California Birth Hospital Policies to Prevent Perinatal Hepatitis B Transmission

Background:  To reduce the number of infants who become perinatally infected with hepatitis B, the Advisory Committee on Immunization Practices (ACIP) recommends that hospitals implement a number of measures at the time women are admitted for delivery and for infants after delivery.  ACIP also recommends that hospitals have written policies and procedures, including standing orders, to ensure that these recommendations are implemented.

Objectives:  Determine if California hospital policies reflect ACIP recommendations for perinatal hepatitis B prevention.

Methods:  Infection Preventionists or Labor/Delivery Managers in 247 California hospitals with >50 births in 2010 were surveyed in 2011.   

Results:  168 (68%) hospitals responded to the survey. 160 (95%) have policies to review the HBsAg status of women admitted for delivery; 96 (57%) verify HBsAg status with a copy of the laboratory report. For women whose HBsAg status is unknown at admission, 144 (86%) have policies to order HBsAg testing. 157 (93%) have policies to administer hepatitis B vaccine and HBIG to infants of HBsAg-positive mothers <12 hours of birth. For mothers with unknown HBsAg status, 153 (91%) have policies to administer hepatitis B vaccine to all infants <12 hours of birth and 105 (63%) also have policies to administer HBIG to infants <2000 grams <12 hours of birth.  133 (79%) have policies to offer hepatitis B vaccine to all infants weighing >2,000 grams before discharge; the most commonly cited barrier (60%) to administering hepatitis B vaccine to infants of HBsAg negative mothers prior to discharge was that pediatricians prefer to give the vaccine in their office.

Conclusions:  Almost all California birth hospitals had policies that reflected at least some of the ACIP recommendations. However, the policies of some hospitals were suboptimal. These results will be used to identify hospitals for targeted education efforts.