Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-22T06:10:14.980Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial Respiratory Syncytial Virus Infections Prevention and Control in Bone Marrow Transplant Patients

Published online by Cambridge University Press:  02 January 2015

Ricardo Garcia ,
Issam Raad ,
Dima Abi-Said ,
Gerald Bodey ,
Richard Champlin ,
Jeffrey Tarrand ,
Lou Anne Hill ,
Jan Umphrey ,
Joyce Neumann  and
Janet Englund
...Show all authors
Ricardo Garcia
Affiliation:
Sections of Infectious Diseases, Houston, Texas
Issam Raad*
Affiliation:
Sections of Infectious Diseases, Houston, Texas
Dima Abi-Said
Affiliation:
Sections of Infectious Diseases, Houston, Texas
Gerald Bodey
Affiliation:
Sections of Infectious Diseases, Houston, Texas
Richard Champlin
Affiliation:
Department of Medical Specialties, the Section of Bone Marrow Transplantation, Houston, Texas
Jeffrey Tarrand
Affiliation:
Department of Hematology, Division of Laboratory Medicine, Houston, Texas
Lou Anne Hill
Affiliation:
Infection Control, Houston, Texas
Jan Umphrey
Affiliation:
Infection Control, Houston, Texas
Joyce Neumann
Affiliation:
Department of Medical Specialties, the Section of Bone Marrow Transplantation, Houston, Texas
Janet Englund
Affiliation:
University of Texas M.D. Anderson Cancer Center, Houston, Texas Baylor College of Medicine, Houston, Texas
Estella Whimbey
Affiliation:
Sections of Infectious Diseases, Houston, Texas
*
Section of Infectious Diseases (Box 47), The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess the effectiveness of a multi-faceted infection control strategy in limiting the nosocomial transmission of respiratory syncytial virus (RSV) infection to patients in a bone marrow transplant (BMT) unit.

Design:

Before/after trial.

Setting:

University-affiliated tertiary cancer center.

Patients:

Adult BMT recipients hospitalized during two consecutive wintertime community outbreaks of RSV infection.

Interventions:

An infection control strategy against nosocomial RSV infection was implemented in the BMT unit in February 1993. The strategy involved prompt identification, isolation, and cohorting of RSV-infected patients; prompt therapy with aerosolized ribavirin; use of masks and gloves by anyone entering an infected BMT patient's room; screening visitors for respiratory symptoms; restricting visitation by all children under 12 years of age and all family members and other visitors with RSV symptoms; and restricting symptomatic hospital staff from working in the BMT unit.

Results:

After implementation of the multifaceted infection-control strategy, there were four cases of nosocomial RSV infection in 3,870 patient days (incidence density, 1.0 case/1,000 patient days) compared with 14 cases of nosocomial RSV infection in 3,152 patient days (incidence density, 4.4 cases/1,000 patient days) during the 1992-1993 RSV season (rate ratio, 4.4; 95% confidence interval [CI95], 1.4-17.9; P<.01). This decrease in incidence occurred despite a comparable prevalence of community-acquired RSV cases between the two seasons (2.2% vs 3.2% in 1992-1993 and 1993-1994, respectively; prevalence ratio, 0.7; CI95, 0.2-2.1; P=0.5)

Conclusion:

Institution of a multifaceted infection control strategy significantly reduced the frequency of nosocomial RSV infection in a high-risk group of adult BMT recipients

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 6 , June 1997 , pp. 412 - 416
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Goldmann, DA. Nosocomial viral infections: recent developments and new strategies. Eur J Clin Microbiol Infect Dis 1989;8:75–81.CrossRefGoogle ScholarPubMed
2. Filippell, MB, Rearick, R. Respiratory syncytial virus. Nurs Clin North Am 1993;28:651–671.Google Scholar
3. Balough, K, Ahrens, R. The cold war against RSV. Iowa Med 1991;81:441–444.Google Scholar
4. Hertz, MI, Englund, JA, Snover, D, Bitterman, PB, McGlave, PB. Respiratory syncytial virus-induced acute lung injury in adult patients with bone marrow transplants: a clinical approach and review of the literature. Medicine 1989;68:269–281.Google Scholar
5. Englund, JA, Sullivan, CJ, Jordan, MC, Dehner, LP, Vercellotti, GM, Balfour, HH. Respiratory syncytial virus infection in immuno-compromised adults. Ann Intern Med 1988;109:203–208.Google Scholar
6. Harrington, RD, Hooton, TM, Hackman, RC, et al. An outbreak of respiratory syncytial virus in a bone marrow transplant center. J Infect Dis 1992;165:987–993.Google Scholar
7. Gala, CL, Hall, CB, Schnabel, KC, et al. The use of eye-nose goggles to control nosocomial respiratory syncytial virus infection. JAMA 1986;256:2706–2708.Google Scholar
8. Hall, CB, Geiman, JM, Douglas, RG, Meagher, MP. Control of nosocomial respiratory syncytial viral infections. Pediatrics 1978;62:728–732.CrossRefGoogle ScholarPubMed
9. Hall, CB. Respiratory syncytial virus: its transmission in the hospital environment. Yale J Biol Med 1982;55:219–223.Google Scholar
10. Valenti, WM, Menegus, MA, Hall, CB, Pincus, PH, Douglas, RG. Nosocomial viral infections, I: epidemiology and significance. Infect Control 1980;1:33–37.Google Scholar
11. Rothman, KJ. Modern Epidemiology. Boston, MA: Little, Brown and Company; 1986.Google Scholar
12. Whimbey, E, Champlin, RE, Englund, JA, et al. Combination therapy with aerosolized ribavirin and intravenous immunoglobulin for respiratory syncytial virus disease in adult bone marrow transplant recipients. Bone Marrow Transplant 1995;16:393–399.Google Scholar
13. Whimbey, E, Couch, RB, Englund, JA, et al. Respiratory syncytial virus pneumonia in hospitalized adult patients with leukemia. Clin Infect Dis 1995;21:376–379.CrossRefGoogle ScholarPubMed
14. Martin, MA, Bock, MJ, Pfaller, MA, Wenzel, RP. Respiratory syncytial virus infections in adult bone marrow transplant recipients. Lancet 1988;1:1396–1397. Letter.Google Scholar
15. Hall, CB, Douglas, RG, Geiman, JM. Possible transmission by fomites of respiratory syncytial virus. J Infect Dis 1980;141:98–102.CrossRefGoogle ScholarPubMed
16. Krasimski, K, LaCouture, R, Holzman, RS, Waithe, E, Bonk, S, Hanna, B. Screening for respiratory syncytial virus and assignment to a cohort at admission to reduce nosocomial transmission. J Pediatr 1990;116:894–898.Google Scholar
17. Takimoto, CH, Cram, DL, Root, RK. Respiratory syncytial virus infections on an adult medical ward. Arch Intern Med 1991;151:706–708.Google Scholar
18. Madge, P, Paton, JY, McColl, JN, Mackie, PLK. Prospective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory syncytial virus. Lancet 1992;340:1079–1083.CrossRefGoogle ScholarPubMed
19. Centers for Disease Control and Prevention, Department of Health and Human Services. Draft guideline for prevention of nosocomial pneumonia. Federal Register 1994;59:4980–5009.Google Scholar
20. Snydman, DR, Greer, C, Meissner, C, McIntosh, K. Prevention of nosocomial transmission of respiratory syncytial virus in a newborn nursery. Infect Control Hosp Epidemiol 1988;9:105–108.CrossRefGoogle Scholar
21. Hall, CB, Douglas, RG. Nosocomial respiratory syncytial viral infections. Should gowns and masks be used? Am J Dis Child 1981;135:512–515.CrossRefGoogle ScholarPubMed
22. Murphy, D, Todd, JK, Chao, RK, Orr, I, McIntosh, K. The use of gowns and masks to control respiratory illness in pediatric hospital personnel. J Pediatr 1981;99:746–750.Google Scholar
23. Agah, R, Cherry, JD, Garavian, AJ, Chapin, M. Respiratory syncytial virus (RSV) infection rate in personnel caring for children with RSV infections. Routine isolation procedure vs routine procedure supplemented by use of masks and goggles. Am J Dis Child 1987;141:695–697.Google Scholar
24. Whimbey, E, Bodey, GP. Viral pneumonia in the immunocompromised adult with neoplastic disease: the role of common community respiratory viruses. Semin Respir Infect 1992;7:122–131.Google Scholar
25. Leclair, JM, Freeman, J, Sullivan, BF, Crowley, CM, Goldmann, DA. Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions. N Engl J Med 1987;317:329–334.CrossRefGoogle ScholarPubMed
26. Hall, CB, McBride, JT, Walsh, EE, et al. Aerosolized ribavirin treatment of infants with respiratory syncytial virus infection: a randomized double-blind study. N Engl J Med 1983;308:1443–1447.Google Scholar