215 - Title: Improving Immunization Rates of Infants Admitted to a Tertiary Neonatal Intensive Care Unit (NICU)

Poster Number: 215
Publication Number: 215.126

Indirapriya Darshini Avulakunta, Childrens hospital at Montefiore, Bronx, NY, United States; Alma A. Rechnitzer, Albert Einstein College of Medicine, Bronx, NY, United States; Toshiba Morgan-Joseph, The Children's Hospital at Montefiore, Bronx, NY, United States; Suhas Nafday, Albert Einstein College of Medicine, Bronx, NY, United States

Background: Preterm and term infants are at increased risk of vaccine-preventable infections. Several studies have shown that there is a delay in timely immunization of hospitalized infants. The Centers for Disease Control and Advisory Committee on Immunization Practices recommend administration of hepatitis B vaccine (HBV) within 24 hours to all stable infants born with a birth weight >2000 gm. The New York state department of health recommends HBV birth dose within 12 hours of life to reduce the perinatally acquired hepatitis B infection. The US national estimated birth dose HBV rate was 71.1 % in 2014 with NYC average of 72%. As shown in fig 1, the baseline rate for birth dose HBV in our NICU was 22.5% within 12 hours of life and 25.8% within 24 hours.

Objective: To improve Birth dose HBV rate by 25 % from base line and to improve HBV at 1 month, and the 2nd and 4th month immunization rates to > 90 %.

Design/Methods: In May 2019, we instituted a quality improvement project to improve the timely immunizations of term and preterm infants admitted to our level IV NICU. Baseline data was acquired for a period of 1 year from April 2019 to April 2020 (fig 1). A multidisciplinary team was assembled; key drivers and Ishikawa diagrams were constructed to identify the barriers for immunization (fig 2). We implemented quarterly Plan-Do-Study-Act cycles (PDSA) to institute, modify and improve our immunization rates per institute of healthcare improvement model. The primary outcome measures were timely immunization of birth dose HBV administration within 12 hours for eligible infants, and subsequent immunizations within one week of recommended schedule.

Results: After four PDSA cycles over a period of 16 months from July 2020 to November 2021, the rate of HBV increased from 22.5 % to 71 % and HBV at 1 month, and 2nd and 4th month immunizations have increased to 100%. Monthly ongoing education for the providers, revising our immunization policy, intervention of nurses in obtaining the consent, reminder on immunization status in the resident sign out, bundling 1-month Hep B consent with our unit specific protocols were some of the most effective interventions.Conclusion(s): Using the QI methodology, we identified barriers for delay in immunization schedule. Multidisciplinary collaboration, provider, and staff education with implementation of PDSA cycles are effective in improving the immunization rates in a timely manner of infants admitted to NICU.
Figure :1 Baseline Immunization rates April 2019-April 2021. Figure: 2 Fishbone Diagram
Birth dose Hepatitis B immunization