İBRAHİM KORUK, Süda KORUK TEKİN, Ayşegül ÇOPUR ÇİÇEK, ZEYNEP ŞİMŞEK

Bir doğum hastanesinde HBsAg testi ve hepatit B’yi önleme uygulamalarının geliştirilmesine yönelik bir müdahale araştırması

AIM: This study was conducted to determine the effectiveness of a multicomponent intervention in Sanliurfa Gynecology and Obstetrics Hospital (SGOH), which is designed to overcome the obstacles encountered in the application of HBsAg testing to all delivering women, the administration of hepatitis B vaccine and Hepatitis B Immunglobulin(HBIG) to newborns of HBsAg positive pregnant women. METHOD: This is an intervention study, conducted between December 15, 2007 and December 30,2008. Intervention procedure is composed of four methods; namely, motivation of all parties through academic leadership, implementation of workshops to determine the obstacles, provision of administrative commitment, and training of healthcare personnel. RESULTS: In 2007, a total of 18,709 deliveries were realized in SGOH; HBsAg testing was performed in only 16.5% of the pregnant women and 0.8% of these women were found to be HBsAg positive. It was determined that HBIG was administered to 28.2% of newborns of HBsAg positive mothers and hepatitis B vaccine was given to 71.4% (n=13349) of all newborns. After the intervention, the increase in HBsAg test application status, HBsAg positivity, HIBG administration and hepatitis B vaccination was 6.0, 5.8, 2.0 and 1.2 fold, respectively (P

An intervention study to improve HBsAg testing and preventive practices for hepatitis B in an obstetrics hospital

AMAÇ: Bu araştırma, gebe kadınlara HBsAg testi yapılmasında karşılaşılan sorunların aşılması,HBsAg pozitif gebe kadınların yenidoğanlarına HBIG ve hepatit B aşısı uygulanması için yapılan çok komponentli müdahalenin etkinliğini belirlemek amacıyla Şanlıurfa Kadın Hastalıkları ve Doğum Hastanesinde (KHDH) yürütülmüştür. YÖNTEM: Bu müdahale araştırması 15 Aralık 2007 ve 30 Aralık 2008 tarihleri arasında yürütülmüştür. Müdahale süreci, tüm tarafların akademik liderlikle motivasyonu, sorunların belirlenmesi için atölye çalışmalarının yapılması, yönetimsel kararlılığın sağlanması ve sağlık personelinin eğitiminden oluşan dört metodu içermektedir. BULGULAR: KHDH’de 2007 yılında 18,709 doğum yapılmış, gebe kadınların sadece %16,5’ine HBsAg testi yapılmış ve %0,8’inde HBsAg pozitifliği saptanmıştır. HBsAg pozitif annelerin yenidoğanlarının %28,2’sine HBIG uygulanmıştır. Tüm yenidoğanların %71,4 (13349)’üne ise Hepatit B aşısı yapılmıştır. Müdahaleden sonra HBsAg testi yapılması, HBsAg pozitifliği durumu, HBIG uygulaması ve Hepatit B aşı uygulaması sırası ile 6,0, 5,8, 2,0 ve 1,2 kat artmıştır (p<0.05). SONUÇ: Hepatit B insidansını azaltmak ve yenidoğanlara yönelik hasta güvenliğini sürdürebilmek için HBsAg testi rutin gebelik tarama programlarında yer almalı, yasal düzenlemelerle ve sistematik sürekli hizmet içi eğitim aktiviteleri ile de desteklenmelidir.

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1 Tekin Koruk S, Koruk I, Gürsoy B, et al. Hepatitis B and C virus seroprevalance in central of Sanliurfa in Turkey. 12th World Congress on Public Health. Istanbul, Turkey, 2009.

2 Dienstag JL. Chronic viral hepatitis. In: Principles and practice of infectious diseases. Eds.: GL Mandell, JE Bennet, R Dolin. 7th edition. Philadelphia: Churchill Livingstone; 2005. p. 1441-1464.

3 European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of chronic hepatitis B. J Hepatol 2009; 50:227-242. Article in press doi: 10.1016/j.jhep.2008.10.001 [Accessed date: 09.07.2010].

4 Alter MJ. Epidemiology of hepatitis B in Europe and worldwide J Hepatol. 2003; 39: 64–69.

5 Khouri ME, dos Santos VA. Hepatitis B: epidemiological, immunological, and serological considerations emphasizing mutation. Rev Hosp Clin Fac Med S Paulo. 2004; 59(4): 216-224.

6 Turkish Ministery of Health, Primary Health Care Services General Directorate, Hepatitis B Control_Program_2002_http://www.saglik.gov.tr /default.asp?sayfa=birimler&sinifi=hizmet&cid=3 &sid=55 [Accessed date: 22.12.2009].

7 Turkish Ministery of Health, Primary Health Care Services General Directorate. Expanded Immunization Program Circular 25.02.2008 6111 Circular 2008/ 14.

8 Janes G, Mullan A. Service improvementeverybody’s business? Nurs Manage. 2007; 14(6): 22-25.

9 Cicek A, Tekin Koruk S. Şanlıurfa Gynecolgy and Obstetrics City Hospital Pregnancy Follow- Up Year 2007 HBsAg and Anti-HCV Testing Frequency and Results. IX.National Viral Hepatitis Congress. Antalya, Turkey, 2008.

10 Human Development Report 2009 Turkey. http://hdrstats.undp.org/en/countries/country_fa ct_sheets/cty_fs_TUR.html [Accessed date: 22.12. 2009].

11 Hacettepe University Population Evaluation Institute, Turkey Population and Health Survey 2003. Hacettepe University Population Evaluation Institute, Ministery of Health Mother Child Health and Family Planning General Directorate, State Planning Organization and European Union, Ankara, Turkey.

12 Governorship of Sanliurfa. Health Statistics. http://www.sanliurfa.gov.tr/icerik.asp?id=25. [Accessed date: 17.06.2009].

13 Elsheikh RM, Daak AA, Elsheikh MA, Karsany MS, Adam I. Hepatitis B virus and hepatitis C virus in pregnant Sudanese women. Virology Journal 2007; 4: 104. doi:10.1186/1743-422X-4- 104 [Accessed date: 09.07.2010].

14 Kwan LC, Ho YY, Lee SS: The declining HBsAg carriage rate in pregnant women in Hong Kong. Epidemiol Infect. 1997; 119(2): 281-283

15 Centers for Disease Control and Prevention. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Morbidity and Mortality Weekly Report. 1991; 40: 1-19.

16 Xiao XM, Li AZ, Chen X, Zhu YK, Miao J. Prevention of vertical hepatitis B transmission by hepatitis B immunoglobulin in the third trimester of pregnancy. Int J Gynaecol Obstet. 2007; 96(3): 167-170.

17 Dayan G H, Caquías C R, García Y, Malik T, Copeland J, Bi D. Medical practices for prevention of perinatal infections in Puerto Rico. Paediatric and Perinatal Epidemiology. 2007; 22(1): 31–39.

18 Bath SK, Singleton JA, Strikas RA, Stevenson JM, McDonald LL, Williams WW. Performance of US hospitals on recommended screening and immunization practices for pregnant and postpartum women. Am J Infect Control. 2000; 28(5): 327-332.

19 Turkish Ministery of Health Mother Child Health and Family Planning General Directorate. Pre- Natal Care Protocol Circular. B100AÇS011000- 010.06.01/832. February 18, 2008.

20 Gıles M L, Pedrana A, Jones Cheryl, Garland S, Hellard M, Lewın SR. Antenatal screening practice for infectious diseases by general practitioners in Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009; 49(1): 39–44.

21 Goetz MB, Hoang T, Bowman C, et al. A System-wide Intervention to Improve HIV Testing in the Veterans Health Administration. J Gen Intern Med. 2008; 23(8): 1200–1207.

22 Thomas A N, Boxall E M, Laha S K. An educational and audit tool to reduce prescribing error in intensive care. Qual Saf Health Care. 2008; 17(5): 360–363.

23 Ferreira CT, da Silveira TR. Viral hepatitis prevention by immunization. J Pediatr(Rio J). 2006; 82(3): 55-66.