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BACKGROUND: New Jersey (NJ) ranks 49th among all states for hepatitis B birth dose vaccination rates (NJ: 52.6%; nationwide: 71.6%), according to the 2012 National Immunization Survey. To raise awareness among healthcare providers and increase rates, the NJ Department of Health (NJDOH) collaborated with the Partnership for Maternal and Child Health of Northern NJ (Partnership) to design and implement a hospital leadership intervention in selected NJ birthing hospitals.
METHODS: Northern NJ birthing hospitals were prioritized by using electronic birth certificate data, review of existing hepatitis B policies, catchment area demographics and accessibility to hospital leadership. NJDOH trained Partnership staff and provided support through monthly in-person meetings and calls. All prioritized hospitals received a leadership outreach meeting; selected hospitals received a medical chart audit or a pediatrician or nurse presentation. Leadership meetings were attended by directors and managers from birth-related units and by staff nurses, obstetricians, pediatricians, and infection preventionists. Presentations included a review of the disease and horizontal transmission, NJDOH goals and objectives, audit findings, and hospital-specific hepatitis B vaccination rates and policies.
RESULTS: Twelve of 24 northern hospitals with the lowest vaccination rates and hospitals lacking policies were prioritized and received a leadership meeting. One facility participated in a leadership meeting; 7 participated in 2 pilot activities; 4 received audits and leadership meetings; 3 participated in audits and in-service sessions; and 1 received all 4 interventions. Of the 12 leadership meetings conducted, 4 hospitals have committed to changing their policy to include birth dose before hospital discharge. Despite variability in patient demographics and hospital location, recurrent themes emerged: pediatrician vaccination administration in private office, off-record discussions insinuating financial incentives, concerns regarding extra dose because of combination vaccines, parental hesitancy, cancelled standing orders, standing orders outside nursing scope of practice (multiple brands/dosages), nursing approach to pediatrician, and nursing approach to parents.
CONCLUSIONS: Lack of awareness was identified as a key factor among hospital leadership regarding their institution’s birth dose rates. Birth dose policies were not comprehensive, and hospital staff and management were often unaware of policies. The hospitals receiving interventions expressed a strong commitment to increase birth dose striving for universal dosage. Monitoring and evaluation of hospital data, policies, and procedures, as well as educating nurses and pediatricians on the public health benefits of administering a dose before hospital discharge might increase birth dose rates. The NJDOH and Partnership project led to increased awareness and action among targeted birthing hospitals.