RSV outbreak in a paediatric intensive care unit.

Area of Science:

• Pediatric Intensive Care
• Infectious Disease Epidemiology
• Nosocomial Infections

Background:

• Paediatric intensive care units (PICUs) typically experience low rates of nosocomial respiratory syncytial virus (RSV) infections.
• A significant outbreak of nosocomial RSV occurred during a single RSV season at the Royal Liverpool Children's Hospital-Alder Hey.

Purpose of the Study:

• To analyze a major outbreak of nosocomial RSV infection in a PICU.
• To identify the sources and transmission dynamics of RSV during the outbreak.
• To evaluate the effectiveness of control measures.

Main Methods:

• Studied all children admitted to the PICU over a six-month winter period (October 2001 to March 2002).
• Utilized nasopharyngeal aspirates tested via enzyme-linked immunoassay (ELISA) for RSV antigen.
• Defined PICU-acquired RSV infection as RSV positivity five or more days post-admission in previously negative patients.

Main Results:

• Fifty-four patients tested positive for RSV on the PICU; all were ventilated.
• Fifteen cases were acquired on the PICU ('acquired' cases), while 39 were RSV positive on admission ('imported' cases).
• The first outbreak peak was linked to RSV-positive children in isolation cubicles; the second peak was attributed to persistent RSV shedders. Seventy-three percent of acquired cases had co-morbidities. Droplet precautions proved more effective than cubicle isolation in limiting spread.

Conclusions:

• Persistent RSV shedders represent a significant risk for nosocomial RSV transmission in PICUs.
• Patients with co-morbidities are at a higher risk for acquiring nosocomial RSV infections.
• Reinforcement of droplet precautions, including handwashing and personal protective equipment, is crucial for controlling RSV outbreaks in PICUs.