Nosocomial Viral Infections Research Articles

Nosocomial viral infection after the covid-19 pandemic

Nosocomial viral infection after the covid-19 pandemic

Retraction Note to: Childhood nosocomial viral acute respiratory tract infections in teaching hospital Anuradhapura, Sri Lanka

We have assessed the risk factors for the occurrence of hospital-acquired (HA) and community-acquired (CA) viral acute respiratory tract infections (ARTIs) in children. Children (1–60 months) who were having ARTI on admission (CA) and develops ARTI following 48 h after admission or 3 days of discharge (HA) were included. Indirect immunofluorescence assay (IFA) was performed and multivariable analyses were done to determine the risk factors for the development of viral CA and HA-ARTI. Total of 818 with ARTIs, 226 (27.6%) RSV cases were detected. Out of 226, 86 (38.0%) HA-RSV cases were detected. CA-viral-ARTI was significantly high (p < 0.05). Compared to CA-RSV-ARTI immunodeficiency, seizures, trisomy-21 and congenital heart disease (CHD) were having 2.3, 3.2, 1.8- and 2.2-times risk for acquiring HA-RSV respectively. The number of deaths was significantly high following HA-RSV. The associated burden was significant following HA-RSV and it was 429.77 disability-adjusted life years. Children who are having immunodeficiency, CHD, seizure episodes and trisomy 21 would lead to the acquisition of nosocomial RSV infections in great. Adherence to meticulous infection control practices will be helpful to minimize the HA-viral ARTIs in great.

Drastic Reduction of Bacterial, Fungal and Viral Pathogen Titers by Cuprous Oxide Impregnated Medical Textiles.

Hospital patients and personnel are at risk of nosocomial viral infections, as clearly manifested during the COVID-19 pandemic. Transmission of respiratory viral pathogens can occur through contaminated surfaces, including from medical textiles. Copper has potent biocidal properties, and cuprous oxide impregnated medical textiles (CMT) reduce hospital-acquired bacterial infections. In the current study we confirm the antimicrobial properties of CMT and determine their capacity to reduce infectious titres of human coronavirus (HCoV-229E) in an independent laboratory. The antibacterial and antiviral activities of the CMT were determined according to AATCC TM100-2019 and ISO 18184:2019 standards, respectively. The CMT reduced by 4 logs the viable titers of MRSA, Klebsiella pneumoniae, Enterococcus faecalis, and Candida auris after 2 h of incubation. Viable titers of Clostridium difficile were reduced by 2.3, 3, and 4 logs after 2, 6, and 18 h, respectively. Infectious titers of HCoV-229E exposed to CMT for 2 h were reduced by 2.8 and 4 logs (99.85% and 99.99% reductions) as compared to Time-0 control and initial inoculum, respectively. The CMT retain their antibacterial efficacy even after 100 industrial washings. Use of cuprous oxide impregnated textiles in clinical settings may reduce not only hospital acquired infections caused by bacterial and fungal pathogens, but also, and equally important, those caused by coronavirus and other viruses.

Dynamics of nosocomial parainfluenza virus type 3 and influenza virus infections at a large German University Hospital between 2012 and 2019

Nosocomial virus infections cause significant morbidity and mortality. Besides influenza viruses, the disease burden of parainfluenza virus type 3 (PIV-3) is comparatively high among hospitalized patients and severe disease courses can occur. PIV-3 showed the highest rates of nosocomial infections of a panel of respiratory viruses. Therefore, a retrospective observational study was conducted among patients with either PIV-3 or influenza viruses, which served as reference pathogen. The aim was to compare the seasonal dynamics and clinical characteristics of nosocomial infections with these highly transmittable viruses. Nosocomial infection occurred in 15.8% (n = 177) of all influenza cases, mainly in the first half of a season. About 24.3% (n = 104) of the PIV-3 cases were nosocomial and occurred mainly in the second half of a season. Both nosocomial rates of influenza and nosocomial rates of PIV-3 varied between the seasons. Community acquired and nosocomial cases differed in underlying medical conditions and immunosuppression. Knowledge of the baseline rates of nosocomial infections could contribute to the implementation of appropriate infection control measures.

The Emergence of Human Pathogenic Coronaviruses: Lectins as Antivirals for SARS-CoV-2.

Human coronaviruses (HCoV) are common viruses and known to be associated with respiratory diseases, including pneumonia. Currently, seven human coronaviruses have been identified and known to cause upper and lower respiratory infections as well as nosocomial viral infections in humans. The bats, palm civets, and camels are identified as the reservoir of human coronaviruses. In 2002-2003, the emergence of SARS-CoV resulted in an outbreak and led towards the more awareness and importance of scientific research and medical urgency. The recently identified SARS-CoV-2 was identified from the seafood market of the city Wuhan, China, in December 2019 and caused a global pandemic. This virus has now spread to more than 213 countries. This is the third highly pathogenic human coronavirus after SARS and MERS-CoV. The coronaviruses have RNA as genetic material and are known to have frequent recombination and mutations in their genome, which lead to the emergence and re-emergence of new virus strains and isolates with novel properties and extended hosts. The genetic mutations and suitable environmental conditions result in the emergence and re-emergence of pathogenic coronaviruses and cause a serious issue to human health and the economy globally. Lectins are the ubiquitous group of proteins that bind to glycosylated molecules. The plant lectins are known to have significant antiviral activities against coronaviruses. Additionally, the plant lectins can be used as potential therapeutics against bacteria, fungus, yeast, and protozoa. In this review, we have discussed the current status of human pathogenic coronavirus emergence and the use of plant lectins as antivirals against SARS-CoV-2.

Hospital-acquired infections in ageing Vietnamese population: current situation and solution

Hospital-acquired infection (HAI) is a growing problem all around the world particularly for countries with aging and high-density population such as Vietnam. In this review, we summarized the current status of HAIs in Vietnam regarding types of infection, rates of infection, hospital-stay duration and cost of treatment, and provided an overview with suggestions on strategies in combating these infections especially in Vietnamese settings. From quite dispersed and varied data reported in English and Vietnamese, we have seen HAI rates of less than 10%. Over the years, the HAIs in Vietnam remained quite stable and even slightly decreased in recent years. Among all HAIs, respiratory tract infections are the most common, occurring in up to 80% of cases. Most Vietnamese statistical data on the etiology of HAIs focused on bacterial HAIs, mostly Candidiasis, whereas limited information was found on fungal infections, nosocomial viral and other parasitic infections. The most important HAI causative pathogens in Vietnamese hospitals include Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Candida species. There is absolutely few scientific data, but web-based information on HAIs treatment cost and measures to control the infections were found. Works are reported to be implemented to control HAIs in Vietnam at both national and hospital level. However, further improvement in controlling HAIs in Vietnam should be considered.

Review of current issues of diagnosis and prevention of blood-borne nosocomial viral infections.

Provision of infection security in transplantology and transfusiology is a challenging and significant problem that depends on the quality of medical donor selection and laboratory diagnosis of the blood collected. At present, a large number of blood-borne viruses are known; nevertheless, in Russia, the list of viral agents to be tested during the examination by the blood service boils down to three ones: HIV, hepatitis C and hepatitis B viruses. The review article demonstrates the need for implementation of additional laboratory tests for the agents of the priority healthcare-associated blood-borne infections (HAI) using a risk-based approach, i.e., on specified sites and in high risk groups. It presents a methodology for determination of a quantitative blood-induced infection residual risk (BIRR) index to be used while evaluating the efficiency of viral security provision in the blood service.

924. Incidence of Symptomatic and Asymptomatic Influenza Among Healthcare Workers: A Multicenter Prospective Cohort Study

BackgroundInfluenza is an important cause of viral nosocomial infections; however, the incidence of asymptomatic influenza among healthcare workers (HCWs) is poorly known. The objective was to estimate the cumulative incidence of asymptomatic and symptomatic influenza among HCWs.MethodsThe AFP (Asymptomatic Influenza Project, NCT02868658) multicenter prospective cohort study was conducted in 5 French university hospitals in Lyon (2 sites), Grenoble, Saint-Etienne, and Dijon. Each voluntary HCW was followed-up during the entire 2016–2017 influenza season with 3 visits for influenza diagnostic by PCR from nasal swabs and serology. The outcome was laboratory confirmed influenza (LCI) defined by an influenza detection by PCR, and/or influenza A seroconversion/significant increase in the anti-A antibodies titer against A/Hong-Kong/4801/2014, with the absence of seroconversion/significant increase in the level of anti-B/Brisbane/60/2008 antibodies; influenza A was indeed the only strain circulating this winter in the Lyon area. Asymptomatic cases presented no general or respiratory sign/symptom, paucisymptomatic LCI cases had those symptoms/signs but not conforming to clinical influenza, symptomatic LCI cases had temperature ≥37.8°C and cough or sore throat. Cumulative incidence was expressed per 100 HCWs.ResultsOverall 278 HCWs were analyzed, 84.2% were female, the mean age was 38 years, and influenza vaccination coverage in 2016–2017 was 45.3%. Globally, 62 HCWs had evidence of LCI. Among laboratory confirmed influenza cases, 67.7% (95% CI: 55.8%–79.7%, n = 42) were asymptomatic, 21.0% (95% CI: 10.5%–31.4%, n = 13) were paucisymptomatic, and 11.3% (95% CI: 3.2%–19.4%, n = 7) were symptomatic. Among HCWs, global cumulative influenza incidence was 22.3% (95% CI: 17.7%–27.5%). Cumulative incidence of asymptomatic influenza was 15.1% (95% CI: 10.9%–19.3%), it was 4.7% (95% CI: 2.2%–7.2%) for paucisymptomatic influenza, and 2.5% (95% CI: 0.1%–4.4%) for symptomatic influenza.ConclusionAsymptomatic influenza is frequent among HCWs, representing two-third of the influenza burden in this population. This highlights the importance of infection control measures among HCWs no presenting influenza symptoms.Disclosures All authors: No reported disclosures.

Modeling Surface Disinfection Needs To Meet Microbial Risk Reduction Targets.

Nosocomial viral infections are an important cause of health care-acquired infections where fomites have a role in transmission. Using stochastic modeling to quantify the effects of surface disinfection practices on nosocomial pathogen exposures and infection risk can inform cleaning practices. The purpose of this study was to predict the effect of surface disinfection on viral infection risks and to determine needed viral reductions to achieve risk targets. Rotavirus, rhinovirus, and influenza A virus infection risks for two cases were modeled. Case 1 utilized a single fomite contact approach, while case 2 assumed 6 h of contact activities. A 94.1% viral reduction on surfaces and hands was measured following a single cleaning round using an Environmental Protection Agency (EPA)-registered disinfectant in an urgent care facility. This value was used to model the effect of a surface disinfection intervention on infection risk. Risk reductions for other surface-cleaning efficacies were also simulated. Surface reductions required to achieve risk probability targets were estimated. Under case 1 conditions, a 94.1% reduction in virus surface concentration reduced infection risks by 94.1%. Under case 2 conditions, a 94.1% reduction on surfaces resulted in median viral infection risks being reduced by 92.96 to 94.1% and an influenza A virus infection risk below one in a million. Surface concentration in the equations was highly correlated with dose and infection risk outputs. For rotavirus and rhinovirus, a >99.99% viral surface reduction would be needed to achieve a one-in-a-million risk target. This study quantifies reductions of infection risk relative to surface disinfectant use and demonstrates that risk targets for low-infectious-dose organisms may be more challenging to achieve.IMPORTANCE It is known that the use of EPA-registered surface disinfectant sprays can reduce infection risk if used according to the manufacturer's instructions. However, there are currently no standards for health care environments related to contamination levels on surfaces. The significance of this research is in quantifying needed reductions to meet various risk targets using realistic viral concentrations on surfaces for health care environments. This research informs the design of cleaning protocols by demonstrating that multiple applications may be needed to reduce risk and by highlighting a need for more models exploring the relationship among microbial contamination of surfaces, patient and health care worker behaviors, and infection risks.

Abstract P-446: VIRAL RESPIRATORY INFECTIONS ACQUIRED DURING PEDIATRIC INTENSIVE CARE UNIT ADMISSION

Aims & Objectives: Reduction of nosocomial infections represents an increasingly recognized aspect of Pediatric Intensive Care Unit (PICU) benchmarking. We investigated the incidence and outcomes of acquired viral respiratory infections in children admitted to a PICU with length of stay (LOS) >48 hours. Methods Multicenter, statewide retrospective study including all children (<16-years) requiring PICU admission for >48hours (1-Jan-2008 until 31-Dec-2013). Testing was performed in symptomatic patients using Polymerase Chain Reaction (PCR) capturing nine respiratory viruses. Patients were defined as having a PICU-acquired viral infection if the PCR result was positive after 48hrs of PICU admission until PICU discharge. Duration of intubation and total duration of respiratory support were primary outcomes. Results Of 3,607 patients admitted >48hours to PICU, 102 (2.8%) had a PICU-acquired viral infection, translating into a nosocomial viral infection rate of 0.9/100 PICU patients and 2.8/1000 PICU patient days. Compared to negative/untested patients with PICU LOS >48hrs, those with PICU-acquired viral infections had greater intubation duration (164 versus 67hrs, p<0.001), longer respiratory support (204 versus 68hrs, p<0.001), were more likely to require extracorporeal life support (OR 5.3;2.7–10.3; p<0.001), high-frequency oscillatory ventilation (OR 3.0;1.7–5.4; p<0.001), and inhaled nitric oxide (OR 2.7;1.5–5.0; p=0.001). In multivariate analysis adjusted for LOS, age and PIM2 score, PICU-acquired viral infections were associated with prolonged intubation (p=0.004) and longer total respiratory support(p<0.001). Conclusions The acquisition of a viral infection during PICU admission is associated with significant morbidity, translating into substantial burden to PICU health-care systems. Surveillance and preventative infection control measures for viruses should be considered in PICU quality improvement initiatives.

Transmission and Control of Respiratory Viral Infections in the Healthcare Setting.

Purpose of the reviewViral respiratory infections have been recognized as a cause of severe illness in immunocompromised and non-immunocompromised hosts. This acknowledgement is a consequence of improvement in diagnosis and better understanding of transmission. Available vaccines and antiviral drugs for prophylaxis and treatment have been developed accordingly. Viral respiratory pathogens are increasingly recognized as nosocomial pathogens as well. The purpose of this review is to describe the most frequent and relevant nosocomial viral respiratory infections, their mechanisms of transmission and the infection control measures to prevent their spread in the healthcare setting.Recent findingsAlthough most mechanisms of transmission and control measures of nosocomial viral infections are already known, improved diagnostic tools allow better characterization of these infections and also lead to the discovery of new viruses such as the coronavirus, which is the cause of the Middle East Respiratory Syndrome, or the human bocavirus. Also, the ability to understand better the impact, dissemination and prevention of these viruses, allows us to improve the measures to prevent these infections.SummaryHealthcare viral respiratory infections increase patient morbidity. Each virus has a different mechanism of transmission; therefore, early detection and prompt implementation of infection control measures are very important in order to avoid their transmission in the hospital setting.

Sibling visits and viral infection in the neonatal intensive care unit.

Sibling visits to the neonatal intensive care unit (NICU) are a part of family-centered care, which is now being increasingly endorsed as a positive development in patient care. Sibling visits, however, pose a risk of viral infection, and hence many NICU in Japan impose strict limits on the practice. The aim of this study was therefore to assess whether sibling visits to the NICU are related to an increase in the nosocomial viral infection rate. This retrospective study was conducted between April 2012 and March 2017 at Tokyo Metropolitan Children's Medical Center in Japan. Sibling visits were implemented after screening for symptoms of viral illness. Symptomatic patients in the NICU were tested for common viruses on rapid antigen test and polymerase chain reaction. The number of sibling visits and the rate of nosocomial viral infections were examined on Spearman's correlation test. The total number of sibling visits and rate of nosocomial viral infection in the NICU was 102 and 0.068 per 1,000 patient-days during the study period, respectively. The number of enterovirus, respiratory syncytial virus, human metapneumovirus, influenza virus A, and Herpes simplex virus infections was 3, 2, 1, 1, 1, and 1, respectively. No infections were identified after sibling visits. The number of sibling visits and the rate of nosocomial viral infections were not correlated (correlation coefficient, -0.1; P = 0.873). Sibling visits to the NICU did not result in an increase in the nosocomial viral infection rate.

Outcomes of Nosocomial Viral Respiratory Infections in High-Risk Neonates.

Neonatal respiratory disease, particularly bronchopulmonary dysplasia, remains one of the leading causes of morbidity and mortality in newborn infants. Recent evidence suggests nosocomially acquired viral respiratory tract infections (VRTIs) are not uncommon in the NICU. The goal of this study was to assess the association between nosocomial VRTIs, neonatal respiratory disease, and the health care related costs. A matched case-control study was conducted in 2 tertiary NICUs during a 6-year period in Nottingham, United Kingdom. Case subjects were symptomatic neonatal patients with a confirmed real-time polymerase chain reaction diagnosis of a VRTI. Matched controls had never tested positive for a VRTI. Multivariable logistic regression was used to test for associations with key respiratory outcomes. There were 7995 admissions during the study period, with 92 case subjects matched to 183 control subjects. Baseline characteristics were similar, with a median gestation of 29 weeks. Rhinovirus was found in 74% of VRTIs. During VRTIs, 51% of infants needed escalation of respiratory support, and case subjects required significantly more respiratory pressure support overall (25 vs 7 days; P < .001). Case subjects spent longer in the hospital (76 vs 41 days; P < .001), twice as many required home oxygen (37%; odds ratio: 3.94 [95% confidence interval: 1.92-8.06]; P < .001), and in-hospital care costs were significantly higher (£49 664 [$71 861] vs £22 155 [$32 057]; P < .001). Nosocomial VRTIs in neonatal patients are associated with significant greater respiratory morbidity and health care costs. Prevention efforts must be explored.

G109 Restricting visitors to the nicu significantly reduces nosocomial viral respiratory tract infections in babies

Introduction Recent data suggest 8–52% of babies on the NICU have evidence of a viral respiratory tract infection (VRTI) (Ronchi 2014, Bennett 2012). These studies, and our own data, indicate babies with VRTIs spend twice as long in hospital and have significantly worse respiratory outcomes such as chronic lung disease and the need for home oxygen. There is little evidence exploring ways of reducing these infections in the NICU. Our recent survey demonstrates significant variation in UK NICU visiting practices and isolation policies for babies with RVTIs. Aim To establish the impact of visitor restriction on the incidence of NICU VRTIs. Methods We performed a retrospective study of all admissions between 2007 and 2013 at two large UK tertiary NICUs (˜13,300 bed days/year). Normal visiting policy included parents, family and friends. During the periods November to April of 2009, 2010 and 2011, in response to the H1N1 pandemic, we restricted visiting to parents/carers only. No other variations in practice occurred. We identified all babies positive for VRTIs. We used a Poisson generalised additive model (GAM), factoring in workload intensity and incidence of community VRTIs, to calculate the impact of these 3 winter restriction periods compared with normal visiting. Results There were 100 PCR proven VRTIs in 93 babies during this period (˜16/yr). Rhinovirus (n = 71), RSV (n = 8) and H1N1 (n = 5) were the most common. The median gestation of infected babies was 29 weeks (IQR 26–34 Weeks) and 46% required an escalation of respiratory support. Two of five H1N1 positive babies died. The results from the GAM suggest there was a 39% reduction (P Conclusion This is the first study demonstrating a significant reduction in NICU VRTIs through restricting visiting practices. VRTIs are associated with significant neonatal respiratory morbidity and have short and long-term resource implications. We need to explore better ways of minimising the impact of VRTIs in this vulnerable population.

985Uncommon Outcomes due to Common Colds: Epidemiology and Outcomes Associated with Nosocomial Viral Infections in Children

985Uncommon Outcomes due to Common Colds: Epidemiology and Outcomes Associated with Nosocomial Viral Infections in Children

Nosocomial respiratory viral infection

Nosocomial viral infections have not been well studied. In this context, the aim of this work is to review epidemiological and therapeutic data published on the main viral agents that can produce nosocomial respiratory infection. The study thus aims to expand knowledge of behaviour of these agents in nosocomial infections and provide information to improve the implementation of preventive measures. The concepts of mimivirus, herpes simplex virus, varicella-zoster virus, cytomegalovirus, respiratory syncytial virus, parainfluenza virus, influenza virus, adenovirus, metapneumovirus and measles viruses are discussed in detail.

P180: The value of real-time sequence based information in surveillance of nosocomial viral infections

Sequence based information is increasingly used in the surveillance of viruses, not only to provide insight in viral evolution, but as a tool to define transmission routes. As most laboratories have not incorporated sequence analysis in their daily routine, information on typing of viruses is mostly available retrospectively. Reducing the time needed to get sequence based information available during an outbreak, should benefit the understanding of transmission routes and guide the implementation of appropriate infection control measures.

A retrospective analysis of nosocomial viral gastrointestinal and respiratory tract infections

A retrospective analysis of nosocomial viral gastrointestinal and respiratory tract infections

A Retrospective Analysis of Nosocomial Viral Gastrointestinal and Respiratory Tract Infections

Viral nosocomial infections (NIs) in children are common and most frequently affect the gastrointestinal or respiratory tract. Few studies are dedicated to this topic. We aimed to determine incidence and characteristics of these specific viral NIs at our hospital. This was a retrospective analysis of nosocomial gastroenteritis and respiratory tract infections (RTIs) of hospitalized patients at the University Children's Hospital Basel over a 12-month period. Patients with new-onset gastroenteritis or RTI during hospitalization or a physician diagnosis of NI on discharge were included for analysis. NIs were defined by use of Centers for Disease Control and Prevention recommendations and specific agents' incubation periods. Overall, 5493 patients were hospitalized accounting for 22,251 hospital days. Forty-five (0.8%) patients acquired an NI: 15 cases of gastroenteritis (mean age, 9.9 months; range: 3-24; NI incidence: 0.7 per 1000 hospitalization days) and 30 cases of RTI (mean age, 63.7 months; range: 1-174; NI incidence: 1.3 per 1000 hospitalization days). Main agents were rotavirus (10/15 gastroenteritis, 67%) and rhinovirus (22/30 nosocomial RTI; 73%). Physicians reported 9 cases of NI, of which 2 (22%) did not fulfill the criteria for an NI, 3 were surgical site infections, 1 was a case of rotavirus gastroenteritis and 3 were RTIs by rhinovirus. Viral NIs, especially caused by rotavirus and rhinovirus, are frequent in children of all ages but underestimated if exclusively reported by physicians. Prospective studies should further investigate the role and epidemiology of rhinovirus in nosocomial RTI, ideally by use of automated information technology support.

Human Coronaviruses: Insights into Environmental Resistance and Its Influence on the Development of New Antiseptic Strategies

The Coronaviridae family, an enveloped RNA virus family, and, more particularly, human coronaviruses (HCoV), were historically known to be responsible for a large portion of common colds and other upper respiratory tract infections. HCoV are now known to be involved in more serious respiratory diseases, i.e. bronchitis, bronchiolitis or pneumonia, especially in young children and neonates, elderly people and immunosuppressed patients. They have also been involved in nosocomial viral infections. In 2002–2003, the outbreak of severe acute respiratory syndrome (SARS), due to a newly discovered coronavirus, the SARS-associated coronavirus (SARS-CoV); led to a new awareness of the medical importance of the Coronaviridae family. This pathogen, responsible for an emerging disease in humans, with high risk of fatal outcome; underline the pressing need for new approaches to the management of the infection, and primarily to its prevention. Another interesting feature of coronaviruses is their potential environmental resistance, despite the accepted fragility of enveloped viruses. Indeed, several studies have described the ability of HCoVs (i.e. HCoV 229E, HCoV OC43 (also known as betacoronavirus 1), NL63, HKU1 or SARS-CoV) to survive in different environmental conditions (e.g. temperature and humidity), on different supports found in hospital settings such as aluminum, sterile sponges or latex surgical gloves or in biological fluids. Finally, taking into account the persisting lack of specific antiviral treatments (there is, in fact, no specific treatment available to fight coronaviruses infections), the Coronaviridae specificities (i.e. pathogenicity, potential environmental resistance) make them a challenging model for the development of efficient means of prevention, as an adapted antisepsis-disinfection, to prevent the environmental spread of such infective agents. This review will summarize current knowledge on the capacity of human coronaviruses to survive in the environment and the efficacy of well-known antiseptic-disinfectants against them, with particular focus on the development of new methodologies to evaluate the activity of new antiseptic-disinfectants on viruses.