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Written Policy for Prevention of Perinatal Hepatitis B: Example
Updated Aug. 25, 1999
HEPATITIS B SURFACE ANTIGEN (HBsAg) SCREENING OF PREGNANT WOMEN
If the mother has not been screened or test results are not available (e.g.,: prenatal record) at the time of admission for labor/delivery, or as soon as possible thereafter, HBsAg testing is to be initiated during hospitalization after checking with physician.
In the event the mother is positive, follow-up will be initiated on the infant as soon as possible following delivery by the attending physician.
If the results of HBsAg screen on sera obtained during labor and delivery are not reported until after the patient's discharge from the hospital, follow-up is provided as appropriate by the attending or family physician.
HOSPITAL PRACTICE GUIDELINES FOR PREVENTION OF PERINATAL HBV INFECTION
The following "Hospital Practice Guidelines" can be adapted for use by any hospital in the development of their written perinatal hepatitis B prevention policies. They were developed by two members of the Hepatitis B Coalition Advisory Board.
Labor and Delivery Unit Guidelines: by Virginia R. Lupo, MD, Director, Maternal-Fetal Medicine, Hennepin County Medical Center, Minneapolis, MN.
- Document maternal HBsAg results on the labor and delivery record and document on infant's delivery summary sheet.
- If HBsAg result is not on the maternal prenatal chart, order ASAP. Lab to call result back as soon as available.
- Notify the nursery if mother is HBsAg-positive or if mother's HBsAg is unknown and test result is pending.
- For HBsAg-positive women, if possible prior to birth, obtain consent to administer hepatitis B vaccine and hepatitis B immune globulin to newborn.
Nursery Clinical Guidelines: by Robert M. Jacobson, MD, Community Pediatrics, Mayo Clinic, Rochester, MN.
- For infants born to mothers who are known to be HBsAg-positive at birth, after consent is obtained, administer hepatitis B immune globulin (0.5ml IM) and hepatitis B vaccine (Engerix-B 10 mcg IM or Recombivax-HB 5 mcg IM) in different sites as soon as the baby is stabilized and bathed, no later than 12 hours after birth. Wash the sites well with soap and water prior to administration, then clean the sites with alcohol.
- For infants born to mothers whose HBsAg is unknown, notify the physician emergently for additional orders. After consent is obtained, administer hepatitis B vaccine (Engerix-B 10 mcg IM or Recombivax-HB 5 mcg IM) as soon as the baby is stabilized and bathed, no later than 12 hours after birth. If the mother is later found to be HBsAg-positive, administer hepatitis B immune globulin to the infant as soon as possible and within 7 days after birth.
- Mothers who are HBsAg-positive may breast feed after HBIG and the first dose of hepatitis B vaccine are administered.
- Confirm that lab has drawn HBsAg on mothers who do not have HBsAg result on chart.
- Notify the physician ASAP for orders if HBsAg result, upon return, is positive.
- Report any maternal HBsAg-positive test to the health department.
- Provide educational material to the mother who is HBsAg-positive, including recommendations for testing and/or vaccinating members of her household as well as hepatitis B treatment information for her and any other HBsAg-positive household members.
- If the infant must be discharged before the mother's HBsAg result is available, document clearly how to reach the parent as well as the infant's future primary care clinic in case further treatment is needed.
- If the infant's mother is HBsAg-positive, make sure the infant's future well child care provider is notified of treatment already provided for the infant and the follow-up that is needed. Directly notify the infant's clinic as well as document in the infant's discharge summary that the mother is HBsAg-positive and that the baby received HBIG and the first dose of hepatitis B vaccine (including the brand and dose in mcg). Also provide notification that the infant will need Engerix-B 10 mcg or Recombivax-HB 5 mcg at 1 month of age and at 6 months of age as well as post- vaccination serology (HBsAg and anti-HBs) at 9-15 months of age.