General Pediatrics, Cohen Children's Medical Center of, New York, New Hyde Park, New York;
Hofstra Northwell School of Medicine, Hempstead, New York; and.
Pediatrics. 2017 Mar;139(3). doi: 10.1542/peds.2016-0607. Epub 2017 Feb 8.
Infants are at greatest risk for severe disease and death from pertussis; most acquire it from household contacts. Centers for Disease Control and Prevention guidelines recommend tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap) vaccination for infant caregivers, especially postpartum women who did not receive it during pregnancy. Our objective was to increase the percentage of women receiving Tdap vaccine before postpartum discharge.
An interdisciplinary workgroup identified barriers to improvement of postpartum Tdap vaccination from which a 5-step intervention was created: (1) provide education on Tdap and pertussis; (2) offer Tdap throughout hospitalization; (3) create a Tdap standing order; (4) keep Tdap as floor stock; and (5) document administration. Pre- and postintervention data were collected from monthly chart reviews. Our main outcome measures were the proportion of postpartum women eligible for Tdap and the proportion of those eligible who received Tdap.
Preintervention baseline data (202 charts) described 166 postpartum women eligible to receive Tdap. Of the eligible women, 91 (55%) received the Tdap vaccine. During the 9-month postintervention period, 844 charts were reviewed (average, 93 per month; range, 82-104). Of the 632 women eligible to receive the Tdap vaccine, 462 (73% overall [range, 67%-79%]) received it. Thirty-three percent more postpartum mothers received the Tdap vaccine before discharge in the postintervention period ( < .01). The percentage of women eligible decreased from 82% to 75%.
This quality improvement initiative substantially increased Tdap immunization in the immediate postpartum period. Efforts to increase immunization during pregnancy for passive transfer of maternal antibodies remain preferable.
婴儿患百日咳的风险最高，且最容易从家庭接触者那里感染百日咳。美国疾病控制与预防中心的指南建议为婴儿看护人接种破伤风类毒素、白喉类毒素和无细胞百日咳疫苗（Tdap），尤其是那些在怀孕期间未接种过 Tdap 疫苗的产后女性。我们的目的是提高产后出院前 Tdap 疫苗接种率。
一个跨学科工作组确定了提高产后 Tdap 疫苗接种率的障碍，并由此创建了一个 5 步干预措施：（1）提供 Tdap 和百日咳相关知识教育；（2）在住院期间提供 Tdap 疫苗接种；（3）创建 Tdap 接种医嘱；（4）保持 Tdap 库存充足；（5）记录接种情况。在干预前后，每月从病历记录中收集数据。我们的主要结局指标是产后有资格接种 Tdap 的女性比例和有资格接种 Tdap 的女性中实际接种 Tdap 的比例。
在干预前的基线数据（202 份病历）中，有 166 名产后女性有资格接种 Tdap。在有资格接种的女性中，有 91 人（55%）接种了 Tdap 疫苗。在干预后的 9 个月期间，共审查了 844 份病历（平均每月 93 份，范围为 82-104 份）。在有资格接种 Tdap 疫苗的 632 名女性中，有 462 名（总体接种率为 73%[范围为 67%-79%]）接种了 Tdap 疫苗。干预后，在出院前接种 Tdap 疫苗的产妇增加了 33%（<0.01）。有资格接种 Tdap 的女性比例从 82%降至 75%。
这项质量改进计划显著提高了产后立即接种 Tdap 的比例。为了通过母体抗体的被动转移增加怀孕期间的免疫接种率，仍需做出努力。
