Background
Key activities or recommendation | Screening strategy | Risk-based strategy | Combination strategy | Dutch guideline |
---|---|---|---|---|
Identify risk factorsa
| No | Yes | Yes | Yes |
Take swab at 35–37 weeks of gestation | Yes | No | Yes | No |
Take swab at onset or during labour | No | No | No | All women with risk factors 4 or 5a
|
Treatment of the woman with IAP | All women who are colonised | All women with ≥ one risk factor | All women with ≥ one risk factor AND who are colonised | All women with risk factors 1, 2, or 3 All women with risk factors 4 or 5a AND who are colonised |
Antibiotic treatment of the child | All baby’s with signs of neonatal infection | All baby’s with signs of neonatal infection | All baby’s with signs of neonatal infection | All baby’s with signs of neonatal infection |
Methods
Setting
Participants and design
Analysis
Results
Participants
Region 1 | Region 2 | Region 3 | Region 4 | Total | |
---|---|---|---|---|---|
Primary care midwife | 1 | 4 | 1 | 1 | 7 |
Hospital based midwife | 2 | 1 | 1 | 2 | 6 |
Obstetrician in training (resident) | 2 | 0 | 2 | 1 | 5 |
Obstetrician | 1 | 1 | 1 | 1 | 4 |
Pediatrician | 1 | 1 | 0 | 1 | 3 |
Obstetric nurse | 0 | 1 | 0 | 1 | 2 |
Total | 7 | 8 | 5 | 7 | 27 |
Determinants mentioned by the care providers
Key activities | Determinants | Screening strategy 1.2
| Risk-based strategy1,2
| Combination strategy1,2
| Dutch guideline 1,2
|
---|---|---|---|---|---|
Identifying risk factors
| Procedural clarity (guideline) | 3 | 3 | 3 | 3 |
Unclear definition previous child with EOGBS |
N
|
N
|
N
|
N
| |
No standard cut-off point urinary tract infection despite guideline |
N
|
N
|
N
|
N
| |
No standard procedure PROM (referral after 18, 24, > 24 hours) |
N
|
N
|
N
|
N
| |
Correctness (guideline) | 1 | 1 | 1 | 1 | |
Symptoms of urinary tract infection are often missed |
N
|
N
|
N
|
N
| |
Social support by other care providers (user) | 2 | 2 | 2 | 2 | |
No adequate history taking of previous child with EOGBS |
N
|
N
|
N
|
N
| |
Not standard GBS detection in urine culture by general practitioner, therefore AB treatment not directed at GBS because status unknown |
N
|
N
|
N
|
N
| |
Legislation and regulations (socio-political context) | 1 | 1 | 1 | 1 | |
Data exchange between care providers of previous pregnancy |
N
|
N
|
N
|
N
| |
Screening for GBS colonization (swab taking)
| Procedural clarity (guideline) | 1 | 0 | 1 | 1 |
Local differences in swab taking (vaginal /vs vaginal rectal /vs urine) |
N
|
N
|
N
| ||
Correctness (guideline) | 0 | 0 | 0 | 1 | |
Test result swab taken during birth not available in time |
N
| ||||
Compatibility with current guideline (guideline) | 1 | 0 | 1 | 0 | |
Collaboration with laboratory already in place |
P
|
P
| |||
Personal benefits / drawbacks (user) | 1 | 0 | 1 | 0 | |
Extra work for primary care midwives |
N
|
N
| |||
Outcome expectations (user) | 4 | 0 | 4 | 0 | |
Sensitivity/specificity swab not 100% because of intermittent carrier status |
N
|
N
| |||
Women can adequately take swab themselves (validity culture) |
N/P
|
N/P
| |||
Swab result not available for every woman at time of birth |
N
|
N
| |||
Client/patient satisfaction (user) | 3 | 0 | 3 | 0 | |
Women do not like swab taking |
N
|
N
| |||
Women prefer swab taking for reassurance |
P
|
P
| |||
Increases anxiety in women and partners |
N
|
N
| |||
Social support by other care provider (user) | 2 | 0 | 2 | 0 | |
Data exchange culture results |
N/P
|
N/P
| |||
Self-efficacy (user) | 1 | 0 | 1 | 0 | |
Confidence in discussing test results with women |
P
|
P
| |||
Knowledge (user) | 1 | 0 | 1 | 0 | |
Care providers know how to take a swab |
P
|
P
| |||
Time available (organisational context) | 1 | 0 | 1 | 0 | |
Time consuming because of providing information and swab taking |
N
|
N
| |||
Staff capacity (organisational context) | 1 | 0 | 1 | 0 | |
Sufficient capacity laboratory personnel |
P
|
P
| |||
Material resources and facilities (organisational context) | 3 | 0 | 3 | 0 | |
Easy to administer in primary care |
P
|
P
| |||
Swabs not available |
N
|
N
| |||
Often delay if culture taken in primary care |
N
|
N
| |||
Financial resources (organisational context) | 2 | 0 | 2 | 0 | |
Increased costs in primary care (swab taking) |
N
|
N
| |||
Increased costs in laboratory personnel |
N
|
N
| |||
Total numbers of determinants, related to | 28 | 7 | 28 | 9 | |
the guideline itself | 6 | 4 | 6 | 6 | |
the user (care provider) | 14 | 2 | 14 | 2 | |
the organisational context | 7 | 0 | 7 | 0 | |
the socio-political context | 1 | 1 | 1 | 1 |
Key activities | Determinants | Screening strategy 1.2
| Risk-based strategy1,2
| Combination strategy1,2
| Dutch guideline 1,2
|
---|---|---|---|---|---|
Antibiotic prophylaxis in the woman
| Procedural clarity (guideline) | 0 | 0 | 1 | 1 |
Logistics birth at home GBS positive mother without risk factor |
N
| ||||
No standard treatment in case of PROM/ –preterm birth and unknown results swab |
N
| ||||
Complexity (guideline) | 0 | 1 | 0 | 0 | |
Easy to follow |
P
| ||||
Compatibility (guideline) | 0 | 1 | 0 | 1 | |
Is already in practice |
P
|
P
| |||
Outcome expectations (user) | 4 | 3 | 6 | 0 | |
Over treatment (IAP, hospital birth, observation baby) |
N
|
N
|
N
| ||
No over treatment |
N
|
P
| |||
Under treatment |
N
|
N
| |||
Increase AB resistance problem |
N
| ||||
No increase AB resistance problem |
P
| ||||
More tailored care in case of GBS carrier ship and PROM |
N
|
P
| |||
Increase hospital birth/decrease home birth |
N
|
N
| |||
Personal benefits / drawbacks (user) | 0 | 1 | 1 | 0 | |
No extra work for primary care midwives |
P
|
N
| |||
Client/patient satisfaction (user) | 0 | 0 | 2 | 0 | |
GBS positive without risk factor: AB prophylaxis desired by woman |
N
| ||||
Suits women critical of AB prophylaxis |
P
| ||||
Staff capacity (organisational context) | 1 | 1 | 1 | 1 | |
Enough capacity in hospital |
N
|
N
|
P
|
P
| |
Material resources and facilities (organisational context) | 1 | 2 | 1 | 2 | |
No problem in daily practice |
P
|
P
| |||
Penicillin not always available in hospital because of pharmacy policy |
N
|
N
|
N
|
N
| |
Financial resources (organisational context) | 1 | 0 | 1 | 0 | |
No reimbursement |
N
|
N
| |||
Total numbers of determinants, related to | 7 | 9 | 13 | 5 | |
the guideline itself | 0 | 2 | 1 | 2 | |
the user (care provider) | 4 | 4 | 9 | 0 | |
the organisational context | 3 | 3 | 3 | 3 | |
the socio-political context | 0 | 0 | 0 | 0 |
Key activities | Determinants | Screening strategy 1.2
| Risk-based strategy1,2
| Combination strategy1,2
| Dutch guideline 1,2
|
---|---|---|---|---|---|
Treatment (AB) and observation of the child
| Procedural clarity (guideline) | 4 | 2 | 4 | 2 |
Logistics observation child at home GBS positive mother without risk factor |
N/P
|
N/P
| |||
AB treatment differs between 3 to 5 days treatment |
N
|
N
|
N
|
N
| |
AB prophylaxis preterm children not specified |
N
|
N
|
N
|
N
| |
Personal benefits/drawbacks (user) | 1 | 0 | 1 | 0 | |
Resistance hospital staff admission child and mother after birth |
N
|
N
| |||
Outcome expectations (user) | 6 | 4 | 4 | 2 | |
40% of cases are missed |
N
|
N
|
N
|
N
| |
Increase in yield infection |
N
|
N
| |||
AB resistance problem |
N
|
N
| |||
Mother or postpartum nursing-aid can adequately observe the child at home of GBS positive mother without risk factor |
N/P
|
N/P
| |||
Hospital not always safe for observation child |
N
|
N
|
N
|
N
| |
Knowledge (user) | 1 | 1 | 1 | 1 | |
Postpartum nursing-aid needs training because of insufficient knowledge |
N
|
N
|
N
|
N
| |
Financial resources (organisational context) | 1 | 1 | 1 | 1 | |
Increased costs because of culture taking in the child |
N
|
N
|
N
|
N
| |
Time available (organisational context) | 1 | 1 | 1 | 1 | |
Taking cultures in a child is time consuming |
N
|
N
|
N
|
N
| |
Total numbers of determinants, related to | 14 | 9 | 12 | 7 | |
the guideline itself | 4 | 2 | 4 | 2 | |
the user (care provider) | 8 | 5 | 6 | 3 | |
the organisational context | 2 | 2 | 2 | 2 | |
the socio-political context | 0 | 0 | 0 | 0 |