Introduction of the new Centers for Disease Control and Prevention group Bstreptococcal prevention guideline at a large West Coast health maintenance organization

OBJECTIVE: Our purpose was to assess the impact of new consensus guidelines issued by the Centers for Disease Control and Prevention, The American Col lege of Obstetricians and Gynecologists, and the American Academy of Pediat rics to prevent perinatal group B streptococcal disease. STUDY DESIGN: We performed a descriptive analysis and a before-and-after an alysis of implementation of the group B streptococcal disease prevention gu idelines among singleton-birth pregnancies in 2 Group Health Cooperative ho spitals from October 1, 1995, through December 31, 1997. We studied the spe ed and completeness of implementation and the effect on pregnancy care prac tices including intrapartum antibiotic use, test ordering, and maternal and neonatal health. RESULTS: Guideline implementation occurred rapidly. The proportion of term pregnancies screened according to the guideline increased markedly, and ove rall intrapartum antibiotic use more than doubled. Among group B streptococ ci-positive women, intrapartum antibiotic prophylaxis increased from 24% be fore to 74% after guideline implementation. Median duration of treatment be fore delivery increased from 1.8 to 4.3 hours. The rate of rash did not inc rease, and there were no cases of anaphylaxis or pseudomembranous colitis. The proportion of infants undergoing evaluation decreased after implementat ion of the neonatal guidelines; among infants of group B streptococci-negat ive women, test ordering dropped by almost 40%. CONCLUSIONS: Implementation of the new guidelines is feasible and can be ac complished rapidly. The guidelines were associated with increased maternal intrapartum antibiotic use, particularly among women at highest risk, and w ith a decrease in laboratory use for infants.