Performance of US hospitals on recommended screening and immunization practices for pregnant and postpartum women

Objective: Recommendations by most national advisory committees on immuniza tion include evaluating all pregnant women for chronic hepatitis B virus in fection and immunity to rubella. It is recommended that all pregnant women be screened for hepatitis B surface antigen during an early prenatal visit and that rubella vaccine be administered in the postpartum period to women not known to be immune. This study determined the extent to which hospitals with labor and delivery services adhere to these recommendations. Methods: We conducted a mail survey of a stratified random sample of all US medical-surgical hospitals to (1) determine the proportion of hospitals wi th hepatitis B screening policies and rubella immunization programs and (2) identify significant factors associated with the presence of these policie s and programs. Hospitals were stratified by number of beds (<100, 100-499, and greater than or equal to 500) and affiliation with a medical school. Results: Of 986 institutions surveyed, 858 (87%) responded. Of these, 635 ( 74%) were labor and delivery hospitals. Approximately half of these (51%) h ad hospital policies related to screening pregnant women for the hepatitis B surface antigen. Twenty-one percent had rubella immunization programs for postpartum women. Only 14% of labor and delivery hospital!; were in full c ompliance with published recommendations for hepatitis B surface antigen sc reening and rubella postpartum vaccination. Hospitals wee more likely to be compliant if they had more than 100 beds, were private rather than public institutions, were affiliated with a medical school, and were in states wit h laws regarding hepatitis B surface antigen screening of pregnant women. Conclusions: Almost half, and more than three quarters, of hospitals were n ot in compliance with hepatitis B screening and rubella postpartum immuniza tion recommendations, respectively. Hospitals should develop and implement policies for these preventive services.