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Effects of hospital policies based on 1996 group B streptococcal disease consensus guidelines. The Active Bacterial
S H Factor1, C G Whitney, S S Zywicki
1Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Insights
The 1996 group B streptococcal disease prevention guidelines have successfully reduced early-onset infections in hospitals. Adoption of these guidelines correlated with a significant decrease in disease occurrence.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Infectious Disease Prevention
Background:
- The Centers for Disease Control and Prevention (CDC), ACOG, and the American Academy of Pediatrics issued guidelines in 1996 to prevent early-onset group B streptococcal (GBS) disease.
- The impact of these consensus guidelines on obstetric practices and GBS disease occurrence required evaluation.
Purpose of the Study:
- To assess the effect of the 1996 consensus guidelines on obstetric practice and the incidence of early-onset group B streptococcal disease.
- To determine if hospitals adopting GBS prevention policies experienced changes in disease rates.
Main Methods:
- Hospitals with obstetric services in seven surveillance areas completed surveys on their GBS prevention policies and patient populations.
- Survey data were linked to GBS cases identified through active surveillance in 1996 and 1997.
- Paired t-tests compared GBS case numbers between 1996 and 1997; linear regression analyzed factors associated with GBS cases.
Main Results:
- Of 177 surveyed hospitals, 96 (58%) had GBS prevention policies.
- Hospitals that implemented or revised policies in 1996 showed a significant decrease in mean GBS cases in 1997 compared to 1996 (0.58 vs. 1.29).
- Adherence to the 1996 ACOG guidelines was associated with fewer GBS cases (P = .038).
Conclusions:
- The publication and implementation of the 1996 consensus guidelines for group B streptococcal disease prevention were associated with a reduction in disease occurrence.
- Hospital policies and adherence to established guidelines play a crucial role in mitigating early-onset GBS disease.
Objective:
To determine whether the 1996 consensus guidelines for prevention of early-onset group B streptococcal disease developed by the Centers for Disease Control and Prevention, ACOG, and the American Academy of Pediatrics are affecting obstetric practice and disease occurrence.
Methods:
Personnel in hospitals with obstetric services in seven surveillance areas completed surveys about their programs, patient populations, and group B streptococcal disease prevention policies. Survey results were linked to group B streptococcal disease cases identified by active surveillance in 1996 and 1997. An early onset case was defined as a case in which group B streptococci were isolated from a sterile site in the 1st 6 days of life. The number of cases in 1996 and 1997 were compared using a paired t test. Linear regression was used to assess hospital characteristics associated with group B streptococcal disease cases.
Results:
Of 177 hospitals, 165 (93%) responded, and 96 (58%) of those had group B streptococcal disease prevention policies. Hospitals that established or revised their policies in 1996 had a lower mean number of cases in 1997 than in 1996 (0.58 versus 1.29, P = .006). Linear regression analysis, controlling for number of births, indicated that a hospital's having more black mothers and location in particular states were associated with more cases of disease. Citing the 1996 ACOG reference as the source for hospital group B streptococcal disease prevention policy was associated with fewer cases of group B streptococcal disease (P = .038).
Conclusion:
The publication and adoption of the guidelines were associated with decreasing occurrence of group B streptococcal disease.