( Version 3.0  05/05/02 - 10/02/02)

Respiratory syncytial virus (RSV) is the most important cause of bronchiolitis and pneumonia in young children. Young neonates are at-risk for severe RSV disease; and RSV may prove fatal to preterm infants and infants with cyanotic heart disease or chronic lung disease. As RSV is a seasonal virus, Synagis (palivizumab) a humanized monoclonal antibody, is administered to select former NICU patients between October and April to decrease the risk of life-threatening disease. However, RSV can also be nosocomially spread within the hospital and poses a threat to current inhabitants of the NICU as well.

Vanderbilt has recently experienced an outbreak of nosocomial RSV in the NICU. The following information is provided to educate staff regarding RSV; and the following measures have been instituted in an attempt to control the spread of infection.

Transmission of RSV is by direct or close contact with contaminated secretions, which may involve droplets or fomites. Infectious RSV can persist on environmental surfaces for 4 – 7 hours and for > 30 minutes on hands.

The incubation period for RSV ranges from 2 – 8 days, most commonly 4 - 6 days. In young infants, viral shedding may continue as long as 3 – 4 weeks.

The RSV antigen detection immunoassay is performed on respiratory secretions and a result can be obtained within an hour. RSV viral culture on the same secretions requires 3 to 5 days. The sensitivity of the RSV antigen assay varies from 53 - 96%, but is usually in the 80 – 90% range.

To obtain a specimen for RSV antigen testing, loose respiratory secretions must be sent to the lab. These secretions may be obtained by bulb suctioning if the infants nose is productive or by nasopharyngeal suctioning. Saline as an irrigant should only be used if the infant does not have loose secretions. Secretions can also be obtained by nasopharyngeal swab or endotracheal tube aspiration.

Infants with documented RSV infection should be transferred to the PICU or pediatric floor if possible.  If not possible, infants with documented RSV infection and those with symptoms consistent with RSV should be cohorted and isolated.  Contact isolation precautions should be used.  If possible, nurses caring for these infants should remain in isolation the entire day.  Hospital personnel who visit other susceptible infants’ bedsides should gown, mask, and glove to handle infected infants.  Physicians are asked to round on infected patients last if possible.

Diligent handwashing before and after all patient contact is essential. 

To prevent a recurrent nosocomial RSV outbreak:

Staff should always adhere to infection control policies.

Staff with symptoms of a URI should avoid entering the nursery if possible.  If not possible, (s)he should practice careful hand-washing and wear a mask until symptoms (coughing/sneezing) abate.  Gloving for patient contact may also be recommended.

Any staff members with symptoms suggestive of RSV or a history of RSV exposure should be evaluated by Occupational Health, where furlough decisions will be made on clinical grounds.  RSV antigen testing will also be performed for epidemiologic investigation.  Staff members with symptoms consistent with RSV will be sent home for 8 days (the duration of RSV viral shedding in adults.)

During RSV season, residents are asked to not return to the NICU after seeing patients in the Continuity Clinic.

No visitors with an upper respiratory infection should be allowed to enter the nursery.  Depending upon the success of the new sibling visitation policy in the NICU, sibling and family visitation may or may not be restricted further during the upcoming RSV season.

Resolved 4/30/02. 

Reference:

American Academy of Pediatrics. The Red Book 2000, 25^th ed. Report of the Committee on Infectious Disease. pgs. 483-487.

Cox RA, Rao P, Brandon-Cox C. The use of palivizumab monoclonal antibody to control an outbreak of respiratory syncytial virus infection in a special care baby unit. J Hosp Infect 2001; 48: 186-92.

Hall CB. Nosocomial respiratory syncytial virus infections: the "Cold War" has not ended. Clin Infect Dis 2000; 31: 590-6.

Ruuskanen O. Respiratory syncytial virus—is it preventable? J Hosp Infect 1995; 30S: 494-7.