Background: In 1991, the United States adopted a strategy for universal Hep-B vaccination of infants in an effort to decrease perinatal transmission and lower incidence of Hep-B in the U.S. In 2016, CDC's Advisory Committee on Immunization Practices (ACIP) and AAP updated their recommendation for the birth dose of Hep-B vaccine to be administered within 24 hours of birth of an eligible infant. This 1st dose of Hep-B vaccine is a critical safety net to protect infants born to Hep-B infected mothers not identified at the time of birth. It alone is 70-95% effective in preventing perinatal Hep-B infection born to carrier mothers. Baseline data from our NICU revealed that only 35% of the vaccine eligible infants were receiving this essential dose of the vaccine in a timely manner.
Objective: Our primary objective was to increase the rate of birth dose Hep-B vaccination to 85% in infants with birth weight >2 kgs in a 12-month period starting Jan 2020. This target corresponds to the Healthy People 2020 (a CDC initiative) target of 85% for Hep-B vaccine coverage by 2020.
Design & Methods: The baseline data was first analyzed from Jan-March 2020 and PDSA cycles were implemented subsequently. The first PDSA cycle aimed at assessing awareness and educating the NICU staff including nurses, nurse practitioners, residents, fellows and attending physicians via a survey-based questionnaire. Subsequent PDSA cycles included placing Hep-B vaccination information flyers in resident and nurses break rooms, monthly email blast with reminders to the in-coming service team. Vaccine information sheets (VIS) were placed in the Labor rooms after the initial PDSA cycle. VIS was also included in our transport-packets along with other consents so that infants who were getting transferred from other hospitals also received the vaccine within 24 hours.
Results: Evaluation of the data since the QI project was implemented has shown improvement in vaccination rate up to 65%. The major delays in vaccine occurred because parents did not receive VIS in time. Late placement of vaccine order and late administration by nursing team despite timely orders were also identified as causes for delay. The most effective intervention included the introduction of VIS to the parents as soon as they arrived in the labor and delivery department.
Conclusion: We increased the vaccination rate from 35% to 65% for the 1st dose of Hep-B vaccine in our NICU. We used the PDSA model of improvement to identify key barriers that delayed the birth dose Hep-B vaccine and worked on the barriers. Periodic staff education and retraining, monthly reminders and placing VIS sheets in the labor rooms proved helpful in achieving this increment. We plan to continue using the PDSA cycles to improve the compliance rate further to 85% in the next few months.
