Fifteen+ Years of Preventing Transmission of Respiratory Viruses in a Children's Hospital

Background: Respiratory viral illness is a common cause for hospitalization of pediatric patients particularly during the winter months. With this influx of infectious patients, transmission of respiratory viruses within the hospital remains a significant risk. We developed a Respiratory Virus Prevention Program (RVPP) to decrease hospital-associated (HA) viral transmission.

Objective: To evaluate the efficacy of an RVPP to reduce the transmission of HA respiratory viruses in a children's hospital.

Methods: The study was performed in a 187-bed pediatric hospital comprised of primarily semi-private patient rooms and 31 private rooms between 1992 and 2008. Case definition of HA respiratory viral infection was a patient with a laboratory-confirmed viral test and symptom onset at least 48 hours after admission or within 3-6 days of discharge. The program began in 1992 with the isolation of patients with RSV between December and May. In subsequent years additional respiratory viruses were added to the program and the program was extended yearlong. In 2001, empiric isolation of patients with clinical respiratory symptoms, for the duration of symptoms, was implemented regardless of viral testing. An annual multi-disciplinary meeting was held to discuss the results from the previous season and to refine policies and practices. 

Results:   The average yearly admissions to the hospital were 8195 with an average occupancy between December and March of 83.4%. There was an average of 11.7 cases yearly of HA respiratory virus prior to the RVPP. Since the program started, the average number of HA respiratory virus cases decreased to 4.5 yearly. Today's RVPP includes RSV, influenza, parainfluenza, adenovirus and human metapneumovirus. The average yearly number of HA cases was 3 RSV, 1 influenza, 2 parainfluenza and 1 adenovirus. Outcomes from the multidisciplinary meeting included: change of “seasonal precautions” to droplet precautions, routine respiratory virus testing in specific patient populations, additional visual identification reminders of patients in droplet precautions, refinement of cohorting options given very few private rooms, and visitor health screening to prevent ill children from visiting inpatients.

Conclusions: An RVPP that includes empiric isolation of patients with clinical respiratory viral infections, utilization of best available room placement options for patients, and health screening of visitors can decrease hospital-associated transmission of respiratory viruses. Evaluation of this program must continue on an annual basis to review current practices and discuss new strategies to prevent HA respiratory virus infections.