Hepatitis B Birth Dose Survey  
The Immunization Action Coalition has prepared the following survey in order to obtain feedback from healthcare professionals who provide hepatitis B vaccine to infants.

If you write orders, create standing orders, develop hospital policies, order lab tests, provide care to pregnant women, newborns, or postpartum women, or make sure written orders are carried out, then you are among those from whom we would very much like to hear.

If you do not have responsibilities that involve providing care for newborns or their mothers, then we appreciate your willingness to consider taking this survey, but there is no need for you to fill it out.

The survey is completely anonymous. We very much appreciate your taking the time to express your views about the hepatitis B birth dose.
 
1. What is your occupation? (Please check all that apply.)
   Pediatrician
   Family physician
   Obstetrician-gynecologist
   Infectious disease specialist
   Hospitalist
   Pediatric nurse practitioner or neonatal nurse practitioner
   Physician assistant
   Hospital administrator
   Nursery / birthing unit medical director
   Nursery / birthing unit nursing director
   Nurse
   Other. Please specify:  
   
2. In which of the following settings do you work? (Please check all that apply.)
   Newborn nursery
   Neonatal Intensive Care Unit
   Labor and delivery unit
   Birthing unit
   Hospital administration
   Hospital policy committee
   Infection control department
   Hospital-based clinic or practice
   Private practice
   Community health center
   Primary care in health department
   Other. Please specify:  
   
3. In what type of community do you do most of your work?
  Urban
  Suburban
  Rural
Note: Some of the following questions may not be appropriate for every profession or work setting. Select "NA" if the statement does not apply to you or your organization.
4. In what state or province is the birthing hospital or newborn unit that you use or work in?
5. In what type of community is the birthing hospital or newborn unit that you use or work in?
  Urban
  Suburban
  Rural
6. Approximately how many births occur annually in your primary birthing hospital?
  Under 500
  500 - 999
  1000-2000
  More than 2000
  Not sure
  NA
NOTE: In the following questions, "eligible newborns" means those for whom hepatitis B vaccine is not medically contraindicated.
7. Does your primary hospital have a (written or unwritten) policy (e.g. guidelines, protocols, procedures) that every eligible newborn receive the birth dose prior to hospital discharge?
  Yes
  No
  Not sure
  NA
  Other. Please specify: 
8. Does your nursery, birthing, or newborn unit have standing orders to give hepatitis B vaccine to every eligible newborm prior to hospital discharge? (Standing orders are institutionally-approved medical orders that do not require a written physician signature in the medical record.)
  Yes
  No
  Not sure
  NA
9. Does your nursery, birthing, or newborn unit use admission orders (pre-printed or electronic) in the newborn chart that include the administration of the first dose of hepatitis B vaccine for every eligible newborn prior to hospital discharge?
  Yes
  No
  Not sure
  NA
10. If you know, please indicate approximately what percentage of eligible newborns in your hospital receives the birth dose prior to hospital discharge?
11. If you are a clinician, and you know, please indicate approximately what percentage of eligible newborns in your group or practice receives the birth dose prior to hospital discharge?
12. If you are a clinician, and you know, please indicate approximately what percentage of your own eligible newborn patients receives the birth dose prior to hospital discharge?
13. If you are a clinician, and you know, please indicate approximately what percentage of your own eligible newborn patients do not receive the birth dose prior to hospital discharge due to parent refusal?
 
14. Do you use a combination vaccine (Comvax or Pediarix) for doses of hepatitis B vaccine given after age 6 weeks?
  Yes
  No
  NA
If yes, which combination vaccine do you generally use (when supplies are adequate)?
  Comvax
  Pediarix
  Both
15. Please give us your views on certain aspects of providing the birth dose before hospital discharge by indicating your level of agreement or disagreement with each of the following statements. Select "NA" if the statement does not apply to you.
 
  Strongly
Disagree		 Disagree Neither
Agree nor
Disagree		 Agree Strongly
Agree		 NA
The hepatitis B birth dose should be given to all eligible newborns before hospital discharge (except if refused by parent).
It is important to have a uniformly applied policy of giving the birth dose prior to hospital discharge to ensure that infants born to HBsAg-positive mothers receive the vaccine despite any medical errors (e.g., in testing, transcribing, ordering, interpreting, failing to administer).
Giving the birth dose prior to hospital discharge is important for protecting newborns from household contacts and caregivers who could be HBsAg positive.
I believe that routinely giving the first dose of hepatitis B vaccine at some time within the first week to second month of life is an acceptable alternative to giving it prior to hospital discharge as long as the mothers are low risk and their infants don't need early protection.
I believe that it is better to give the first dose of hepatitis B vaccine in the office instead of the hospital because the patient and/or insurance plan will incur fewer charges.
I prefer to give the first dose of hepatitis B vaccine in the office as part of a combination vaccine after age 6 weeks because it is more cost effective—the child will receive only 3 doses of hepatitis B vaccine instead of 4.
I prefer to provide all doses of hepatitis B vaccine in the office due to the difficulties of communications with the hospital about the newborns’ vaccination records.
I believe newborns should not routinely be given vaccines in the first few days of life.
It is best to follow the guidelines and give the first dose of hepatitis B vaccine in the hospital in order to avoid any potential liability should an unvaccinated newborn become infected with the hepatitis B virus.
Although there are benefits to having a policy of providing the birth dose before hospital discharge, they do not outweigh the burden on the nursing staff who have to educate the mothers and administer and document the vaccinations.
I am aware of the CDC and AAP vaccination recommendations but believe they are often made with the general public health in mind and don’t necessarily apply to my patients.
16. I am aware that newborns infected with hepatitis B virus are at increased risk for developing premature death from cirrhosis and liver failure.
  Yes
  No
17. I am aware of the specific language in the official CDC and AAP recommendations that states: "On a case-by-case basis and only in rare circumstances, the first dose may be delayed until after hospital discharge for an infant who weighs at least 2,000 g and whose mother is HBsAg negative. When such a decision is made, a physician's order to withhold the birth dose and a copy of the original laboratory report indicating that the mother was HBsAg negative during this pregnancy should be placed in the infant's medical record."
  Yes
  No
18. I recommend to parents of all eligible newborns under my care that the first dose of hepatitis B vaccine be given before hospital discharge.
  Yes, I do.
  No, I do not.
  NA
19. I recommend to all pregnant women for whom I provide prenatal care that their newborns receive the first dose of hepatitis B vaccine before hospital discharge.
  Yes, I do.
  No, I do not.
  NA
20. Does your hospital receive health department-supplied hepatitis B vaccine to be given to newborns and provided at no charge?
  Yes
  No
  Do not know
  Other. Please specify: 
  NA
If no, would the availability of health department-supplied hepatitis B vaccine be a major factor in removing any objection you might have to routinely giving the birth dose before hospital discharge?
  Yes
  No
  NA
21.

Please tell us what you believe is the strongest reason there should be a uniformly applied hospital policy of giving the birth dose prior to hospital discharge:
 
22.

Please tell us what you believe is the strongest reason there should not be a uniformly applied hospital policy of giving the birth dose prior to hospital discharge:
 
23. Has your hospital or practice changed its policy from not providing hepatitis B vaccine to all eligible newborns before hospital discharge to doing so?
  Yes
  No
  Do not know
  NA
  If yes, in what year? 
  If yes, what motivated the change?
24.

Please provide any additional comments you may have about the birth dose.
 
     
    
There may be a delay after sending. Please be patient.  

Thank you for taking our survey!
 
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Immunization Action Coalition  |  1573 Selby Avenue  |  St. Paul MN 55104
contact: admin@immunize.org  |  www.immunize.org
tel: 651.647.9009  |  fax: 651.647.9131