Nosocomial viral infections revisited

Abstract

In 1980 and 1981, Valenti et al. (l-4) published a series of ground-breaking articles that addressed, for the first time in a comprehensive manner, the epidemiology and control of nosocomial viral infections. Since then, significant advances have been made in viral diagnosis, prophylaxis, and treatment of viral infections. Moreover, these guidelines were published before the recognition of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) and before the implementation of “standard” precautions in the health care setting. The following, then, is an overview and an update on the detection and prevention of nosocomial viral infections. Nosocomial viral infections can be separated into different categories based on their mode of transmission. Bloodborne viruses, such as cytomegalovirus (CMV), hepatitis B virus (HBV), HCV, hepatitis D virus, HIV1 and -2, parvovirus, HTLV-I, and HTLV-II, are transmitted by transfusion and blood and blood products. In addition, undergoing dialysis or organ-transplantation and contact with certain body fluids have also been shown as routes of transmission for some of these viruses (5). Airborne transmission by smallparticle aerosol nuclei ( Gum in size) has been implicated for influenza, measles, and varicella-zoster (VZV) viruses. Large-droplet (>5pm) aerosol transmission occurs with adenovirus, influenza virus, mumps virus, parainfluenza virus, parvovirus B 19, rhinovirus, respiratory syncytial virus, and rubella virus. Enteric adenoviruses, enteroviruses, hepatitis A virus (HAV), rotavirus, and other gastroenteritis viruses are transmitted by the fecal-oral route or by contact with contaminated objects or surfaces in the patient’s environment. Herpes simplex virus (HSV) and VZV are spread by direct contact with patient lesions; CMV and HSV are spread by intimate contact with infectious secretions (2,6,7).