Improving Tdap Vaccination Rates: A Case Study

• 4/9/2010
• Author: Steven Berman
• Category: The Journal Blog
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A recent issue of The Joint Commission Online  included a call for strategies to improve tetanus, diphtheria, and acellular pertussis (Tdap) vaccination rates in health care organizations. The Joint Commission is asking health care organizations to share their approaches for implementing vaccination programs for patients and health care workers. The information will be considered for inclusion in an educational monograph that will be available free of charge later this year on the Joint Commission's Web site. Organizations are asked to complete the online survey by April 26, 2010. This week, Tina Q. Tan, the lead author of  Pertussis and Patient Safety: Implementing Tdap Vaccine Recommendations in Hospitals,  which appears in the April 2010 issue,  guests on the Journal blog. Dr. Tan and her co-author Melvin V. Gerbie describe efforts at two hospitals in Chicago—Prentice Women’s Hospital and Children's Memorial Hospital—to increase postpartum use of Tdap vaccine and to replace the tetanus and diphtheria toxoids (Td) booster with Tdap vaccine in emergency department (ED) settings. The authors also call attention to the need for vaccination of health care personnel.  Dr. Tan follows up on the article to provide some updates on progress. We welcome your comments.

Since the vaccination program was instituted in June 2008, more than 18,200 doses of Tdap vaccine have been administered to postpartum women. We recently administered a patient survey, which, as we stated in the article, we were developing at the request of the Chicago Department of Public Health to assess patient acceptance and barriers to acceptance of Tdap vaccine. Some 1,087 postpartum women completed this brief, anonymous, self-administered survey in a six-month period (from August 1, 2009 to February 28, 2010). Some 79% of the respondents received a dose of postpartum Tdap vaccine and 7% had previously received a dose of Tdap vaccine before becoming pregnant; overall, 86% of the women were vaccinated with Tdap. The most common reasons cited for receiving Tdap vaccine were to protect their infant from pertussis disease and to protect themselves from pertussis disease or the need for a tetanus vaccine.

For the 14% of women who declined vaccine, the major reasons for not receiving the vaccine were a preference to receive the vaccine at their primary care physician’s office, concerns about vaccine side effects, perception of not being at risk for pertussis, and a distrust of vaccines. More than 96% of the respondents, regardless of whether or not they received the postpartum Tdap vaccine, felt that the hospital’s offer of the vaccine was a worthwhile and valuable service. Further analysis of the survey data is ongoing.

Children’s Memorial Hospital’s emergency room program of administering Tdap vaccine for wound prophylaxis continues, with no changes in the protocol, as do monitoring and evaluation of the program.