HOSPITALS RESPONSES TO UNIVERSAL INFANT HEPATITIS-B VACCINATION RECOMMENDATIONS

Objective. To assess the extent to which hospitals in a midwestern sta te with low acute hepatitis B virus (HBV) morbidity offered hepatitis B (Hep B) vaccine to all infants, whether offering infants Hep B vacci ne was associated with hospital geographic location or size, as measur ed by the number of births, and how hospital staff resolved key progra mmatic issues. Methods. The managers of hospital newborn nurseries (N = 110) were surveyed by mail. The written response rate was 72%; all o f the nonresponders were interviewed by telephone. The outcome measure d was the number of hospitals offering Hep B vaccine to all infants by geographic region and hospital size. Results. Sixty-five percent of t he hospitals routinely offered Hep B vaccine to all infants; these hos pitals accounted far 80% of reported Wisconsin births. In univariate a nalysis, the decision to offer infants Hep B vaccine was associated wi th both hospital size and hospital location. After controlling for siz e, hospitals in the northeastern region were eight times more likely ( relative risk, 8.21; 95% confidence interval, 1.30, 51.79) to offer in fants Hep B vaccine than hospitals in the southeastern (referent) regi on. Regional differences in reported rates of acute HBV infection do n ot explain this finding, because morbidity in the northeastern region (1 per 100 000) is among the lowest in Wisconsin. Although more than 8 0% of hospitals with Hep B vaccination programs required written infor med consent for vaccination, had standing orders for administering Hep B vaccine to infants whose mothers' hepatitis B surface antigen (HBsA g) test results were known, and had mechanisms to notify the infants' physicians that the infants had been vaccinated, only 38% had standing orders for testing mothers whose HBsAg test results were unknown. Con clusions. Hospitals are not necessarily deterred from implementing inf ant Hep B vaccination programs by low community HBV morbidity. Hospita ls should develop policies to assure that parturient women with unknow n HBsAg status are screened and their infants are appropriately treate d.