Increasing Universal Hepatitis B Virus Screening in Adults

Approximately 580,000 to 2.4 million individuals in the United States (US) live with hepatitis B virus (HBV), and 66% of those might be unaware of their infection. Although HBV is a vaccine-preventable infection, a 2018 survey indicated that 70% of adults in the US revealed that they were not vaccinated for HBV. Implementing a modified universal standardized protocol based on recent Centers for Disease Control and Prevention (CDC) guidelines for screening HBV to identify HBV to improve overall patient health outcomes. Local Problem: Most clinic staff were unaware of the updated CDC HBV screening guidelines. In addition, none of the staff reported they had been trained or participated in education sessions about the new CDC HBV guidelines, resulting in low HBV screening for high-risk patients Methods: A quality improvement project was developed to assess current screening practices, including perceived barriers and facilitators to screening, with the goal of increasing screening for HBV using triple panel tests. Information was presented to clinic staff through email and an education session. Information about HBV testing was placed on the back door of rooms in the clinic to increase patient and family awareness of screening and serve as a reminder to clinic staff. Interventions: Education about HBV and updated CDC HBV triple panel screening guidelines were provided to all staff in the clinic. Questionnaires were administered to clinicians and staff pre-intervention and post-intervention to assess awareness of the CDC protocol and perceived barriers and facilitators to screening. Results: There were changes in retained and improved awareness about screening criteria for HBV. However, there was no increase in the number of HBV triple panels ordered. Documented barriers to screening include needing more time in the clinic or remembering to order. Facilitators include an electronic medical record (EMR) reminder and other external reminders, including patient conversations and visible signage in the clinic and patient rooms. Conclusion: Relying only on the clinician to discuss and recommend screening did not increase screening. Developing a robust screening tool that includes care gap flags in EMRs is critical to remind providers of the need for HBV triple panel screening. The next steps include working with the EMR super users to create a new care gap flag for HBV triple panel screening.