More Than a Cold: Hospital-Acquired Respiratory Viral Infections, Sick Leave Policy, and A Need for Culture Change

Abstract Background The guideline-driven and widely implemented single room isolation strategy for respiratory viral infections (RVI) such as influenza or respiratory syncytial virus (RSV) can lead to a shortage of available hospital beds. We discuss our experience with the introduction of droplet precautions on-site (DroPS) as a possible alternative. Methods During the 2018/19 influenza season we introduced DroPS on several wards of a single tertiary care center, while other wards maintained the traditional single room isolation strategy. On a daily basis, we evaluated patients for the development of respiratory symptoms and screened those with a clinical diagnosis of hospital-acquired respiratory viral infection (HARVI) for influenza/RSV by molecular rapid test. If negative, it was followed by a multiplex respiratory virus PCR. We report the concept of DroPS, the feasibility of the strategy and the rate of microbiologically confirmed HARVI with influenza or RSV infection on the DroPS wards compared to wards using the traditional single room isolation strategy. Results We evaluated all hospitalised patients at risk for a HARVI, 741 (72%) on the DroPS wards and 293 (28%) on the regular wards. The hospital-acquired infection rate with influenza or RSV was 2/741 (0.3%; 1× influenza A, 1× RSV) on the DroPS wards and 2/293 (0.7%; 2× influenza A) on the regular wards. Conclusions Droplet precautions on-site (DroPS) may be a simple and potentially resource-saving alternative to the standard single room isolation strategy for respiratory viral infections. Further studies in a larger clinical context are needed to document its safety.

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Hospital-Acquired Respiratory Viral Infections: Incidence, Morbidity, and Mortality in Pediatric and Adult Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx006 ◽

2017 ◽

Vol 4 (1) ◽

Cited By ~ 29

Author(s):

Eric J. Chow ◽

Leonard A. Mermel

Keyword(s):

Pediatric Patients ◽

Viral Infections ◽

A Priori ◽

Tertiary Care ◽

Morbidity And Mortality ◽

Pediatric Hospital ◽

Pediatric Hospitals ◽

Respiratory Viral Infections ◽

Hospital Acquired ◽

Hospital Study

Abstract Background Hospital-acquired respiratory viral infections can result in morbidity and mortality of hospitalized patients. This study was undertaken to better understand the magnitude of the problem of nosocomial respiratory viral infections in adult and pediatric patients. Methods This was a retrospective study at a tertiary care adult and pediatric teaching hospital. Study patients met a priori criteria for definite or possible nosocomial respiratory viral infection. Results From April 1, 2015 to April 1, 2016, we identified 40 nosocomial respiratory viral infections in 38 patients involving 14 definite and 3 possible cases in our adult hospital and 18 definite and 5 possible cases in our pediatric hospital. The incidence was 5 cases/10 000 admissions and 44 cases/10 000 admissions to our adult and pediatric hospitals, respectively. Only 6.8% of cases were due to influenza. Although 63% of cases occurred during the fall and winter, such infections were identified throughout the year. Five (13%) nosocomial respiratory viral infections occurred in 2 adult and 3 pediatric patients who died during the hospitalization. Conclusions Nosocomial respiratory viral infections are an underappreciated cause of morbidity and mortality in hospitalized adult and pediatric patients. The incidence was nearly 10-fold higher in our pediatric hospital. We estimate there are approximately 18 955 pediatric and adult cases of nosocomial respiratory viral infections in US acute care hospitals each year.

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Prevention of hospital-acquired respiratory viral infections: Assessment of a multimodal intervention program

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.337 ◽

2019 ◽

Vol 40 (3) ◽

pp. 362-364 ◽

Cited By ~ 9

Author(s):

Leonard A. Mermel ◽

Julie A. Jefferson ◽

Michael A. Smit ◽

Dianne B. Auld

Keyword(s):

Intervention Program ◽

Respiratory Virus ◽

Viral Infections ◽

Multimodal Intervention ◽

Hospital Units ◽

Respiratory Viral Infections ◽

Hospital Acquired

AbstractA multimodal program focused on preventing nosocomial respiratory viral infections. Definite cases per 1,000 discharges increased 1.3-fold in hospital units screening visitors for respiratory viral symptoms during the 2017–2018 respiratory virus season but not during the 2016–2017 season. Definite cases per 1,000 discharges increased 3.1-fold in hospital units that did not screen visitors either season.

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Epidemiology and Clinical Outcomes of Respiratory Viral Infections at a Single Tertiary Centre in Alberta, Canada

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.746 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S318-S318

Author(s):

Alastair Teale ◽

Lori Zapernick ◽

Geoffrey Taylor ◽

Stephanie Smith

Keyword(s):

Clinical Outcomes ◽

Respiratory Infection ◽

Influenza A ◽

Viral Infections ◽

Antiviral Treatment ◽

Respiratory Viruses ◽

Icu Admission ◽

Respiratory Viral Infections ◽

Hospital Acquired ◽

Related Mortality

Abstract Background Respiratory viral infections (RVI) are commonly seen in hospitalized patients. While many studies have examined outcomes with influenza, fewer studies have examined outcomes of community and hospital acquired infections of other respiratory viruses. Methods Data were prospectively collected from adult (age>17 years) inpatients with a positive result from respiratory viral multiplex panel testing during consecutive viral respiratory seasons from November 2014 to April 2017 at our facility. Ambulatory patients were excluded. Clinical outcomes including ICU admission requiring intubation, overall mortality and respiratory virus infection-related mortality was assessed at 30 days post infection. Results A total of 731 inpatients with positive results were identified. Influenza A was the most commonly detected virus (44%) followed by respiratory syncytial virus (RSV)(14%) and rhinovirus/enterovirus (13%). Rates of RSV and human metapneumovirus infections displayed significant yearly variability. There were no significant differences in rates of ICU admission requiring intubation (16.8% vs. 14.3% P = 0.35) between infections caused by influenza A and B and other respiratory viruses. In addition, mortality related to respiratory infections between these groups was also similar (5.7% Influenza vs. 4.5% non-Influenza P = 0.46). Ninety-five (15%) of identified patients had hospital acquired respiratory viral infections. Influenza A was the most commonly isolated hospital acquired infection (39%). Rates of ICU admission requiring intubation (22.6% vs. 14.6%, P = 0.06) and respiratory infection-related mortality (7.4% vs. 4.8%, P = 0.14) were higher in hospital acquired RVI but did not meet statistical significance. Less than half (45%) of all patients testing positive for influenza received antiviral treatment (oseltamivir). Respiratory infection-related mortality was not significantly different between those who were treated and those who were not treated (5.5% vs. 4.4%, P = 0.64). Conclusion While influenza remains the most common community and hospital acquired respiratory viral infection in inpatients at our facility, half of infections were attributed to other respiratory viruses and these resulted in similar rates of serious outcomes including ICU admission and mortality. Disclosures All authors: No reported disclosures.

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