P3B341: Hepatitis B Vaccine Guideline Knowledge and Adherence in a NICU for Infants Born at Less Than 2 Kg: Is There Room for Improvement?

Purpose/Objectives: The hepatitis B vaccine remains the most effective method to prevent new cases of hepatitis B infection in infants. The American Academy of Pediatrics (AAP) recommends that infants weighing < 2 kg at birth receive the hepatitis B vaccine at 1 month of life or at time of discharge if leaving the hospital before 1 month of age. The AAP also recommends that infants born < 2 kg to a HepBsAg positive mother should receive the hepatitis B vaccine soon after birth and again at 1 month of age. We sought to evaluate the knowledge of NICU staff and adherence to the AAP hepatitis B vaccine recommendations.

Design/Methods: Using an online survey tool, NICU physicians, NPs, and RNs were asked to answer two case-based questions related to the hepatitis B vaccine recommendations for infants weighing < 2 kg at birth. Additionally, we performed an EHR query over a 6 month period to determine how many infants had received the hepatitis B vaccine in accordance with AAP recommendations prior to their discharge. Patients included in the query were those with a birthweight < 2 kg, admitted to our NICU when the vaccine was due, and either negative or positive maternal HepBsAg status. Patients whose parents declined the hepatitis B vaccine were also included in the analysis. A run chart was constructed with the 6 months of query results to assess vaccine adherence.

Results: Scores on the knowledge assessment were below the expected goal across all NICU disciplines (see Figure 1). The median percentage of patients vaccinated according to AAP recommendations in the NICU was 48% as displayed on the run chart (see Figure 2).

Conclusion/Discussion: The knowledge assessment revealed a deficit among all NICU staff and was below the goal score of 100%. Adherence to AAP recommendations for the hepatitis B vaccination of infants with birthweight < 2 kg discharged from the NICU was well below our goal of >80% each month. Based on the results of both the knowledge and vaccine adherence assessments, a NICU-wide educational project was developed as part of an initial quality improvement (QI) effort with the aim of improving the above deficiencies. This may be an important area of study and target for QI in other NICUs.