Scanning for Maternal Disease

The full article appears in the February 2018 issue Patient Safety Monitor Journal.

On July 1, 2018, The Joint Commission will implement three new elements of performance (EP) for maternity care. The announcement, which came in the latest R3 Report, is intended to reduce the risk of transmitting diseases like HIV and syphilis from mother to newborn.

“The requirements will help improve maternal and neonatal health in Joint Commission–accredited hospitals and critical access hospitals across the country,” said Kathy Clarke, MSN, RN, Joint Commission associate project director specialist in the accreditor’s Division of Health Care Quality Evaluation, in a press release. “If left undiagnosed or untreated, infectious diseases can be extremely dangerous and even life-threatening, so it is critical that testing and treatment for both the woman and baby is completed according to clinical practice guidelines.”

The EPs say that when a pregnant woman arrives at a hospital to give birth the hospital must check her medical record to see if she’s been tested (during her current pregnancy) for:

  • HIV
  • Hepatitis B
  • Group B streptococcus (GBS)
  • Syphilis

If she hasn’t, then the hospital needs to run all four tests and document the results. Since GBS testing can take 24-48 hours, providers can choose not to do it, but only if they give the patient prophylactic antibiotics instead. And if the mother tests positive for any of the diseases, then that information needs to be documented in the newborn’s records as well.

David B. Nelson, MD, FACOG, medical director of prenatal clinics for Parkland Health & Hospital System in Dallas, says the reason tests are mandated for these particular pathogens is because they carry a heavy risk of vertical transmission: passing a disease from mother to infant. For example, without treatment, the risk of vertical transmission of HIV and be as high as 25%.

“To emphasize the importance of testing for these infections, in the state of Texas there were 374 cases of congenital syphilis from 2011 through 2015,” Nelson says. “This is an effort to reduce those rates of infection.”

It’s not safe to assume that people will know if they have these diseases, he says. Syphilis, for example, can go unnoticed if the primary lesion is missed or the patient is asymptomatic. As for HIV, up to one out of seven Americans who have it may not know they are infected.

“Patients who don’t have the diagnosis of HIV but are infected are not receiving treatment that could improve some of the conditions they may know or unknowingly have,” he says. “This effort is not just to address the current pregnancy during prenatal care, but to also act as a window into the future health needs of these patients.”

Most hospitals already test pregnant women for the diseases on the R3 report, he says, including Parkland. The Joint Commission’s goal then is to reinforce the practice. But the new EPs also serve to address a major problem: a lack of access to maternity care. For example, in Texas, 26% of women didn’t have a personal doctor in 2016.

“[The R3] also guidelines the fact that some women don’t receive adequate prenatal care according to clinical practice guidelines,” he says. “So this effort is to promote timely testing for both the mother and the newborn, if the screening hasn’t been done in that patient.”

This is an excerpt from a member only article. To read the article in its entirely, please login or subscribe to Patient Safety Monitor Journal.