title: Nosocomial respiratory syncytial virus infection in Canadian pediatric hospitals: a Pediatric Investigators Collaborative Network on Infections in Canada Study.
abstract: OBJECTIVE
  To determine nosocomial transmission of respiratory syncytial virus (RSV) in Canadian pediatric hospitals, outcomes associated with nosocomial disease, and infection control practices.
  
  
  METHODS
  A prospective cohort study in the 1992 to 1994 winter respiratory seasons.
  
  
  METHODS
  Nine Canadian pediatric university-affiliated hospitals.
  
  
  METHODS
  Hospitalized children with symptoms of lower respiratory tract infection (at least one of cough, wheezing, dyspnea, tachypnea, and apnea) and RSV antigen identified in a nasopharyngeal aspirate.
  
  
  RESULTS
  Of 1516 children, 91 (6%) had nosocomial RSV (NRSV), defined as symptoms of lower respiratory tract infection and RSV antigen beginning >72 hours after admission. The nosocomial ratio (NRSV/[com-munity-acquired RSV {CARSV})] + NRSV) varied by site from 2.8% to 13%. The median length of stay attributable to RSV for community-acquired illness was 5 days, but 10 days for nosocomial illness. Four children with NRSV (4. 4%) died within 2 weeks of infection, compared with 6 (0.42%) with CARSV (relative risk = 10.4, 95% confidence interval: 3.0, 36.4). All sites isolated RSV-positive patients in single rooms or cohorted them. In a multivariate model, no particular isolation policy was associated with decreased nosocomial ratio, but gowning to enter the room was associated with increased risk of RSV transmission (incidence rate ratio 2.81; confidence interval: 1.65, 4.77).
  
  
  CONCLUSIONS
  RSV transmission risk in Canadian pediatric hospitals is generally low. Although use of barrier methods varies, all sites cohort or isolate RSV-positive patients in single rooms. Children with risk factors for severe disease who acquire infection nosocomially have prolonged stays and excess mortality.
authors.affiliation: Department of Pediatrics, Izaak Walton Killam Grace Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: Langley
authors.forename: J C
authors.initials: JC
authors.lastname: LeBlanc
authors.forename: E E
authors.initials: EE
authors.lastname: Wang
authors.forename: B J
authors.initials: BJ
authors.lastname: Law
authors.forename: N E
authors.initials: NE
authors.lastname: MacDonald
authors.forename: I
authors.initials: I
authors.lastname: Mitchell
authors.forename: D
authors.initials: D
authors.lastname: Stephens
authors.forename: J
authors.initials: J
authors.lastname: McDonald
authors.forename: F D
authors.initials: FD
authors.lastname: Boucher
authors.forename: S
authors.initials: S
authors.lastname: Dobson
mesh_terms: D002170:Canada / Q000453:epidemiology; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D017053:Infection Control / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D007902:Length of Stay; D015999:Multivariate Analysis; D016134:Organizational Policy; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*