Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review

Abstract

Respiratory syncytial virus (RSV) causes a significant public health burden, and outbreaks among vulnerable patients in hospital settings are of particular concern. We reviewed published and unpublished literature from hospital settings to assess: (i) nosocomial RSV transmission risk (attack rate) during outbreaks, (ii) effectiveness of infection control measures. We searched the following databases: MEDLINE, EMBASE, CINAHL, Cochrane Library, together with key websites, journals and grey literature, to end of 2012. Risk of bias was assessed using the Cochrane risk of bias tool or Newcastle–Ottawa scale. A narrative synthesis was conducted. Forty studies were included (19 addressing research question one, 21 addressing question two). RSV transmission risk varied by hospital setting; 6–56% (median: 28·5%) in neonatal/paediatric settings (n = 14), 6–12% (median: 7%) in adult haematology and transplant units (n = 3), and 30–32% in other adult settings (n = 2). For question two, most studies (n = 13) employed multi‐component interventions (e.g. cohort nursing, personal protective equipment (PPE), isolation), and these were largely reported to be effective in reducing nosocomial transmission. Four studies examined staff PPE; eye protection appeared more effective than gowns and masks. One study reported on RSV prophylaxis for patients (RSV‐Ig/palivizumab); there was no statistical evidence of effectiveness although the sample size was small. Overall, risk of bias for included studies tended to be high. We conclude that RSV transmission risk varies widely during hospital outbreaks. Although multi‐component control strategies appear broadly successful, further research is required to disaggregate the effectiveness of individual components including the potential role of palivizumab prophylaxis.

What the FLOQ? A quality improvement project to reduce unnecessary paediatric respiratory viral swabs in a peripheral metropolitan hospital

“…At our centre, all admitted patients over 4 weeks of age with a viral URTI, wheeze, cough, bronchiolitis or any respiratory symptoms are cohorted together due to bed availability issues and this is known to occur at other institutions including metropolitan and specialist paediatric clinical centres in Sydney. The evidence for isolating/cohorting patient with similar viral infections together is limited and up to 30% of ‘bronchiolitis’ patients (age 0–2 years) test positive for multiple viruses . We noted a significant number of our cohorted patients had a FLOQ performed but a random sample review suggested it did not lead to a change in management.…”

“…We acknowledge there will always be cases where viral testing is appropriate to guide management, for example antibiotic stewardship in a febrile neonate with no source. However, the focus of our quality improvement project, backed by local physician agreement as well as current evidence, was to reduce testing in those patients in whom identifying the specific virus has no apparent impact on their clinical management in ED or as an inpatient and this has been a success.…”

Outcomes of Nosocomial Viral Respiratory Infections in High-Risk Neonates

“…Strategies aimed at reducing nosocomial VRTIs include infected patient isolation cohorts, personal protective equipment use by staff, hand hygiene policies and restricting visitors during periods of high community VRTI prevalence 17,38,39 . Few of these have been studied in a systematic way in the NICU and further high quality studies are required.…”

Respiratory Syncytial Virus Infection

“…The introduction of strict infection control policies in hospital settings (isolation and hand washing) and personal protective equipment (gowns, gloves and possibly goggles) reduced nosocomial transmission. (10)…”