title: Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review.
abstract: Respiratory syncytial virus (RSV) causes a significant public health burden, and outbreaks among vulnerable patients in hospital settings are of particular concern. We reviewed published and unpublished literature from hospital settings to assess: (i) nosocomial RSV transmission risk (attack rate) during outbreaks, (ii) effectiveness of infection control measures. We searched the following databases: MEDLINE, EMBASE, CINAHL, Cochrane Library, together with key websites, journals and grey literature, to end of 2012. Risk of bias was assessed using the Cochrane risk of bias tool or Newcastle-Ottawa scale. A narrative synthesis was conducted. Forty studies were included (19 addressing research question one, 21 addressing question two). RSV transmission risk varied by hospital setting; 6-56% (median: 28·5%) in neonatal/paediatric settings (n = 14), 6-12% (median: 7%) in adult haematology and transplant units (n = 3), and 30-32% in other adult settings (n = 2). For question two, most studies (n = 13) employed multi-component interventions (e.g. cohort nursing, personal protective equipment (PPE), isolation), and these were largely reported to be effective in reducing nosocomial transmission. Four studies examined staff PPE; eye protection appeared more effective than gowns and masks. One study reported on RSV prophylaxis for patients (RSV-Ig/palivizumab); there was no statistical evidence of effectiveness although the sample size was small. Overall, risk of bias for included studies tended to be high. We conclude that RSV transmission risk varies widely during hospital outbreaks. Although multi-component control strategies appear broadly successful, further research is required to disaggregate the effectiveness of individual components including the potential role of palivizumab prophylaxis.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.|NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK.
authors.forename: Clare E
authors.initials: CE
authors.lastname: French
authors.affiliation: University of Nottingham, Nottingham, UK.
authors.forename: Bruce C
authors.initials: BC
authors.lastname: McKenzie
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.|NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK.|Public Health England, London, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Coope
authors.affiliation: University of Nottingham, Nottingham, UK.
authors.forename: Subhadra
authors.initials: S
authors.lastname: Rajanaidu
authors.affiliation: Public Health England, London, UK.
authors.forename: Karthik
authors.initials: K
authors.lastname: Paranthaman
authors.affiliation: Public Health England, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Pebody
authors.affiliation: University of Nottingham, Nottingham, UK.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Nguyen-Van-Tam
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.|NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK.
authors.forename: Julian P T
authors.initials: JP
authors.lastname: Higgins
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.|NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK.|Public Health England, London, UK.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Beck
mesh_terms: D000818:Animals; D003428:Cross Infection / Q000517:prevention & control / Q000635:transmission / Q000821:virology; D006801:Humans; D017053:Infection Control; D018357:Respiratory Syncytial Virus Infections / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D018113:Respiratory Syncytial Virus, Human / Q000235:genetics / Q000502:physiology*
keywords: Infection control; nosocomial infections; palivizumab; personal protective equipment; respiratory syncytial virus