Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review

Clare E French, Bruce McKenzie, Caroline M Coope, Subhadra Rajanaidu, Karthik Paranthaman, Richard Pebody, Jonathan Nguyen-Van-Tam, Julian P T Higgins, Charles R Beck

Research output: Contribution to journalArticle (Academic Journal)peer-review

44 Citations (Scopus)
332 Downloads (Pure)

Abstract

Aim

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 We reviewed published and unpublished literature from hospital settings to assess: 1) nosocomial RSV transmission risk (attack rate) during outbreaks, 2) effectiveness of infection control measures.

Method
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.

Results
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.

Conclusion
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.
Original languageEnglish
Pages (from-to)268-290
Number of pages13
JournalInfluenza and Other Respiratory Viruses
Volume10
Issue number4
Early online date22 Feb 2016
DOIs
Publication statusPublished - Jul 2016

Keywords

  • Infection control
  • nosocomial infections
  • palivizumab
  • personal protective equipment
  • respiratory syncytial virus

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