title: Screening for respiratory syncytial virus and assignment to a cohort at admission to reduce nosocomial transmission.
abstract: To limit nosocomial spread of respiratory syncytial virus (RSV) infection, a longitudinal intervention trial was instituted. Nasal secretions or washes were screened for RSV antigen by enzyme-linked immunosorbent assay, and patients were assigned to an RSV-infected or an RSV-uninfected cohort. The baseline (preintervention) rate of 7.17 nosocomial cases of RSV per 1000 patient-days of care was used for comparison. Despite continued infections in the community after screening was initiated, there were no cases of RSV infection in 1880 patient-days of care for 3 months (p = 0.039). During the fourth month, an RSV-infected child was erroneously assigned to the RSV-uninfected cohort, and three nosocomial cases occurred--5.33/1000 patient-days of care (p = 0.286). Overall, there were three nosocomial RSV infections in 2443 patient-days of care in the 1987 season after screening was introduced--1.23/1000 patient-days of care (p = 0.026). In the subsequent RSV season, there was one nosocomial case--0.461/1000 patient-days of care for 3 months (p = 0.0074). During the same period, nosocomial cases of RSV were observed in the pediatric and neonatal intensive care units, where assignment to a cohort was not possible. We conclude that entry into a cohort at the time of admission, on the basis of prospective RSV screening by enzyme-linked immunosorbent assay, effectively reduces nosocomial transmission of RSV.
authors.affiliation: Department of Pediatrics, New York University Medical Center-Bellevue Hospital Center, NY 10016.
authors.forename: K
authors.initials: K
authors.lastname: Krasinski
authors.forename: R
authors.initials: R
authors.lastname: LaCouture
authors.forename: R S
authors.initials: RS
authors.lastname: Holzman
authors.forename: E
authors.initials: E
authors.lastname: Waithe
authors.forename: S
authors.initials: S
authors.lastname: Bonk
authors.forename: B
authors.initials: B
authors.lastname: Hanna
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008137:Longitudinal Studies; D008403:Mass Screening; D010343:Patient Admission; D012136:Respiratory Syncytial Viruses; D012141:Respiratory Tract Infections / Q000517:prevention & control* / Q000635:transmission; D010253:Respirovirus Infections / Q000517:prevention & control* / Q000635:transmission; D012307:Risk Factors