Tdap immunization in pregnancy: provider compliance with CDC guidelines

Aurora Affiliations

Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, Center for Urban Population Health

Presentation Notes

Presented at 2014 Aurora Scientific Day, Milwaukee, WI


Background: Pertussis, also known as whooping cough, is a highly contagious, acute respiratory illness. In children and infants, morbidity is more often substantial and the disease may be fatal. There has been a steady increase in reported cases in the United States (27,550 in 2010 vs. 41,000 in 2012). Mothers were responsible for 30-40% of infant infections when the source of pertussis was identified. In October 2012, the Centers for Disease Control and Prevention (CDC) and Advisory Committee for Immunization (ACIP) recommended that caregivers provide a Tdap immunization for all pregnant women for each pregnancy, irrespective of the patient’s prior history of receiving Tdap.

Purpose: Evaluate provider compliance with Tdap immunization guidelines at four different time periods: prior to change in CDC guidelines, immediately after change, 5 months after change/educational intervention, and 1 year after change.

Methods: Records review of 400 random charts, 100 in each of the above categories from 2012 to 2013. Excluded were patients without an appointment during the 27-36 gestational weeks. Educational lecture and survey was provided to all staff of the Women’s Health Center regarding Tdap immunization changes. Compliance rate was calculated for each time period. Two-sample t-test was used to compare compliance rates, and chi-square test with Yates correction for 2 × 2 tables.

Results: Compliance rate was 62% prior to change, 39% immediately after change, 50% at 5 months after change/ intervention, and 72% at 1 year after change. Odds ratios for the three time periods were: 1.00, 1.62 and 4.14, respectively (P=0.00000). The vaccine was received appropriately in the immediate postpartum period in 32% prior to change, 43% immediately after change, 44% at 5 months after change/intervention, and 13% at 1 year after change. Resident physicians answered 63% correct and faculty physicians answered 67% correct regarding frequency and timing of Tdap vaccination survey questions; however, the residents were more compliant (60% vs. 52%) in actual clinical practice.

Conclusion: Educational intervention and time had a statistically significant impact in improving compliance rate. Appropriate vaccination during the postpartum period and adequate documentation are areas of improvement.

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