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Program Evaluation for Tdap Immunization Standing Orders in a Birthing Hospital

Newborn infants are vulnerable to pertussis infections. Although the Advisory Committee on Immunization Practices (ACIP) recommends that babies begin their diphtheria, tetanus and acellular pertussis (DTaP) immunization series at two months of age, the minimum age for administration of the vaccine is six weeks of age (Centers for Disease Control [CDC], 2008). Young infants are at risk for whooping cough infection transmitted from parents, siblings and care-givers during the pre-vaccination period in the first two months of life, particularly pertussis transmitted from their mothers. Since the licensure of adult/adolescent formulations of tetanus, diphtheria and acellular pertussis (Tdap) vaccine in 2005, healthcare providers have been encouraged to use Tdap vaccine in the family and caregivers of susceptible infants. Vaccinating the family and close contacts of the baby helps to establish a ‘protective cocoon’ of immunization against pertussis around the child (CDC, 2008). The ACIP guideline on the prevention of pertussis in post-partum women promotes the use of Tdap vaccine in the period immediately following delivery in the hospital setting for susceptible mothers (CDC, 2008). The purpose of this project was to conduct a program evaluation of current immunization practices, and to assess the feasibility of instituting standing orders for Tdap immunization, in a birthing hospital. The evaluation was conducted with members of the medical and nursing obstetrical service in a tertiary care medical center of 783 beds in Western Massachusetts during the winter of 2009-2010. The project was carried out utilizing program evaluation guidelines published by the Centers for Disease Control (CDC, 2007). The program evaluation found that the project hospital met standards for providing immunization in a non-traditional setting and the evaluation culminated with a recommendation for instituting Tdap immunization on the birthing unit. The Capstone experience concluded that the birthing hospital is an apt setting for immunization standing orders and an ideal partner in addressing the public health issue of increasing pertussis incidence.