CONTROL OF NOSOCOMIAL RESPIRATORY SYNCYTIAL VIRUS(RSV) INFECTIONS

Abstract

RSV has been the major cause of nosocomial infections on our infant wards, affecting 45% of infants hospitalized for ≥ 1 week, and 42% of the staff. We evaluated methods to control the hospital spread of RSV during a community RSV outbreak. Methods included isolation of all infants with respiratory illness; strict handwashing, gowns, secretion precautions, cohorting of staff to ill infants, but no masks. Every 3-4 days all infants and staff were examined and nasal washes obtained. Of 123 infants admitted; 36 had RSV. Of 87 contact infants, 42 were hospitalized for ≥ 1 week. Nosocomial illness occurred in 8 or 9% of contact infants and in 19% of those hospitalized for ≤ 1 week. Three had pneumonia and 1 died. Of 43 staff, 24 or 56% acquired RSV (60% of nurses and doctors, 38% of medical students). Symptomatic illness occurred in 83% and 46% missed work. Hence, these procedures reduced infant nosocomial infection by over half, but did not affect staff infection rates. This suggests that staff continue to be infected while closely caring for infected babies, perhaps by self-inoculation of contaminated secretions from their hands or fomites, or by large droplets while holding infants. However, with handwashing and changing gowns between rooms, but without masks, staff did not appear to transmit RSV to neighboring un-infected infants.