Nosocomial respiratory syncytial virus infection: impact of prospective surveillance and targeted infection control.
BACKGROUND
Nosocomially acquired respiratory syncytial virus (RSV) infections cause serious problems in hospitalized patients. An increased effort should be made to describe the problems connected with such infections in pediatric hospitals, with the aim of reducing the occurrence of nosocomial RSV infections (NI).


METHODS
A specialized database was introduced for surveillance and a multifaceted barrier concept based on the CDC recommendations was developed for the control of NI in a university children's hospital in Germany.


RESULTS
Between 1999 and 2002 (November 1-April 30), 283 RSV infections (general population) were prospectively documented. Thirty-nine cases (13.8%) were nosocomial infections (NI) with an incidence density (ID) of 0.99/1000 patient days; 48.7% of all NI were found in prematurely born infants. Following the introduction of a surveillance and prevention policy, a 9-fold decrease of the ID (1.67 vs. 0.18/1000 patient-days) was found when comparing the first and the last season. Intensive care treatment was required in 18% of all documented RSV-infections, in 48.7% of all NI cases and in 43.5% of all RSV-infected prematurely born infants. Overall RSV-related mortality was 0.71%.


CONCLUSIONS
Early diagnosis, a strict cohorting and contact isolation policy, and prospective surveillance contribute to the reduction of nosocomial RSV infection.
Simon
Arne
A
Children's Hospital, Medical Centre, University of Bonn, Adenauerallee, Germany. asimon@ukb.uni-bonn.de
Khurana
Karun
K
Wilkesmann
Anja
A
Müller
Andreas
A
Engelhart
Steffen
S
Exner
Martin
M
Schildgen
Oliver
O
Eis-Hübinger
Anna M
AM
Groothuis
Jessie R
JR
Bode
Udo
U
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005858:Germany; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D017053:Infection Control; D007902:Length of Stay; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D012307:Risk Factors; D012720:Severity of Illness Index
D000305:Adrenal Cortex Hormones; D004837:Epinephrine