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Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review

French, Clare E.; McKenzie, Bruce C.; Coope, Caroline; Rajanaidu, Subhadra; Paranthaman, Karthik; Pebody, Richard; Nguyen-Van-Tam, Jonathan S.; Higgins, Julian P.T.; Beck, Charles R.


Clare E. French

Bruce C. McKenzie

Caroline Coope

Subhadra Rajanaidu

Karthik Paranthaman

Richard Pebody

Julian P.T. Higgins

Charles R. Beck


Respiratory syncytial virus (RSV) causes a significant public health burden, and outbreaks among vulnerable patients in hospital settings are of particular concern. We reviewed published and unpublished literature from hospital settings to assess: (i) nosocomial RSV transmission risk (attack rate) during outbreaks, (ii) effectiveness of infection control measures. We searched the following databases: MEDLINE, EMBASE, CINAHL, Cochrane Library, together with key websites, journals and grey literature, to end of 2012. Risk of bias was assessed using the Cochrane risk of bias tool or Newcastle–Ottawa scale. A narrative synthesis was conducted. Forty studies were included (19 addressing research question one, 21 addressing question two). RSV transmission risk varied by hospital setting; 6–56% (median: 28·5%) in neonatal/paediatric settings (n = 14), 6–12% (median: 7%) in adult haematology and transplant units (n = 3), and 30–32% in other adult settings (n = 2). For question two, most studies (n = 13) employed multi-component interventions (e.g. cohort nursing, personal protective equipment (PPE), isolation), and these were largely reported to be effective in reducing nosocomial transmission. Four studies examined staff PPE; eye protection appeared more effective than gowns and masks. One study reported on RSV prophylaxis for patients (RSV-Ig/palivizumab); there was no statistical evidence of effectiveness although the sample size was small. Overall, risk of bias for included studies tended to be high. We conclude that RSV transmission risk varies widely during hospital outbreaks. Although multi-component control strategies appear broadly successful, further research is required to disaggregate the effectiveness of individual components including the potential role of palivizumab prophylaxis.


French, C. E., McKenzie, B. C., Coope, C., Rajanaidu, S., Paranthaman, K., Pebody, R., …Beck, C. R. (2016). Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review. Influenza and Other Respiratory Viruses, 10(4), 268-290.

Journal Article Type Article
Acceptance Date Feb 10, 2016
Online Publication Date Mar 24, 2016
Publication Date 2016-07
Deposit Date Oct 20, 2016
Publicly Available Date Oct 20, 2016
Journal Influenza and Other Respiratory Viruses
Print ISSN 1750-2640
Electronic ISSN 1750-2659
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 10
Issue 4
Pages 268-290
Keywords Infection control
nosocomial infections
personal protective equipment
respiratory syncytial virus
Public URL
Publisher URL


French_et_al-2016-Influenza_and_Other_Respiratory_Viruses.pdf (236 Kb)

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