title: Compliance with a risk-factor-based guideline for the prevention of neonatal group B streptococcal sepsis.
abstract: OBJECTIVE
  The purpose of this study was to determine the compliance rate with a maternal risk-factor-based guideline for the prevention of neonatal group B streptococcal (GBS) sepsis.
  
  
  METHODS
  In August 1994, a risk-factor-based guideline for selective intrapartum prophylaxis against neonatal GBS was adopted by a group model health maintenance organization. This guideline identified the following maternal risk factors for neonatal GBS sepsis: preterm delivery, rupture of membranes for >18 h, fever/chorioamnionitis, and history of a previous GBS-affected child. Patients with one or more risk factors were to receive intrapartum antibiotic prophylaxis consisting of either ampicillin, erythromycin, or clindamycin. We conducted a retrospective chart review to record risk factors and use of antibiotics. We hypothesized that >90% of patients with risk factors would receive intrapartum chemoprophylaxis.
  
  
  RESULTS
  A total of 805 maternal charts were reviewed. Of these, 105 (13%) were candidates for intrapartum prophylaxis. We found an overall compliance rate of 65%. Compliance rates by risk factor were preterm delivery (51%), prolonged rupture of membranes (73%), fever/chorioamnionitis (87%), and previous affected child (100%).
  
  
  CONCLUSIONS
  Our results show unexpectedly low compliance rates with a risk-factor-based guideline for the prevention of neonatal GBS sepsis. Only 65% of women with any risk factor for neonatal GBS sepsis received intrapartum antibiotic prophylaxis appropriately. Educational efforts to improve compliance with a risk-factor-based guideline should specifically address mothers delivering at 34-36 weeks gestation and mothers with prolonged rupture of membranes.
authors.affiliation: Department of Obstetrics and Gynecology St. Joseph Hospital and Kaiser Permanente 1835 Franklin Street Denver CO USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Fleming
authors.forename: R S
authors.initials: RS
authors.lastname: McDuffie
authors.forename: K
authors.initials: K
authors.lastname: Russell
authors.forename: S
authors.initials: S
authors.lastname: Meikle