Barriers to implementing the group B streptococcal prevention guidelines.
BACKGROUND
Group B streptococcal disease is the leading cause of neonatal sepsis in the United States. We assessed predictors of compliance with the consensus guidelines for perinatal group B streptococcus disease prevention at two Group Health Cooperative hospitals.


METHODS
A descriptive and cohort analysis was conducted of failure to comply with the screening-based approach to group B streptococcus prevention among singleton birth pregnancies in two Group Health Cooperative hospitals, September 1, 1996 to December 31, 1997. We studied determinants of failure to screen pregnant women for group B streptococcus at 35 to 37 weeks' gestation and failure to deliver intrapartum antibiotic prophylaxis to Group B streptococcus-positive women.


RESULTS
Nearly 28 percent of 1969 women delivering at two Group Health Cooperative hospitals were not screened appropriately for group B streptococcus. Women who were not screened properly were more likely to be in their teens. A short length of hospital stay before delivery was the strongest predictor of the lack of administration of intrapartum antibiotic prophylaxis to infected multiparas at delivery. Group B streptococcus-positive women without pregnancy complications were less likely to receive intrapartum antibiotic prophylaxis than infected women with complications.


CONCLUSIONS
The findings of this study suggest that to improve group B streptococcus disease prevention, screening efforts should focus on teenage women, and intrapartum antibiotic prophylaxis delivery efforts should be aimed at low-risk women with precipitous labor.
Cárdenas
Vicky
V
Department of Epidemiology at the University of Washington, Seattle, Washington 98195, USA.
Davis
Robert L
RL
Hasselquist
Mary Beth
MB
Zavitkovsky
Ann
A
Schuchat
Anne
A
D000293:Adolescent; D019072:Antibiotic Prophylaxis / Q000379:methods; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007902:Length of Stay; D016015:Logistic Models; D008403:Mass Screening / Q000592:standards; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011253:Pregnancy in Adolescence; D011295:Prenatal Care / Q000592:standards; D011322:Primary Prevention / Q000592:standards*; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D013290:Streptococcal Infections / Q000517:prevention & control*; D013292:Streptococcus agalactiae; D014481:United States