364
(1,198 hospital-admitted cases). We compared hospital-acquired RVIs per 1,000 discharges in patient care units that did not screen visitors during the 2016–2017 and 2017–2018 respiratory virus seasons to those units that went from no visitor screening during the 2016–2017 season to visitor screening during the 2017–2018 season. Comparing 2016–2017 to 2017–2018, the rate ratio for total and definite cases of hospital-acquired RVIs was greater in units that did not screen visitors during either season compared to those that did screen visitors during the 2017–2018 season; how- ever, the difference was not statistically significant (Table 2).
Discussion
Respiratory viruses are spread by multiple potential routes.3 Use of contact and droplet precautions for all RVIs reduces risk of hospi- tal-acquired RVIs.4 Multimodal infection prevention programs, including both contact and droplet precautions as well as visitor screening, have dramatically reduced risk of nosocomial RSV infec- tions in immunocompromised patients.5,6 We developed a multimo- dal respiratory virus prevention program over 8 years. It is difficult to determine the impact of individual elements of the program during that time, and our analysis is limited to the last 2 respiratory virus sea- sons when our intervention focused on visitor screening. The major finding of our study is that a multimodal program, which includes visitor screening, is associated with a reduced risk of such infections in patients hospitalized in a large, academic medical center that includes a pediatric hospital within a hospital. Although the incidence density of hospital-acquired RVIs in the
2017–2018 season was greater on patient care units that screened visitors compared to those that did not, we believe this reflects the facts that visitor screening included our pediatric units where there is a greater risk of RVIs compared to our adult units2 and that adult units that screened visitors were high risk units such as our transplant and hematology/oncology units. We informally polled nursing staff regarding use of contact and
droplet precautions for all respiratory viral infections and found that this was preferred and easier to follow than our prior use of virus-specific precautions. Additionally, we more formally polled our children’s hospital nursing staff and visitors regarding visitor screening. The vast majority of responses were positive from both groups. Additionally, after we started screening visitors in some of our adult hospital units, unit directors of other hospital units made requests to initiate such screening on their units. Regarding limitations, we did not closely monitor the incidence
of hospital-acquired RVIs prior to the 2016–2017 season, so we are unable to compare the impact of our interventions with previous years. Also, we did not measure compliance with visitor screening. Our study may have been underpowered to show a significant dif- ference in rate ratios on units that did and did not screen visitors. Because hand hygiene was significantly better in the units with vis- itor screening, it is difficult to know how much of the reduction in hospital-acquired respiratory viral infections was associated with this infection control intervention. Lastly, visitor screening during the 2017–2018 season in predominantly high-risk patient care units may have magnified the impact of this intervention.
Leonard A. Mermel et al In conclusion, a multimodal program focused on reducing risk
of RVIs among hospitalized patients can be effectively imple- mented in a large adult and pediatric teaching hospital with asso- ciated culture change. Although twice as many hospital admissions with RVIs occurred during the 2017–2018 season than during the 2016–2017 season, there was only a 1.3-fold increase in definite cases per 1,000 discharges in units that screened visitors during 2017–2018, compared with a 3.1-fold increase in unit that did not screen visitors. As such, screening visitors for respiratory viral infection signs and symptoms appears to reduce risk of transmission to hospitalized patients. Moving forward, we hope that our hospital will review our sick leave policy in an effort to further limit, in a nonpunitive fashion, our hospital staff from com- ing to work if they have signs and symptoms suggestive of a RVI.7
Supplementary material. To view supplementary material for this article, please visit
https://doi.org/10.1017/ice.2018.337
Acknowledgements. Our hospital nursing and physician staff provided crucial assistance in successfully implementing our multimodal program. We specifically thank Lisa Paolino, RN, for her generous assistance in trialing our first unit-based visitor screening program. Our Rhode Island Hospital Department of Epidemiology and Infection Control assisted in initiating and maintaining our multimodal program. We thank YJ Choe, MD, PhD, for assistance with organizing the data and Jason
T.Machon, PhD, who kindly assisted in performing the logistic regression analysis. The SeattleCancer Care Alliance generously allowed an on-site assessment of their respiratory virus management plan (by J.J.) and kindly supplied us with copies of materials used in their visitor screening program. The hospital administration and microbiology laboratory transitioned to our current nucleic acid amplifica- tion testing modality, which allowed for expeditious identification of patients with respiratory viral infections. Finally, our operational excellence teamled a failure modes and effects analysis regarding cases of nosocomial respiratory viral infections.
Financial support. No financial support was provided relevant to this article.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
References 1. Wenzel RP, Deal EC, Hendley JO. Hospital-acquired viral respiratory illness on a pediatric ward. Pediatrics 1977;60:367–371.
2. Chow EJ, Mermel LA. Hospital-acquired respiratory viral infections: incidence, morbidity and mortality in pediatric and adult patients. Open Forum Infect Dis 2017;4:ofx006.
3. Hall CB. The spread of influenza and other respiratory viruses: complexities and conjectures. Clin Infect Dis 2007;45:353–359.
4. Rubin LG, Kohn N, Nullet S, Hill M. Reduction in rate of nosocomial respi- ratory virus infections in a children’s hospital associated with enhanced iso- lation precautions. Infect Control Hosp Epidemiol 2018;39:152–156.
5. Raad I, Abbas J,WhimbeyE. Infection control of nosocomial respiratory viral disease in the immunocompromised host. Am J Med 1997;102:48–52.
6. Chu HY, Englund JA, Podczervinski S, et al. Nosocomial transmission of res- piratory syncytial virus in an outpatient cancer center. Biol Blood Marrow Transplant 2014;20:844–851.
7. Chow EJ, Mermel LA. More than a cold: hospital-acquired respiratory viral infections, sick leave policy and a need for culture change. Infect Control Hosp Epidemiol 2018;39:861–862.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132
