Maj Angela S. Williamson, Keesler AFB, MS
On July 1 of 1997, the State of Mississippi became only the fifth state in the nation to legally mandate that hearing screening be performed on all infants prior to age six months. The State Department of Health (DoH) began to implement statewide screenings in October of 1996 when they received federal grant funding which was used to purchase ALGO-II automated auditory brainstem response (AABR) test units for hospitals throughout the state.
Training was conducted at all birthing facilities in the state (those that had more than 100 births per year), and testing for all newborns was essentially in place when the law took effect. The DoH chose the ALGO-II method of screening since it does not require a certified or licensed specialist to perform the test. Many sites in Mississippi are rural and are not served by an audiologist; the decision was made to use AABR in lieu of OAE for the numerous facilities without audiological support.
Unfortunately, Keesler AFB sits on federal property and the DoH forgot about us! We were not provided with an ALGO-II unit, nor were we contacted with the information that the law would be going into effect on 1 July. Our first awareness of the program was in mid-July when a DoH early intervention nurse called our nursery to ask how our program was going! Needless to say, after several phone calls between our nursery staff, the DoH and audiology, we were given a better understanding of the legal requirements in place and the program being utilized by the DoH.
If you are considering implementing a UNHS in your medical treatment facility, please read on for a whirlwind description of the activities at Keesler in the subsequent six weeks. If we could do it in six weeks, you can, too!
An initial meeting was held in early August to formulate a plan of action. Attending this meeting was the senior nurse from the nursery, the chief neonatologist, and an audiologist. During this meeting we discussed the equipment requirements, supplies needed, who would test the infants, how data would be tracked, how the information would be reported to the DoH and procedures to follow-up patients that referred (fail is not politically correct). An overwhelmingly positive factor was the support and interest of the senior nurse and the neonatologist. From the outset, only a can-do attitude was projected, which prevented the audiology staff from having to sell the concept of UNHS.
During the initial meeting it was decided that the audiology staff would train 10 nurses from four teams, so that 24/7 coverage would be provided, even during a leave or TDY. The audiology clinic had two Otodynamics ILO-88 units, one desktop and one portable. Because we didn’t have time to acquire new equipment, the audiology clinic would permanently hand-receipt the portable unit to the nursery; the nurses would learn how to run the equipment, monitor results and store and print information. Data would be logged into an especially created database accessible to nursery and audiology staff members (our systems personnel were called in to create it based on our specifications), and monthly, audiology would forward the results to the DoH. Infants who had an initial refer would be seen for follow-up OAE tests in the audiology clinic during a walk-in clinic; those that remained abnormal would be scheduled for Auditory Brainstem Response (ABR).
With a plan outlined, the training began. Informational letters were created to give to the new parents to indicate whether their child had passed or needed further testing. Information systems personnel set to work to develop a database. On 15 September 97 we instituted 100% hearing screening on all infants discharged from Keesler Medical Center. An article appeared in the base newspaper describing the test and the implications for detection of hearing loss at such a young age.
Problems have been minimal. The nursing staff has willingly tackled the testing process, and with practice are becoming quite proficient at using the ILO-88. Computer data storage maintenance has been a random problem. General lack of computer knowledge by most users of the equipment has caused the A or C drive to fill up, preventing further data storage. It was decided on a monthly basis, after the data has been sent to the DoH, the audiology staff will clean up the computer storage on the ILO-88. The nursery staff was advised that audiology was on-call for any problems. Initially, we went up once or twice a week, but now the program is running so smoothly, our support is only requested a few times a month.
Our program has been in place for 3 months. We have tested 185 infants, and have confirmed one sensorineural hearing loss of moderate degree. In the process, Audiology has received a high level of positive exposure in the hospital and on the base, our referrals from general pediatrics are up 25%, and patient satisfaction with the program is overwhelmingly positive.
The nursery will ultimately purchase their own screening equipment and return our ILO-88. The decision to use AABR or Otoacoustic Emissions will be up to their staff; audiology has served as an information source and advisor to them as they investigate equipment and screening methods. UNHS with Otoacoustic Emissions has worked well to this point, with test times averaging less than 2 minutes per infant. Our refer rate has dropped to 18%, and we expect it to level off at 10-15% with continued experience by the test-givers.
Screening infant hearing will soon be the standard of care in our medical treatment facilities. If you need help setting up your program, or just want more information, an excellent resource is the National Center for Hearing Assessment and Management at:
Utah State University
2880 University Blvd
Logan, UT 84322-2880
http://www.infanthearing.org/
Major Angela S. Williamson is the Chief of Audiology, 81st Medical Group, Keesler AFB, MS.