Preventing early-onset group B streptococcal sepsis: efforts to measure and improve compliance with guidelines

We describe strategies employed in achieving a high level of compliance with Centers for Disease Control and Prevention guidelines for the prevention of early-onset Group B streptococcal neonatal sepsis.

This is a retrospective review of all deliveries at or beyond 37 weeks gestation at Gundersen Lutheran Medical Center to determine (1) whether and when cultures were obtained for group B Streptococcus, (2) whether antibiotics were administered, and (3) the timing of antibiotic treatment relative to delivery, following educational efforts to an integrated medical center's departments of Obstetrics and Gynecology and Family Practice. Changes were made in prenatal records and admission order forms to facilitate compliance.

Cultures were obtained antenatally from 946 (99.0%) of the 956 women, with 87.4% (827) of these obtained between 35 and 37 weeks gestation. One hundred eighty-two (19.2%) of the women were colonized with group B Streptococcus. One hundred sixty of the 173 patients eligible for antibiotic prophylaxis (92.5%) received it.

Our rates of antenatal culturing and prophylactic antibiotic administration compared favorably with those previously reported. Our strategies for achieving high compliance with group B Streptococcus prevention protocols include educating and obtaining consensus from individuals providing obstetrical care and building reminders into physician and nurse workflows.