Best Practices for Implementing Hospital Hepatitis B Vaccine Birth Dose Programs

Background:  The New York State (NYS) Hepatitis B Hospital Birth Dose Initiative, established in October 2003, provides hepatitis B vaccine to hospitals adopting a universal hepatitis B birth dose policy.  While some hospitals meet or exceed the Healthy People 2010 goal of 90%, more than 70% of hospitals still remain below this goal. According to data provided by NYSIIS, the average percent of infants vaccinated in NYS (exclusive of New York City) for 2009 was 75.4%. 

Objectives: 

1. Identify best practices for birth dose administration to improve the percentage of infants vaccinated within 12 hours of birth.
2. Share best practice recommendations with other birthing facilities.

Methods:  In 2010, out of 98 birthing hospitals, 28 achieved universal birth dose rates of ≥90%.  Maternity managers at these hospitals were interviewed to identify common practices that may have led to high coverage rates. There was 100% completion of the interview surveys.

Results:  The maternity manager interview survey identified the following:

• 84.7% provide a prenatal/childbirth class with information on the hepatitis B birth dose.
• 100% provide the VIS and have the consent form signed prior to leaving the delivery room.  85.7% have the VIS given and consent obtained prior to delivery.
• 93% administer the birth dose either in the delivery room or during the initial newborn assessment in conjunction with the administration of vitamin K and erythromycin.

Conclusions:  The results of the survey suggest the flowing recommendations for improving the birth dose rate:

• Parental education regarding the benefits of the birth dose should be provided early in prenatal/childbirth classes.
• The VIS should be presented and consent to vaccinate obtained from the mother prior to entering the delivery room.
• The hepatitis B birth dose should be administered either in the delivery room or as soon as possible during admission to the newborn nursery.