Changing in-hospital ordering procedures for postpartum Tdap vaccination considerably increased vaccination rates in birth mothers, investigators reported in the March issue of the American Journal of Obstetrics & Gynecology.
Tdap vaccinations protect against tetanus, diphtheria, and pertussis (whooping cough), the latter of which has increased in recent years and causes significant morbidity for adults and children and mortality in infants.
ACIP recommended postpartum Tdap vaccination in birth mothers in 2006 and then updated their recommendations in 2011 to administer the Tdap during pregnant women’s second or third trimester each pregnancy. Yet a 2012 survey showed update of the Tdap during pregnancy as low as 2.6%, and postpartum vaccination remaining limited.
Dr. Sylvia Yeh of the University of California, Los Angeles, and her colleagues reported on an intervention at a Los Angeles private community hospital with a 0% baseline rate of postpartum Tdap vaccination (Am. J. Obstet. Gynecol. 2014;210:237.e1-6).
For completed deliveries between October 2009 and July 2010, the researchers reviewed 658 charts for birth mothers at that hospital and compared them with 606 women’s charts at a hospital with no procedure changes. The comparison hospital, also with a 0% baseline vaccination rate, was located 18 miles from the intervention hospital and served a relatively similar demographic population.
Implementing physician opt-in orders for postpartum Tdap vaccination at the intervention hospital in November 2009 led to an increase in the vaccination rate to 18.8% (P less than .001). The hospital then implemented standing orders in February 2010, allowing nurses to deliver the vaccines without an additional physician order. The postpartum Tdap vaccination rate then climbed again to 62.7% (P less than .001). The comparison hospital’s rate for postpartum Tdap vaccination remained at 0% throughout the same period.
The researchers identified no differences in demographic characteristics among the women who received in-hospital postpartum Tdap vaccination and those who did not.
The study was funded by the Centers for Disease Control and Prevention. No disclosures were reported.