Bath S K, Singleton J A, Strikas R A, Stevenson J M, McDonald L L, Williams W W
Centers for Disease Control and Prevention, National Immunization Program, Epidemiology and Surveillance Division, Adult Vaccine Preventable Diseases Branch, Atlanta, GA 30333, USA.
Am J Infect Control. 2000 Oct;28(5):327-32. doi: 10.1067/mic.2000.109886.
Recommendations by most national advisory committees on immunization include evaluating all pregnant women for chronic hepatitis B virus infection and immunity to rubella. It is recommended that all pregnant women be screened for hepatitis B surface antigen during an early prenatal visit and that rubella vaccine be administered in the postpartum period to women not known to be immune. This study determined the extent to which hospitals with labor and delivery services adhere to these recommendations.
We conducted a mail survey of a stratified random sample of all US medical-surgical hospitals to (1) determine the proportion of hospitals with hepatitis B screening policies and rubella immunization programs and (2) identify significant factors associated with the presence of these policies and programs. Hospitals were stratified by number of beds (<100, 100-499, and > or =500) and affiliation with a medical school.
Of 986 institutions surveyed, 858 (87%) responded. Of these, 635 (74%) were labor and delivery hospitals. Approximately half of these (51%) had hospital policies related to screening pregnant women for the hepatitis B surface antigen. Twenty-one percent had rubella immunization programs for postpartum women. Only 14% of labor and delivery hospitals were in full compliance with published recommendations for hepatitis B surface antigen screening and rubella postpartum vaccination. Hospitals were more likely to be compliant if they had more than 100 beds, were private rather than public institutions, were affiliated with a medical school, and were in states with laws regarding hepatitis B surface antigen screening of pregnant women.
Almost half, and more than three quarters, of hospitals were not in compliance with hepatitis B screening and rubella postpartum immunization recommendations, respectively. Hospitals should develop and implement policies for these preventive services.
大多数国家免疫咨询委员会的建议包括评估所有孕妇是否感染慢性乙型肝炎病毒以及对风疹是否具有免疫力。建议在孕早期产检时对所有孕妇进行乙型肝炎表面抗原筛查，并在产后为已知无免疫力的妇女接种风疹疫苗。本研究确定了提供分娩服务的医院遵循这些建议的程度。
我们对美国所有内科-外科医院的分层随机样本进行了邮件调查，以（1）确定制定了乙型肝炎筛查政策和风疹免疫计划的医院比例，以及（2）识别与这些政策和计划的存在相关的显著因素。医院按床位数（<100张、100 - 499张以及≥500张）和是否隶属于医学院进行分层。
在986家接受调查的机构中，858家（87%）做出了回应。其中，635家（74%）是分娩医院。这些医院中约一半（51%）制定了与筛查孕妇乙型肝炎表面抗原相关的医院政策。21%的医院为产后妇女制定了风疹免疫计划。只有14%的分娩医院完全遵循了关于乙型肝炎表面抗原筛查和产后风疹疫苗接种的已发布建议。床位超过100张、是私立而非公立机构、隶属于医学院以及所在州有关于孕妇乙型肝炎表面抗原筛查法律的医院更有可能遵循这些建议。
分别有近一半和超过四分之三的医院未遵循乙型肝炎筛查和产后风疹免疫的建议。医院应制定并实施这些预防服务的政策。
