Investigation and Mitigation of a Respiratory Syncytial Virus (RSV) Outbreak on an Adult Inpatient Leukemia Unit

Abstract

<h3>Background</h3> In February 2020, an uptick in RSV infections was detected on an adult, inpatient leukemia unit at a tertiary oncology hospital. Upon outbreak identification, an epidemiological investigation was launched, and outbreak mitigation responses implemented. <h3>Methods</h3> All new RSV results were reviewed for connections to the uptick detected on the inpatient adult leukemia unit which houses patients on high-risk services. Upon identification of an outbreak, the Infection Control Department met with interdisciplinary stakeholders to implement a stepwise approach to stop the outbreak. The infection control team provided education to staff, implemented enhanced twice daily unit cleaning, performed daily unit rounds, monitored sick staff calls and performed daily patient chart reviews for symptoms. As additional cases were identified in roommates of index patients, further contact tracing and surveillance testing was performed. In response to continued detection of cases, all patients were placed on droplet precautions, the unit closed to new admissions, patients and healthcare staff were cohorted, employee surveillance testing was performed, and a physical containment barrier created. <h3>Results</h3> The Infection Control Department monitored outbreak activity and implemented mitigation responses between February 1, 2020, to March 24, 2020. There were 23 patient cases associated with this outbreak, 18 of which were hospital-acquired and 5 of which were community onset. 22 patients associated with the outbreak were on a high-risk service. There were 7 cases detected in healthcare workers. The outbreak was declared over when there were no cases within 2 incubation periods, 14 days. The unit subsequently returned to routine practices. <h3>Conclusions</h3> This outbreak investigation indicates that high-risk inpatient units require a multitude of interventions. Surveillance testing and quarantine are essential in this population, and mitigation efforts should be enacted as quickly as possible to stop transmission.