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Audit of the implementation of selective neonatal BCG immunisation in south east London
E Tseng1, A Nesbitt, D O'Sullivan
1Optimum Health Services, London.
Insights
A selective neonatal Bacillus Calmette-Guérin (BCG) immunisation policy in South East London saw low uptake. Despite feedback, only 14% of eligible infants were immunised, prompting a shift to community-based services.
Area of Science:
- Public Health
- Immunisation Policy
- Neonatal Care
Background:
- A selective neonatal Bacillus Calmette-Guérin (BCG) immunisation policy was implemented in Lambeth, Southwark, and Lewisham in 1992.
- Audits were conducted to assess the policy's effectiveness and identify barriers to uptake.
Purpose of the Study:
- To audit the implementation and uptake of a selective neonatal BCG immunisation policy.
- To identify factors contributing to poor immunisation rates.
- To inform strategies for improving BCG immunisation coverage in neonates.
Main Methods:
- A policy was implemented in 1992, followed by two surveys at 18-month and 35-month intervals.
- The surveys assessed the percentage of eligible infants receiving neonatal BCG immunisation.
- Feedback was provided to neonatal units to encourage improvements.
Main Results:
- Initial audit showed only 11% of eligible infants received BCG immunisation.
- A follow-up audit after intervention showed a marginal increase to 14% uptake.
- Complex selection criteria, staff turnover, and short neonatal stays were identified as barriers.
Conclusions:
- The selective neonatal BCG immunisation programme in the audited areas demonstrated poor uptake.
- Barriers to effective implementation within neonatal units necessitate alternative service delivery models.
- A community-based BCG immunisation service has been commissioned to address low coverage.
Abstract:
The implementation of a selective neonatal BCG immunisation policy adopted in south east London boroughs of Lambeth, Southwark, and Lewisham in 1992 has been audited. A survey conducted 18 months after the policy was implemented showed that only 11% of infants identified as eligible for neonatal BCG immunisation had been immunised. The results of the survey were fed back to neonatal units, which were encouraged to improve access to BCG immunisations for eligible infants. A second survey 17 months later showed that 14% of eligible infants had been immunised. Difficulties in applying complex selection criteria, rapid turnover of trained staff in acute units, and short neonatal stay were thought to contribute to the poor uptake of the selective programme delivered in the neonatal units. A community based BCG immunisation service has been commissioned to improve uptake.