Prospective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory syncytial virus

doi:10.1016/0140-6736(92)93088-5

The Lancet

Volume 340, Issue 8827, 31 October 1992, Pages 1079-1083

https://doi.org/10.1016/0140-6736(92)93088-5 Get rights and content

Abstract

To determine the most effective infection control procedure in preventing nosocomial infection with respiratory syncytial virus (RSV), we did a prospective controlled study of four infection-control strategies in four wards in a large paediatric hospital in the west of Scotland. All children under two years old admitted to four general wards during three winter RSV epidemics (1989-92) were screened for RSV infection (by nasopharyngeal aspirate and direct immunofluorescence) within 18 hours of admission. The main outcome measure was the occurrence of nosocomial infection, defined as the number of children initially RSV negative who became RSV positive 7 days or more after hospital admission (incubation period for RSV infection is 5-8 days). Without special precautions, there was a high rate of nosocomial RSV infection (26%). Nosocomial infection was significantly reduced by the combination of cohort nursing with the wearing of gowns and gloves for all contacts of RSV-infected children (p=0·0022). Neither the use of gowns and gloves alone nor cohort nursing alone produced a significant reduction in cross-infection. In the final year, general clinical use of a policy of cohort nursing with gowns and gloves resulted in a reduction in the cross-infection rate by two-thirds of its original value (9·5% vs 26%). Combined with rapid laboratory diagnosis, cohort nursing and the wearing of gowns and gloves for all contacts with RSV-infected children can significantly reduce the risk of nosocomial RSV infection.

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Citation Excerpt :
New, molecular RT-PCR tests for RSV either conducted singly (Alere i RSV test) or as part of a multiplex panel (bioMerieux BioFire FilmArray) provide results in 13-45 minutes which is of essence to rapidly control outbreaks.17,24,34,48-51 All the reports on RSVNI in the NICU setting documented the use of standard preventive measures as the first step in the control of an outbreak which is rational and aligns with the published literature.8,14,22,23,34,36,57-60 In our review, 7 out of the 17 studies implemented infection control measures as the sole intervention.10,15,30-32,35,36
The main objective was to determine the incidence, management, and outcomes of respiratory syncytial virus nosocomial infection (RSVNI) outbreaks in neonatal intensive care units.
A comprehensive search of RSVNI in 9 databases was conducted from January 1, 2000 to May 1, 2021, of which the Cochrane Library comprised the Cochrane central register of controlled trials and the Cochrane database of systematic reviews. Two hundred and twenty-eight articles were retrieved and 17 were retained. A descriptive analysis was performed, and frequencies are reported as mean, median, and range where pertinent.
One hundred and seventeen infants were analyzed and comprised preterms (88.1%) and those with pre-existing co-morbidities. The estimated proportional incidence of RSVNI was 23.8% (177/744) infants. Outbreaks were principally managed by conventional protective measures, neonatal intensive care unit closure, and visitor restriction. Palivizumab was used to control RSVNI in 10 studies. RSVNI-related mortality was 8.5% (15/177) and 8.0% (7/87) among infants where infection control was solely employed.
RSVNI is associated with significant morbidity and mortality. The use of palivizumab should be a multidisciplinary decision, based on rapidly spreading infection. Prospective studies are essential to determine the cost-benefit of palivizumab versus standard prevention control for an RSVNI outbreak.
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2018, Avery's Diseases of the Newborn: Tenth Edition
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  Viral infections of the fetus and newborn are common problems in neonatology practice and must be considered in the differential diagnosis of newborns with intrauterine growth retardation, physical examination and laboratory abnormalities, and illness in the newborn period.
- •
  The diversity of fetal and neonatal viral infections is vast. The depth and breadth of viral disease are extensive and the differential diagnosis broad.
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  Clinicians should consider specific causes and not rely on broad-based categorical consideration of Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes Simplex Virus (TORCH) syndromes, since specific signs, symptoms, and findings are quite diverse, depending on the pathogen being considered.
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  Antiviral therapies are now available for many of these pathogens, underscoring the importance of making a specific diagnosis.
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  Laboratory studies focused on virologic detection, driven in most cases by molecular assays, are much more precise and reliable than serologic diagnosis.
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Reverse-transcription loop-mediated isothermal amplification for rapid detection of respiratory syncytial virus directly from nasopharyngeal swabs
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Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infection in young infants and a major cause of nosocomial infection in pediatric care. Currently available RSV point-of-care tests are of limited sensitivity and relatively expensive. We developed and evaluated a novel RSV rapid test for use at point-of-care, based on reverse-transcription loop-mediated isothermal amplification (RT-LAMP) for direct testing of nasopharyngeal swab specimens. RT-LAMP can detect RSV within 30 min, without the need for RNA extraction. The sensitivity of our RT-LAMP assay was 70–80% in comparison to RT-PCR. The RT-LAMP test sensitivity is at least equivalent to currently available rapid antigen detection tests (RADT), and the cost of RT-LAMP test reagents is only approximately 10% of that of commercially available RADT tests. RT-LAMP appears to be an attractive alternative to RADT, particularly in settings with limited financial resources. Future improvements could include lyophilization of test reagents and automated read-out of RT-LAMP results.

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CLINICAL PRACTICEProspective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory syncytial virus

Abstract

J Pediatr

J Pediatr

J Pediatr

Respiratory syncytial virus in hospital cross-infection

BMJ

Respiratory syncytial virus infection in infants with congenital heart disease

N Engl J Med

Respiratory syncytial virus infection in children with compromised immune function

N Engl J Med

Possible transmission by fomites of respiratory syncytial virus

J Infect Dis

Infectivity of respiratory syncytial virus by various routes of inoculation

Infect Immun

Infection rate in personnel caring for children with RSV infections

Am J Dis Child

CLINICAL PRACTICE
Prospective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory syncytial virus