Objective
Pertussis causes significant morbidity among adults, children, and especially infants.
Since 2006, pertussis vaccination has been recommended for women after delivery. We
conducted a prospective, controlled evaluation of in-hospital postpartum pertussis
vaccination of birth mothers from October 2009 through July 2010 to evaluate the effectiveness
of hospital-based procedures in increasing postpartum vaccination.
Study Design
The intervention and comparison hospitals are private community facilities, each with
2000-6000 births/year. At the intervention hospital, physician opt-in orders for tetanus
toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) before discharge
were implemented in November 2009, followed by standing orders in February 2010. The
comparison hospital maintained standard practice. Randomly selected hospital charts
of women after delivery were reviewed for receipt of Tdap and demographic data. We evaluated
postpartum Tdap vaccination rates and conducted multivariate analyses to evaluate
characteristics that are associated with vaccination. We reviewed 1264 charts (658
intervention hospital; 606 comparison hospital) from women with completed deliveries.
Results
Tdap postpartum vaccination was 0% at both hospitals at baseline. In the intervention
hospital, the introduction of the opt-in order was followed by an increase in postpartum
vaccination to 18%. The introduction of the standing order approach was followed by
a further increase to 69% (P < .0001). No postpartum Tdap vaccinations were documented in the comparison hospital.
Postpartum Tdap vaccination in the intervention hospital did not differ by demographic
characteristics.
Conclusion
In-hospital ordering procedures substantially increased Tdap vaccination coverage
in women after delivery. Opt-in orders increased coverage that increased substantially
with standing orders.
Key words
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Article Info
Publication History
Published online: October 04, 2013
Accepted:
September 27,
2013
Received in revised form:
August 28,
2013
Received:
June 1,
2013
Footnotes
Supported by the Centers for Disease Control and Prevention , grant number 5U01-IP000192 .
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers of Disease Control and Prevention.
Cite this article as: Yeh S, Mink C, Kim M, et al. Effectiveness of hospital-based postpartum procedures on pertussis vaccination among postpartum women. Am J Obstet Gynecol 2014;210:237.e1-6.
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© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
