P3.D077: Improving Hepatitis B Vaccination Rates in Infants Born at <2 kg in a NICU: a Quality Improvement Project

Purpose/Objectives: The hepatitis B vaccine remains the most effective method to prevent new cases of hepatitis B infection in infants. The American Academy of Pediatrics (AAP) recommends that infants weighing < 2 kg at birth receive the hepatitis B vaccine at 1 month old or at time of discharge if leaving the hospital before 1 month old. The AAP also recommends infants born < 2 kg to a HepBsAg positive mother should receive the hepatitis B vaccine soon after birth and again at 1 month old. Our objective was to increase the rate of appropriate administration of the initial Hepatitis B vaccine to infants in the NICU born at < 2 kg with a goal of >80% compliance by December 31, 2023.

Design/Methods: An EHR query was conducted over a 6-month period to determine how many infants had received the hepatitis B vaccine in accordance with AAP recommendations. Inclusion criteria consisted of a birthweight < 2 kg, NICU admission when the vaccine was due, and either negative or positive maternal HepBsAg status. Patients whose parents declined the vaccine were also included in the analysis. At the start of the project, NICU physicians, advanced practice providers, and NICU nurses were asked to answer two case-based questions to measure a baseline knowledge of the hepatitis B vaccine guideline. Both in-person presentations and educational flyers were used to re-educate healthcare personnel on the hepatitis B vaccine. In addition, a birthweight specific hepatitis B vaccine order was added to NICU admission order set, along with reminders in Daily Progress Note plans. Vaccine reference cards were distributed to health care personnel to also reinforce the guideline. Temperature instability was used as a balancing measure to ensure the vaccine was not causing harm.

Results: The pre-intervention data showed the median percentage of patients vaccinated according to AAP recommendations in the NICU was 48%. We received a total of 169 responses on the knowledge assessment and scores were below the expected goal across all NICU disciplines (Figure 1). Following re-education of current vaccine guidelines and other interventions carried out in the last 2 PDSA cycles the number of appropriately vaccinated infants increased to 70% on average (Figure 2).

Conclusion/Discussion: Based on post-intervention data, our interventions have improved adherence to the vaccination guideline. Efforts are ongoing and future areas of study include improving the vaccine consent process as this was found to be a barrier to timely administration of the initial hepatitis B vaccine.