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Primary Prevention and Rubella Immunity: Overlooked Issues in the Outpatient Obstetric Setting

Published online by Cambridge University Press:  02 January 2015

Deborah D. Schoenhoff ,
Timothy W. Lane  and
Charles J. Hansen
Deborah D. Schoenhoff*
Affiliation:
Internal Medical Training Program of the Moses Cone Health Systems, Area Health Education Center, and, University of North Carolina-Chapel Hill School of Medicine
Timothy W. Lane
Affiliation:
Internal Medical Training Program of the Moses Cone Health Systems, Area Health Education Center, and, University of North Carolina-Chapel Hill School of Medicine
Charles J. Hansen
Affiliation:
Internal Medical Training Program of the Moses Cone Health Systems, Area Health Education Center, and, University of North Carolina-Chapel Hill School of Medicine
*
Internal Medicine Training Program, Moses Cone Health System, 1200 N Elm St, Greensboro, NC 27401-1020
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Abstract

Objective:

To determine the knowledge of rubella immune status among practicing obstetrician-gynecologists in the United States and of rubella immunity policies covering healthcare workers in the obstetric-care office setting.

Design:

Mailed survey questionnaire, August through December 1994.

Setting:

Physicians from multiple-practice sites including private office, public institution, university or teaching hospital, and closed panel health maintenance organization settings.

Participants:

3,302 practicing obstetrician-gynecologists, chosen by a systematic random sample from the AMA national physician database.

Main Outcome Measures:

Participants were defined as rubella immune if they reported knowledge of prior rubella vaccination or positive antibody titer. Knowledge of a policy for documenting rubella immunity among employees in the office-based practice setting also was assessed.

Results:

Questionnaires were returned from 50% (1,666) of the 3,302 surveyed, and 96% (1,599) were evaluable. Approximately 20% (304/1,599) of the responding obstetrician-gynecologists did not have knowledge of documented rubella immunity, and the majority of office-based practices did not require documentation of rubella immunity in the following groups: physicians, 66% (723/1,094); office nurses, 62% (666/1,070); and other office staff, 69% (728/1,063). Sixty-two percent (993/1,599) of responding physicians had individual rubella serologies performed, with 916 known to be positive, 53 reported negative, and 24 reported unknown. Fifty-seven percent (918/1,599) reported receiving monovalent rubella vaccine or trivalent measles-mumps-rubella vaccine. Multiple logistic regression analysis revealed the following to be independent predictors of positive immune status among respondents: female gender (odds ratio [OR], 2.4; 95% confidence interval [CI95], 1.8-3.1), medical school graduation since 1980 (OR, 2.6; CI95, 2.0-3.3), providing obstetric or fertility services (OR, 1.5; CI95, 1.2-1.9), and group practice setting ≥5 physicians; OR, 1.2; CI95, 1.1-14).

Conclusions:

Nationally, nearly one of every five practicing obstetricians may not have documented rubella immunity, and the majority of office-based practices have no system for assuring such immunity. Rubella immunity should extend beyond the hospital setting, with consideration for requiring rubella immunity as a condition for employment. Methods for effective implementation and documentation of current guidelines need to be addressed, particularly in the office setting.

Type
Originals Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 9 , September 1997 , pp. 633 - 636
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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