Infection Control & Hospital Epidemiology (2019), 40,362–364 doi:10.1017/ice.2018.337


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


Leonard A. Mermel DO, ScM1,2,3, Julie A. Jefferson RN,MPH3, Michael A. Smit MD,MSPH3,4 and Dianne B. AuldMT(ASCP)3 1Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 2Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode Island, 3Department of Epidemiology and Infection Control, Rhode Island Hospital, Providence, Rhode Island and 4Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island


Abstract


Amultimodal 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.


(Received 10 September 2018; accepted 27 November 2018)


Hospital-acquired respiratory viral infections (RVIs) are transmit- ted to patients from infected visitors, staff, and roommates,1 and they are a cause of morbidity and mortality.2


Methods


Wedeveloped a multimodal program focused on the prevention of hospital-acquired RVIs with staged interventions over 8 years at Rhode Island Hospital, an academic center licensed for 719 beds that includes Hasbro Children’s Hospital (Table 1). We defined a definite case as a patient admitted without clinical signs or symp- toms of a respiratory infection and whose number of days from hospital admission to symptom onset exceeded the upper range for the incubation period of the identified virus.2 We also included any patient who, when the duration of a patient’s hospital stay was within an incubation period for the identified virus, was discharged and readmitted but the duration of time out of hospital was less than the lower range of the incubation period. We defined a possible hospital-acquired respiratory virus infection as a patient admitted without clinical signs or symptoms of a respiratory infec- tion and in whom the number of days from hospital admission to symptom onset was within the range of the incubation period for the identified virus. We also included any patient who was without clinical signs or symptoms of a respiratory infection during hospi- talization, was discharged and readmitted with new respiratory symptoms, and the lower range of the incubation period for the identified virus covered both the time of the patient’s last hospital admission and the time the patient was out of the hospital before readmission. Community-acquired RVIs were cases with positive respiratory virus testing on hospital admission or when symptoms began after admission but before the lower range of the incubation


Author for correspondence: Leonard A. Mermel, Email: lmermel@lifespan.org Cite this article: Mermel LA, et al. (2019). Prevention of hospital-acquired respiratory


viral infections: Assessment of a multimodal intervention program. Infection Control & Hospital Epidemiology, 40: 362–364, https://doi.org/10.1017/ice.2018.337


© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.


period for the identified virus. Interventions occurred during the respiratory virus season (October through April). Nasopharyngeal swabs were used to diagnose RVIs. The respi-


ratory virus panel assay (RVP; Luminex, Austin, TX) included adenovirus; coronavirus; influenza A H1, and H3, and nontype- able; influenza B; human metapneumovirus; parainfluenza virus 1, 2, 3, and 4; respiratory syncytial virus A and B; and human rhinovirus/enterovirus. The respiratory pathogen panel assay (RPP; Genmarkdx, Carlsbad, CA) included adenovirus; coronavi- rus 229E; HKU1; NL63; OC43; human metapneumovirus; human rhinovirus/enterovirus; influenza A H1, 2009 H1N1, and H3; influenza B; parainfluenza 1, 2, 3, and 4; and respiratory syncytial virus A. The panels did not differentiate rhinovirus and enterovi- rus. Rapid influenza testing (Xpert; Cepheid, Sunnyvale, CA) and rapid respiratory syncytial virus testing (Xpert; Cepheid) were also used. Unit secretaries and/or nursing staff screened visitors for respi-


ratory viral infection signs and symptoms using a standardized form(Supplement Fig. 1 online). Those who screened positive were prohibited fromvisiting patients. Exceptions were made on a case- by-case basis; such ill visitors were instructed to mask, to perform hand hygiene, and to remain in the room of the patient they were visiting. Hasbro Children’s Hospital nursing staff and visitors were polled May 2017 to assess attitudes regarding our visitor screening policy.


Logistic regression was used (SAS software, SAS Institute, Cary,


NC) to compare the change in incidence of hospital-acquired RVIs during the last 2 respiratory virus seasons in patient care units that did not screen visitors during either season to those units that did not screen visitors during the 2016–2017 season but began screening visitors during the 2017–2018 season.


Results


Greater colonization pressure was associated with RVIs during the 2017–2018 respiratory virus season (2,244 hospital-admitted cases of community-acquired RVIs) than with the 2016–2017 season


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