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Abstract
BackgroundThe guideline-driven and widely implemented single room isolation strategy for respiratory viral infections (RVI) such as influenza or respiratory syncytial virus (RSV) can lead to a shortage of available hospital beds. We discuss our experience with the introduction of droplet precautions on-site (DroPS) as a possible alternative.MethodsDuring the 2018/19 influenza season we introduced DroPS on several wards of a single tertiary care center, while other wards maintained the traditional single room isolation strategy. On a daily basis, we evaluated patients for the development of respiratory symptoms and screened those with a clinical diagnosis of hospital-acquired respiratory viral infection (HARVI) for influenza/RSV by molecular rapid test. If negative, it was followed by a multiplex respiratory virus PCR. We report the concept of DroPS, the feasibility of the strategy and the rate of microbiologically confirmed HARVI with influenza or RSV infection on the DroPS wards compared to wards using the traditional single room isolation strategy.ResultsWe evaluated all hospitalised patients at risk for a HARVI, 741 (72%) on the DroPS wards and 293 (28%) on the regular wards. The hospital-acquired infection rate with influenza or RSV was 2/741 (0.3%; 1× influenza A, 1× RSV) on the DroPS wards and 2/293 (0.7%; 2× influenza A) on the regular wards.ConclusionsDroplet precautions on-site (DroPS) may be a simple and potentially resource-saving alternative to the standard single room isolation strategy for respiratory viral infections. Further studies in a larger clinical context are needed to document its safety.
Highlights
Introduction of droplet precautions on-site (DroPS)DroPS was introduced on four wards
In rhinovirus and human coronavirus infections, isolation precautions are not required in immunocompetent patients, but these viruses can lead to nosocomial transmissions as well [6, 7]
Definition of hospital‐acquired viral infection (HARVI) We evaluated patients for hospital-acquired respiratory viral infection (HARVI) who developed acute respiratory symptoms after two days (i.e. ≥ day 3) after admission to one of the DroPS or regular wards, in line with the definition of nosocomial infections, which is characterised as infection occurring 48 h or later after hospital admission [14]
Summary
Introduction of DroPSDroPS was introduced on four wards (totaling 73 beds, including 5 single rooms, 24 twin rooms, 2 four-bed and 2 six-bed rooms). The guideline-driven and widely implemented pathogen-based single room isolation strategy for respiratory viral infections (RVI) such as influenza or respiratory syncytial virus (RSV) [1,2,3] can lead to a shortage of single rooms in hospitals, especially in times of increased demand (e.g. strong seasonal influenza epidemic, concurrent outbreaks with multidrug-resistant organisms or the Birrer et al Antimicrobial Resistance & Infection Control (2022) 11:2 ongoing SARS-CoV-2 pandemic) This leads to patient movements that would otherwise not be necessary, is both inconvenient for patients and healthcare workers (HCW), may result in lower quality of care and can cause tangible economic strains for the hospital. Any pathogen-based isolation strategy will depend on costly diagnostic tools
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