HBV was the American Academy of Pediatrics. The most common initial source of information about the availability of thimerosal-free HBV was pharmaceutical companies. Physician, nurse, and pharmacist colleagues were cited as sources of information with similar frequency (12, 11, and 20 cases, respectively).

Conclusions. Physicians are not the sole initiators and developers of HBV policy in the newborn nursery. Although almost all nurseries designate a physician as a nursery director, in many cases (55% of cases) the position is "rotating" or as part of another administrative position (63% of cases). Many hospital nurseries involve nurses and pharmacists in key roles to stay current with HBV recommendations and to develop subsequent policy. Using nonphysician national organizations as additional channels of information might expedite dissemination about changes in HBV recommendations and, as a result, improve nursery awareness and adoption of national HBV guidelines.

Key Words: hepatitis B vaccination • physician practice patterns • nursery • hospital organization • practice guidelines

Abbreviations: HBV, hepatitis B vaccination • CDC, Centers for Disease Control and Prevention • AAP, American Academy of Pediatrics • NICU, neonatal intensive care unit • AAFP, American Academy of Family Physicians

Received for publication Aug 3, 2001; Accepted Sep 27, 2001.