Nosocomial Viral Infections Research Articles

Infection control in pediatric hospitals.

Important characteristics of hospital infection control are specific to pediatric facilities. For example, colonization and infection with vancomycin-resistant enterococci, which are widely spread in many units housing adult patients, are uncommon in children, especially in the neonatal intensive care unit where vancomycin use is heavy. Characteristics of the neonatal intensive care unit, such as the insulated environment and infrequent treatment with antibiotics with broad anaerobic activity, likely account for this finding. Artificial fingernails have been discovered to promote colonization with potential pathogens; their implication in recent nursery epidemics emphasizes the need to prohibit their use in this environment in particular. Finally, nosocomial viral infections occur with regularity in pediatric hospitals. Programs that successfully and cost-effectively control hospital spread of respiratory syncytial virus, however, demonstrate that rational, multifaceted interventions can nearly eliminate transmission of certain viral pathogens on the pediatric wards.

Epidemiology and prevention of pediatric viral respiratory infections in health-care institutions.

Nosocomial viral respiratory infections cause considerable illness and death on pediatric wards. Common causes of these infections include respiratory syncytial virus and influenza. Although primarily a community pathogen, rhinovirus also occasionally results in hospitalization and serious sequelae. This article reviews effective infection control interventions for these three pathogens, as well as ongoing controversies.

Nosocomial viral infections revisited

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).

S08 – Nosocomial viral infections in pediatrics

S08 – Nosocomial viral infections in pediatrics

Prospective Evaluation of Community-Acquired and Nosocomial Viral Respiratory Tract Infections in a Neonatal and Pediatric Intensive Care Unit

Prospective Evaluation of Community-Acquired and Nosocomial Viral Respiratory Tract Infections in a Neonatal and Pediatric Intensive Care Unit

P38 Viral nosocomial infections in diabetic children and adolescents

P38 Viral nosocomial infections in diabetic children and adolescents

Viral hazards to and from health care workers

Much attention has been directed towards nosocomial transmission of viruses as a result of clear evidence of patient-to-staff and staff-to-patient transmission of the blood-borne viruses HIV and hepatitis B virus. Although the relatively long incubation periods of these viruses, together with the frequency of asymptomatic infections, renders problems for surveillance it has been possible to study modes of transmission and levels of risk over a number of years. Information on trends of incidence of other nosocomial virus infections has been difficult to obtain for a number of reasons. Often, an outbreak in the health care setting parallels an epidemic in the community. Although it may be possible to define nosocomial transmission from recording dates of onset of illness relative to admission date and, at times, demonstrate circulation of a common strain by molecular techniques, the relative contributions of patient-to-staff and staff-to-patient transmission may be difficult to clarify. In this review, details are presented of the major viruses associated with nosocomial transmission with examples of infections to and from staff where these have occurred. The major defences against patient-to-staff and staff-to-patient transmission are awareness of potential risks, education and adherence to infection control policies, immunization of staff, effective decontamination and sterilization and the adoption of ‘Universal Precautions’ in patient care. In addition, there may be occasions when additional measures should be considered including isolation, cohorting and the use of specific chemo- and immunoprophylaxis.

200 NOSOCOMIAL TRANSMISSION OF ADENOVIRUS INFECTIONIN NEONATES

Limited information about the impact of viral infections in neonatal intensive care units (NICU) represents an important gap. On 30 December 1992 onset of acute respiratory illness with lobar Pneumonia, fever and oxygen deficit was observed in a full-term hospitalized newborn who was admitted to NICU six weeks ago with meconium ileus and M. Hirschprung diseases. In spite of isolation of the male infant in the unit, five neonates became ill with coryza and fever after 6 days of his isolation. Of the six neonates, three were full-term male newborn suffering from humerus fracture, mucoviscidosis, congenital vitium cordis for 6, 14 and 26 days, respectively. The other two sick female neonates were nursed for 41 and 10 days, respectively, in Unit of Premature infants. Adenovirus infection was proved from nose and fecal samples by virus isolation and immunofluorescence assay of all sick newborns. In male infants, particularly, the viral infection associated with serious complications. All of them developed pneumonia and onw was lost. Rigorous triage and cohorting of staff and babies were started and the nosocomial outbreak abruptly stopped on 19 January. It was concluded that health care workers could be important contributors to the nosocomial spread of adenovirus infection to newborns. Attention is called to the importance of effective preventive measures and well-trained staff in NICU to decrease the risk of nosocomial viral infections.

Transmission of nosocomial virus infections by health care workers

Transmission of nosocomial virus infections by health care workers

Major trends in nosocomial viral infections

Viruses have recently become appreciated as nosocomial pathogens. There is insufficient data to characterize trends in rates of viral nosocomial infections, but there have been major trends in methodologies and concepts. New groups of patients, such as infants and the elderly, are becoming appreciated as being at risk for serious nosocomial viral infections, whereas other groups, such as immunodeficient patients are expanding because of the epidemic of human immunodeficiency virus (HIV) infection and expanded use of immunosuppressive treatment. The continued addition of new viruses, such as HIV, human parvovirus B19, and rabies virus, to the list of potential nosocomial pathogens suggest that most human viruses can probably be serious nosocomial pathogens under the right circumstances. Advances in medical treatments and procedures, such as cadaveric dura mater grafts and laser treatment of warts, have provided new avenues for nosocomial transmission of viruses. Improved and wider availability of diagnostics promises to be a major force in improving our understanding and ability to prevent viral nosocomial infections. With these advances, viral diagnostic laboratories should become an important member of the infection control team. In parallel with trends in methodologies and concepts, there have been major advances in our understanding of ways to prevent some nosocomial viral infections. Application of these prevention measures is an important challenge to the infection control practitioner.

Nosocomial viral and fungal infections and miscellanceous topics

Nosocomial viral and fungal infections and miscellanceous topics

Nosocomial viral infections: Recent developments and new strategies

Surveillance studies generally have underestimated the importance of viruses in the pathogenesis of nosocomial respiratory tract infections. The development of rapid, sensitive and reliable diagnostic techniques has permitted documentation of viral respiratory pathogens and has led to increased understanding of the epidemiology of these organisms in the hospital. These advances are exemplified by studies of respiratory syncytial virus infections in hospitalized children. The pulmonary sequelae of RSV infection are particularly serious in neonates and in children with underlying cardiopulmonary disease or immunodeficiency. Virus is spread by direct hand contact with the secretions of infected patients or with contaminated objects in the patients' environment. Personnel may infect themselves by rubbing their eyes or nose with contaminated hands, thus becoming vectors in the transmission of RSV to patients under their care. Compliance with contact precautions, which requires the use of gloves and gown, dramatically reduces the incidence of nosocomial RSV infection. When children do become ill, ribavirin may ameliorate the disease. Immunological approaches to treatment and prevention are being examined.

Risk factors associated with echovirus 11' infection in a hospital nursery.

An outbreak of nosocomial echovirus 11' illness occurred between July 22 and August 12, 1983, infecting 14 infants in the nurseries at a hospital. Stool, throat or cerebrospinal fluid specimens for viral isolation were obtained from 142 and serum pairs from 98 of the 192 infants exposed to the nurseries during the outbreak. Infection was determined by isolation of virus from stool or cerebrospinal fluid and/or a 4-fold rise in neutralizing antibody to echovirus 11'. Eight infants were severely ill with seizures, pleocytosis or apnea; one infant died. Four infants were mildly ill; two were asymptomatic. Immune serum globulin, administered to all hospitalized infants on July 31, did not appear to attenuate echovirus 11' illness. Infants present in the Intermediate Care Unit greater than 48 hours were more likely to become infected than infants present less than or equal to 48 hours (attack rates, 25 and 3%, respectively). Among infants present in the Intermediate Care Unit, illness was associated with gavage feeding, mouth care and being a twin (P less than 0.05). These findings support the importance of good hygienic practices in preventing nosocomial viral infections.

Nosocomial viral infections: IV. Guidelines for cohort isolation, the communicable disease survey, collection, and transport of specimens for virus isolation, and considerations for the future.

Virus transmission within the hospital is related to transmissibility of the virus and susceptibility of the population at risk. General guidelines for the use of cohort isolation, for the control of virus transmission in the hospital, and for the use of the communicable disease survey for pediatric patients and visitors to the hospital are out-lined. We also present a brief review of how to collect and transport specimens for virus isolation to assist the infection control practitioner and the clinician and conclude with recommendations for further investigations in the areas of virology and infection control.

Nosocomial viral respiratory infections: Perennial weeds on pediatric wards

The frequency and importance of nosocomial infections of the respiratory tract in pediatrics have generally been underestimated. In part this has resulted from the emphasis on bacterial infections which occur primarily in select at-risk populations. Most respiratory infections in pediatric patients, hospital- and community-acquired, are viral and all patients are potentially susceptible. The epidemiologic patterns of these viral respiratory agents on the ward mirror those seen in the community in terms of frequency, season, age affected and severity of illness. Hence, the most frequent nosocomial agents are the viruses that occur in outbreaks or epidemics and cause respiratory illness, epidemic respiratory viruses—respiratory syncytial virus, which causes the greatest morbidity and mortality; influenza, and the parainfluenza viruses. Their import, as exemplified by respiratory syncytial virus, results from (1) the severity of disease produced in young children, which is magnified in those hospitalized with certain underlying conditions; (2) the abundant and prolonged viral shedding, allowing easy spread; (3) the potential susceptibility of all patients and staff, since infections recur throughout life; and (4) the difficulty in controlling nosocomial spread.

Nosocomial viral infections: III. Guidelines for prevention and control of exanthematous viruses, gastroenteritis viruses, picornaviruses, and uncommonly seen viruses.

This communication is the third in a four-part series on nosocomial viral infections from the Strong Memorial Hospital. This third article discusses guidelines for prevention and control of exanthematous viruses, gastroenteritis, viruses, adenoviruses and the picornaviruses other than rhinoviruses. Several uncommonly seen viruses, such as the virus of Creutzfeldt-Jakob disease and Marburg, Ebola, and Lassa fever viruses, also are reviewed briefly.

Seminars in Infectious Disease

This offering is second volume of what is planned be an annual series of review articles. Its aim is recognize the need for yearly review of old and recently acquired knowledge in area of infectious and to provide a forum useful all physicians interested in art and science of infectious diseases. A distinguished group of clinicians and investigators has assembled ten review articles that include Hirschman's masterpiece on viral hepatitis, Ratzan's scholarly analysis of role of surface factors in pathogenesis of infection, and well-written discussion on mechanisms in production of fever. Equally informative are chapters on nosocomial viral infections, nutritional determinants of host responses in infection, and diseases caused by human herpesviruses. An outstanding feature of all these articles is inclusion of current references, some as recent as 1979. The review of newer microbiological methods is well

Nosocomial viral infections: I. Epidemiology and significance.

Viral illnesses in Strong Memorial Hospital were monitored over a 17-month period. Using criteria based primarily on the incubation periods for a number of common virus infections, the infections we found were classified as hospital- or community-acquired. Hospital-acquired viral infections occurred on most hospital services; the majority of infections occurred on the pediatric and psychiatric services. Infections due to herpesviruses were seen more frequently in a group of patients aged 14 years or older, while infections in patients aged three years or younger were more likely to be due to respiratory syncytial virus, influenzavirus, adenovirus, or parainfluenza virus. Patients with nosocomial infections due to viruses were hospitalized an average of 9.3 days longer than uninfected controls; thus nosocomial viral infections result in increased costs of hospitalization.

Nosocomial viral infections: II. Guidelines for prevention and control of respiratory viruses, herpesviruses, and hepatitis viruses.

This article reviews the most likely mechanisms of transmission of the commonly encountered respiratory viruses (influenza, respiratory syncytial virus, parainfluenza, rhinovirus), herpesviruses, and hepatitis viruses, and presents the guidelines used currently for prevention and control that are in use at Strong Memorial Hospital.