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

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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Droplet precautions on-site (DroPS) during the influenza season 2018/2019: a possible alternative to single room isolation for respiratory viral infections

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-01038-y ◽

2022 ◽

Vol 11 (1) ◽

Author(s):

Michèle Birrer ◽

Martin Perrig ◽

Fabienne Hobi ◽

Christina Gfeller ◽

Andrew Atkinson ◽

...

Keyword(s):

Influenza A ◽

Viral Infections ◽

Influenza Season ◽

Care Center ◽

Tertiary Care ◽

Rapid Test ◽

Single Room ◽

Hospitalised Patients ◽

Respiratory Viral Infections ◽

Hospital Acquired

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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Respiratory viral infections in the elderly

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466621995050 ◽

2021 ◽

Vol 15 ◽

pp. 175346662199505

Author(s):

Alastair Watson ◽

Tom M. A. Wilkinson

Keyword(s):

Immune System ◽

Viral Infections ◽

Point Of Care ◽

The Elderly ◽

Respiratory Viruses ◽

Morbidity And Mortality ◽

Detection Methods ◽

Respiratory Viral Infections ◽

Tract Infections ◽

Prolonged Hospital

With the global over 60-year-old population predicted to more than double over the next 35 years, caring for this aging population has become a major global healthcare challenge. In 2016 there were over 1 million deaths in >70 year olds due to lower respiratory tract infections; 13–31% of these have been reported to be caused by viruses. Since then, there has been a global COVID-19 pandemic, which has caused over 2.3 million deaths so far; increased age has been shown to be the biggest risk factor for morbidity and mortality. Thus, the burden of respiratory viral infections in the elderly is becoming an increasing unmet clinical need. Particular challenges are faced due to the interplay of a variety of factors including complex multimorbidities, decreased physiological reserve and an aging immune system. Moreover, their atypical presentation of symptoms may lead to delayed necessary care, prescription of additional drugs and prolonged hospital stay. This leads to morbidity and mortality and further nosocomial spread. Clinicians currently have limited access to sensitive detection methods. Furthermore, a lack of effective antiviral treatments means there is little incentive to diagnose and record specific non-COVID-19 viral infections. To meet this unmet clinical need, it is first essential to fully understand the burden of respiratory viruses in the elderly. Doing this through prospective screening research studies for all respiratory viruses will help guide preventative policies and clinical trials for emerging therapeutics. The implementation of multiplex point-of-care diagnostics as a mainstay in all healthcare settings will be essential to understand the burden of respiratory viruses, diagnose patients and monitor outbreaks. The further development of novel targeted vaccinations as well as anti-viral therapeutics and new ways to augment the aging immune system is now also essential. The reviews of this paper are available via the supplemental material section.

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#87: Association Between Healthcare-Associated Respiratory Viral Infections and Length of Stay at a Pediatric Hospital

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.044 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S15-S15

Author(s):

Zachary Most ◽

Michael Sebert ◽

Patricia Jackson ◽

Trish M Perl

Keyword(s):

Length Of Stay ◽

Incubation Period ◽

Respiratory Infection ◽

Symptom Onset ◽

Viral Infections ◽

Pediatric Hospital ◽

Time Period ◽

Life Years ◽

Respiratory Viral Infections ◽

Healthcare Associated

Abstract Background Healthcare-associated infections (HAI) are major preventable causes of morbidity and mortality. While there are fewer overall HAI in children, there is a greater potential impact in disability-adjusted life years. Healthcare-associated respiratory viral infections (HARVI) are not frequently tracked within institutions, yet the risk for such infections in pediatric hospitals is very high. Recent data demonstrate large inter-hospital variability of HARVI incidence that may depend on various factors including the number of immunocompromised patients in the hospital and the presence of shared rooms. We hypothesize that the burden of healthcare-associated respiratory viral infections and their impact on the length of stay (LOS) is substantial at a large urban pediatric hospital. Methods A cohort of all children with any HARVI admitted to a large urban pediatric hospital between July 2017 and June 2018 were included after obtaining IRB approval. We defined a HARVI as a respiratory infection with an onset of symptoms while the patient was hospitalized meeting three criteria: A positive microbiologic test for one of 8 viruses, presence of symptoms of a respiratory infection, and onset of symptoms after admission beyond the minimum incubation period for each virus. Infections with symptom onset after admission beyond the maximum incubation period were considered definite hospital onset whereas others were considered possible hospital onset. The electronic medical record provided data on demographics, underlying medical conditions, hospital length of stay prior to infection and hospital unit of infection, and consequences and outcome of HARVI. The at-risk population for calculation of the incidence of HARVI was all admitted patient-days at the hospital over this time period. Results Between July 2017 and June 2018 the incidence of HARVI (definite or possible hospital onset) was 1.2 infections per 1,000 admitted patient-days (60% due to rhinovirus/enterovirus, 12% due to respiratory syncytial virus, and 9% due to influenza). Overall, 48% of patients were under 2 years of age, 18% were between 2 and 5 years of age, and 34% were over 5 years of age. Twenty-one percent were immunocompromised and 35% had underlying lung disease. The median length of stay prior to symptom onset was 11 days (IQR 5–36 days) and the median total length of stay was 30 days (IQR 15–82.5 days). Eight individuals had more than one HARVI over this time period. Nineteen percent were transferred to the intensive care unit and 7% died during their hospital admission Conclusion HARVI occurs frequently in a pediatric hospital and often in patients with underlying comorbidities. The risk for HARVI increases substantially with increased length of stay. Such data support the need for tracking HARVI in high-risk institutions.

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.94 ◽

2018 ◽

Vol 39 (07) ◽

pp. 861-862 ◽

Cited By ~ 7

Author(s):

Eric J. Chow ◽

Leonard A. Mermel

Keyword(s):

Sick Leave ◽

Culture Change ◽

Viral Infections ◽

Leave Policy ◽

Respiratory Viral Infections ◽

Hospital Acquired

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Clinical Features of Respiratory Viral Infections Among Inpatients at a Major US Tertiary Care Hospital

Southern Medical Journal ◽

10.14423/smj.0000000000000503 ◽

2016 ◽

Vol 109 (8) ◽

pp. 481-486 ◽

Cited By ~ 1

Author(s):

Prashant Malhotra ◽

Arthur Luka ◽

Carla S. McWilliams ◽

Kaitlin G. Poeth ◽

Rebecca Schwartz ◽

...

Keyword(s):

Clinical Features ◽

Viral Infections ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Respiratory Viral Infections

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Respiratory viral infections in pediatric patients with hematopoietic stem cell transplantation

Boletín Médico del Hospital Infantil de México ◽

10.24875/bmhim.20000126 ◽

2021 ◽

Vol 78 (3) ◽

Author(s):

José F. Gaytán-Morales ◽

Iván Castorena-Villa ◽

Dolores C. Cortés-Flores ◽

Martha J. Avilés-Robles ◽

José L. Sánchez-Huerta ◽

...

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Pediatric Patients ◽

Viral Infections ◽

Hematopoietic Stem ◽

Respiratory Viral Infections

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Prescribing antibiotics to pediatric dengue: increasing risk of bacterial resistance

Paediatrica Indonesiana ◽

10.14238/pi1.1.2018.51-5 ◽

2018 ◽

Vol 1 (1) ◽

pp. 53

Author(s):

Dhanunjaya Sandopa ◽

Sree Keerthi Nethi ◽

Sai Charitha Sreeram ◽

Narasimha Kumar Godlaveti Vijay ◽

Vyshnavi Biradavolu ◽

...

Keyword(s):

Bacterial Resistance ◽

Viral Infections ◽

Treatment Guidelines ◽

Tertiary Care ◽

Control Program ◽

Hospital Acquired Infections ◽

Inappropriate Use ◽

Vector Borne ◽

Hospital Acquired ◽

Morbid Conditions

Background Use of antibiotics to treat self-limiting viral infections like dengue fever (DF) without any co-morbid conditions in pediatric patients is common practice in India, and a major contribution of the inappropriate use of antibiotics in the country.Objective To provide an analysis of diagnosis, grading, and prescribing of antibiotics in pediatric inpatients with DF in a tertiary care teaching hospital in India.Methods Data from case sheets of all pediatric inpatients (n=370) diagnosed with DF without co-morbid conditions were collected with regards to diagnosis, grading, presence, and appropriateness of antibiotic usage according to the 2009 WHO Guidelines, the National Vector Borne Disease Control Program (NVBDCP) of India Guidelines, and the Hospital Infection Society (HIS) Guidelines.Results Platelet count determination (50% of the cases) was the major diagnostic method for dengue. Inappropriate grading of DF was seen in 20% of patients. Almost 75% of the 370 dengue cases were prescribed antibiotics for the expressed purpose of avoiding hospital-acquired infections. A single antibiotic was given in 225 cases (60.81%), 2 antibiotics in 33 (8.91 %) cases, and 3 antibiotics in 9 (2.43%) cases.Conclusions From the results it is clear that antibiotics were prescribed to treat DF where the antibiotics do not have any role. DF is a self-limiting viral infection that can be treated with proper management of hemodynamic status with IV fluids. To avoid the usage of antibiotics in the treatment of dengue, awareness has to be created in healthcare professionals regarding the treatment guidelines for dengue and appropriate use of antibiotics to avoid hospital acquired infections.

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Patient characteristics and cardiac surgical outcomes at a tertiary care hospital in Kenya, 2008–2017: a retrospective study

PeerJ ◽

10.7717/peerj.11191 ◽

2021 ◽

Vol 9 ◽

pp. e11191

Author(s):

Tamara Chavez-Lindell ◽

Bob Kikwe ◽

Anthony Gikonyo ◽

Agricola Odoi

Keyword(s):

Surgical Complications ◽

Pediatric Patients ◽

Tertiary Care ◽

Temporal Trends ◽

Patient Characteristics ◽

Adult Patients ◽

Morbidity And Mortality ◽

Surgical Patients ◽

Care Hospital ◽

Risk Of Death

Background Cardiac surgeries are high risk procedures that require specialized care and access to these procedures is often limited in resource-poor countries. Although fatalities for surgical patients across Africa are twice that of the global rate, cardiac surgical mortality continent-wide is only slightly higher than all-surgical mortality. Understanding demographic and health characteristics of patients and the associations of these characteristics with morbidity and mortality events is important in guiding care decisions. Therefore, the objectives of this study were to: (a) describe the characteristics of cardiac surgical patients; (b) identify the associations between these characteristics and morbidity and mortality events following cardiac surgery. Methods Patient characteristics and post-surgical complications were abstracted for all cardiac surgical patients treated at a tertiary care hospital in Kenya from 2008 to 2017. Descriptive analyses of demographic factors, co-morbidities, peri-operative conditions, and post-surgical complications were conducted for adult and pediatric patients. Cochran-Armitage trend test was used to assess temporal trends in risk of death. Multivariable ordinary logistic and Firth logistic models were used to investigate predictors of surgical outcomes. Results The study included a total of 181 patients (150 adult and 31 pediatric patients). Most (91.3%) adult patients had acquired conditions while 45.2% of the pediatric patients had congenital defects. Adult patients tended to have co-morbid conditions including hypertension (16.7%), diabetes mellitus (7.3%), and nephropathy (6.7%). Most patients (76.0% adults and 96.8% pediatric patients) underwent ≤ 2 surgical procedures during their hospital stay. Seventy percent of adult and 54.8% of the pediatric patients experienced at least one post-surgical complication including mediastinal hemorrhage, acute kidney injury and death. Patient characteristics played the greatest roles in predicting post-surgical complications. For adult patients, significant predictors of acute kidney injury included atrial fibrillation (OR = 18.25; p = .001), mitral valve replacement (OR = 0.14; p = .019), and use of cardiopulmonary bypass (OR = 0.06; p = .002). Significant predictors of 30-day mortality were age (OR = 1.05; p = .015) and atrial fibrillation (OR = 4.12, p = .018). Although the number of surgeries increased over the decade-long study period, there were no significant (p = .467) temporal trends in the risk of death. Conclusions Awareness of demographic and peri-surgical factors that are predictors of complications is useful in guiding clinical decisions to reduce morbidity and mortality. Identification of co-morbidities as the most useful predictors of post-surgical complications suggests that patient characteristics may be a larger contributor to the incidence of complications than surgical practices.

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