Barriers to Implementing the Group B Streptococcal Prevention Guidelines

Authors

  • Vicky Cárdenas MHS,

    1. Vicky Cárdenas is a doctoral candidate in Epidemiology in the Department of Epidemiology at the University of Washington, Seattle, Washington; Robert Davis is an Associate Professor of Pediatrics and Epidemiology at the University of Washington; Mary Beth Hasselquist is an obstetrician/gynecologist at Group Health Cooperative of Puget Sound, Seattle, Washington; Ann Zavitkovsky is a Project Coordinator at the Center for Health Studies, Group Health Cooperative, Seattle, Washington; Anne Schuchat is Chief of the Respiratory Diseases Branch at the Centers for Disease Control and Prevention, Atlanta, Georgia.
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  • Robert L. Davis MD,

    1. Vicky Cárdenas is a doctoral candidate in Epidemiology in the Department of Epidemiology at the University of Washington, Seattle, Washington; Robert Davis is an Associate Professor of Pediatrics and Epidemiology at the University of Washington; Mary Beth Hasselquist is an obstetrician/gynecologist at Group Health Cooperative of Puget Sound, Seattle, Washington; Ann Zavitkovsky is a Project Coordinator at the Center for Health Studies, Group Health Cooperative, Seattle, Washington; Anne Schuchat is Chief of the Respiratory Diseases Branch at the Centers for Disease Control and Prevention, Atlanta, Georgia.
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  • Mary Beth Hasselquist MD,

    1. Vicky Cárdenas is a doctoral candidate in Epidemiology in the Department of Epidemiology at the University of Washington, Seattle, Washington; Robert Davis is an Associate Professor of Pediatrics and Epidemiology at the University of Washington; Mary Beth Hasselquist is an obstetrician/gynecologist at Group Health Cooperative of Puget Sound, Seattle, Washington; Ann Zavitkovsky is a Project Coordinator at the Center for Health Studies, Group Health Cooperative, Seattle, Washington; Anne Schuchat is Chief of the Respiratory Diseases Branch at the Centers for Disease Control and Prevention, Atlanta, Georgia.
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  • Ann Zavitkovsky MPH,

    1. Vicky Cárdenas is a doctoral candidate in Epidemiology in the Department of Epidemiology at the University of Washington, Seattle, Washington; Robert Davis is an Associate Professor of Pediatrics and Epidemiology at the University of Washington; Mary Beth Hasselquist is an obstetrician/gynecologist at Group Health Cooperative of Puget Sound, Seattle, Washington; Ann Zavitkovsky is a Project Coordinator at the Center for Health Studies, Group Health Cooperative, Seattle, Washington; Anne Schuchat is Chief of the Respiratory Diseases Branch at the Centers for Disease Control and Prevention, Atlanta, Georgia.
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  • Anne Schuchat MD

    1. Vicky Cárdenas is a doctoral candidate in Epidemiology in the Department of Epidemiology at the University of Washington, Seattle, Washington; Robert Davis is an Associate Professor of Pediatrics and Epidemiology at the University of Washington; Mary Beth Hasselquist is an obstetrician/gynecologist at Group Health Cooperative of Puget Sound, Seattle, Washington; Ann Zavitkovsky is a Project Coordinator at the Center for Health Studies, Group Health Cooperative, Seattle, Washington; Anne Schuchat is Chief of the Respiratory Diseases Branch at the Centers for Disease Control and Prevention, Atlanta, Georgia.
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  • This study was financially supported by a research grant from the Centers for Disease Control and Prevention, Atlanta, Georgia.

Address correspondence to Vicky Cárdenas, Box 357236, Department of Epidemiology, 1959 NE Pacific Street, University of Washington, Seattle, WA, 98195.

Abstract

ABSTRACT: Background: Group B streptococcal disease is the leading cause of neonatal sepsis in the United States. We assessed predictors of compliance with the consensus guidelines for perinatal group B streptococcus disease prevention at two Group Health Cooperative hospitals.

Methods: A descriptive and cohort analysis was conducted of failure to comply with the screening-based approach to group B streptococcus prevention among singleton birth pregnancies in two Group Health Cooperative hospitals, September 1, 1996 to December 31, 1997. We studied determinants of failure to screen pregnant women for group B streptococcus at 35 to 37 weeks’ gestation and failure to deliver intrapartum antibiotic prophylaxis to Group B streptococcus-positive women.

Results: Nearly 28 percent of 1969 women delivering at two Group Health Cooperative hospitals were not screened appropriately for group B streptococcus. Women who were not screened properly were more likely to be in their teens. A short length of hospital stay before delivery was the strongest predictor of the lack of administration of intrapartum antibiotic prophylaxis to infected multiparas at delivery. Group B streptococcus-positive women without pregnancy complications were less likely to receive intrapartum antibiotic prophylaxis than infected women with complications.

Conclusions: The findings of this study suggest that to improve group B streptococcus disease prevention, screening efforts should focus on teenage women, and intrapartum antibiotic prophylaxis delivery efforts should be aimed at low-risk women with precipitous labor. (BIRTH 29:4 December 2002)

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