Introduction of the new Centers for Disease Control and Prevention group B streptococcal prevention guideline at a large West Coast health maintenance organization.
OBJECTIVE
Our purpose was to assess the impact of new consensus guidelines issued by the Centers for Disease Control and Prevention, The American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics to prevent perinatal group B streptococcal disease.


METHODS
We performed a descriptive analysis and a before-and-after analysis of implementation of the group B streptococcal disease prevention guidelines among singleton-birth pregnancies in 2 Group Health Cooperative hospitals from October 1, 1995, through December 31, 1997. We studied the speed and completeness of implementation and the effect on pregnancy care practices including intrapartum antibiotic use, test ordering, and maternal and neonatal health.


RESULTS
Guideline implementation occurred rapidly. The proportion of term pregnancies screened according to the guideline increased markedly, and overall intrapartum antibiotic use more than doubled. Among group B streptococci-positive women, intrapartum antibiotic prophylaxis increased from 24% before to 74% after guideline implementation. Median duration of treatment before delivery increased from 1.8 to 4.3 hours. The rate of rash did not increase, and there were no cases of anaphylaxis or pseudomembranous colitis. The proportion of infants undergoing evaluation decreased after implementation of the neonatal guidelines; among infants of group B streptococci-negative women, test ordering dropped by almost 40%.


CONCLUSIONS
Implementation of the new guidelines is feasible and can be accomplished rapidly. The guidelines were associated with increased maternal intrapartum antibiotic use, particularly among women at highest risk, and with a decrease in laboratory use for infants.
Center for Health Studies, the Clinical Planning and Improvement Division, and the Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Seattle, Washington, USA.
R L
RL
Davis
M B
MB
Hasselquist
V
V
Cardenas
D M
DM
Zerr
J
J
Kramer
A
A
Zavitkovsky
A
A
Schuchat
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002487:Centers for Disease Control and Prevention, U.S.; D005260:Female; D005865:Gestational Age; D006279:Health Maintenance Organizations; D006284:Health Plan Implementation; D006801:Humans; D007902:Length of Stay; D008403:Mass Screening; D008499:Medical Records; D016347:Medical Records Systems, Computerized; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D013290:Streptococcal Infections / Q000175:diagnosis / Q000517:prevention & control*; D013292:Streptococcus agalactiae; D014481:United States
D000900:Anti-Bacterial Agents