Did Hospital Quality Assurance Reviews Have An Impact on Increasing the Hepatitis B Vaccination Coverage Rate for Infants Born In Los Angeles County (LAC)?

Background:  Hepatitis B virus (HBV) infects the liver and may cause chronic hepatitis, leading to liver cancer, the 3rd leading cause of cancer deaths in the world. Ninety percent of infants infected with HBV at birth become chronically infected, compared to adults whose risk of becoming chronically infected following acute infection is only 5%. The 2006 National Immunization Survey demonstrated LAC’s hepatitis B universal vaccination rate (HBUVR) for 2003-2005 was 33.7% compared to the national average of 50.1%. Since 2008, the Perinatal Hepatitis B Prevention Unit (PHBPU) has been conducting hospital quality assurance reviews (HQAR) to increase awareness of the Advisory Committee on Immunization Practices (ACIP) recommendations and the California Health and Safety Codes (CHSC) to prevent perinatal hepatitis B (PHB).

Setting:  The maternal/child health units in nine LAC hospitals.

Population:  Thirty-six maternal/child nurses and 3218 randomly selected mother and infant medical records.

Project Description:  HQAR activities included an assessment of the hospitals’ PHB prevention (PHBP) policies and procedures, review of maternal and infant medical records to identify the hospital’s compliance with the ACIP’s recommendations and the CHSCs to prevent PHB, and a survey of nursing staff to identify barriers to infants being universally immunized. In an effort to improve the HBUVR, hospitals received PHBP literature and consultations 3 months prior to each HQAR and invited to attend a PHBP continuing medical education event. Hospital administrators received immediate feedback and recommendations for improvement following each HQAR.

Results/Lessons Learned:  Annual follow-up demonstrated the HBUVR for 5 hospitals increased by as much as 81%, and 1 remained at 96%. Poor implementation of the recommendations may have caused 3 hospital’s HBUVR to decrease. Annual HQARs will continue to reinforce PHBP strategies until the HBUVR is at 90%. This sample suggests LAC’s HBUVR is 83% and QARs are necessary to consistently bring PHBP awareness to the hospitals.