title: [Respiratory syncytial virus outbreak in a tertiary hospital Neonatal Intensive Care Unit].
abstract: BACKGROUND
  Investigation and control of a respiratory syncytial virus (RSV) outbreak that affected the Neonatal Intensive Care Unit (NICU) of a university hospital from October to December 2012.
  
  
  METHODS
  Cohort study of children admitted to the NICU. The infection attack rate was calculated. A descriptive analysis of the cases and a multivariate analysis was performed using the variables that were shown to be risk factors for RSV infection. Preventive measures taken were: contact isolation; hand hygiene training and observation; exclusivity of a health team of nurses and physicians for positive cases, restrictions on visitor numbers; surveillance RSV testing, and palivizumab prophylaxis.
  
  
  RESULTS
  The outbreak had three epidemic waves and 20 positive cases out of a total of 48 children admitted. The overall attack rate was 42%. Half of positive cases were children, with a median age of 36 days (p25=22, p75=58). The independent risk factors for RSV infection were birth weight below 1000 grams (OR=23.5; P=.002) and to have another nosocomial infection the week before the diagnosis of RSV infection (OR=19.98; P=.016).
  
  
  CONCLUSIONS
  It was an outbreak with a high number of cases, due to the delay in notification, prolonged RSV carrier status, and low adherence to hand hygiene practice, which favoured the cross-transmission of infection. The most effective preventive measures were direct observation of hand hygiene and supervision of isolation measures.
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, España. Electronic address: carlos.moreno.parejo@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Moreno Parejo
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: Aurea
authors.initials: A
authors.lastname: Morillo García
authors.affiliation: Servicio de Microbiología y Parasitología, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Lozano Domínguez
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: Concepción
authors.initials: C
authors.lastname: Carreño Ochoa
authors.affiliation: Servicio de Microbiología y Parasitología, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Aznar Martín
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Conde Herrera
mesh_terms: D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology* / Q000517:prevention & control; D062606:Tertiary Care Centers
keywords: Brote epidémico; Cross infection; Cuidados intensivos neonatales; Disease outbreaks; Hand hygiene; Higiene de manos; Infección nosocomial; Intensive care, neonatal; Respiratory syncytial viruses; Virus respiratorio sincitial