title: Implementing guidelines on the prevention of opportunistic infections in inflammatory bowel disease.
abstract: BACKGROUND
  Opportunistic infections are a key safety concern in the management of patients with inflammatory bowel disease (IBD). Despite the existence of international guidelines, many gastroenterologists have not adopted routine screening and vaccination. The aim of this study was to modify clinical behaviour by use of a simple screening tool.
  
  
  METHODS
  A screening and vaccination proforma for hepatitis B, varicella, Influenza, Pneumococcus, human papillomavirus, tuberculosis, hepatitis C and HIV was provided to each participating gastroenterologist. Gastroenterologists were surveyed for awareness of vaccine recommendations and current practice prior to and following the introduction of the proforma. Rates of immunity and the proportion of patients receiving the recommended screening and vaccinations were documented.
  
  
  RESULTS
  30 gastroenterologists at 8 different IBD centres took part in the assessment. A total of 919 patients were included (55% female, 65% Crohn's, 33% ulcerative colitis, 2% indeterminate IBD). Introduction of the proforma increased self-reported gastroenterologist screening from 47% to 97% pre- and post-intervention respectively, p<0.001. After the proforma was applied, vaccination against hepatitis B, varicella, Influenza, and Pneumococcus was recommended in 67%, 2.5%, 75% and 69% of the patients respectively. Of these, 42%, 39%, 66% and 49% patients followed the recommendations and were vaccinated. Cervical smears were recommended in 31%, with 62% of these obtaining the recommended cervical smear.
  
  
  CONCLUSIONS
  Implementation of a screening and vaccination proforma significantly changed gastroenterologist self-reported behaviour. Patient compliance with these recommendations was not optimal and suggests the need for further patient education, in addition to other forms of support.
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital, Sydney, Australia. Electronic address: awalsh@stvincents.com.au.
authors.forename: A J
authors.initials: AJ
authors.lastname: Walsh
authors.forename: M
authors.initials: M
authors.lastname: Weltman
authors.forename: D
authors.initials: D
authors.lastname: Burger
authors.forename: S
authors.initials: S
authors.lastname: Vivekanandarajah
authors.forename: S
authors.initials: S
authors.lastname: Connor
authors.forename: M
authors.initials: M
authors.lastname: Howlett
authors.forename: G
authors.initials: G
authors.lastname: Radford-Smith
authors.forename: W
authors.initials: W
authors.lastname: Selby
authors.forename: A S
authors.initials: AS
authors.lastname: Veillard
authors.forename: M C
authors.initials: MC
authors.lastname: Grimm
authors.forename: S P L
authors.initials: SP
authors.lastname: Travis
authors.forename: I C
authors.initials: IC
authors.lastname: Lawrance
mesh_terms: D000328:Adult; D002644:Chickenpox / Q000517:prevention & control; D005260:Female; D005762:Gastroenterology / Q000592:standards; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000517:prevention & control; D006526:Hepatitis C / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy*; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D009894:Opportunistic Infections / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000517:prevention & control; D010349:Patient Compliance; D011008:Pneumococcal Infections / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011996:Records; D057566:Self Report; D014376:Tuberculosis / Q000175:diagnosis; D014611:Vaccination / Q000592:standards*
chemical_list: D007166:Immunosuppressive Agents
keywords: Implementing guidelines; Inflammatory bowel disease; Screening; Vaccination