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.

Abstract

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 We reviewed published and unpublished literature from hospital settings to assess: (i) nosocomial RSV transmission risk (attack rate) during outbreaks, (ii) effectiveness of infection control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.

Citation

French, C. E., McKenzie, B. C., Coope, C., Rajanaidu, S., Paranthaman, K., Pebody, R., Nguyen-Van-Tam, J. S., Higgins, J. P., & 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. https://doi.org/10.1111/irv.12379

• 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
• DOI: https://doi.org/10.1111/irv.12379
• Keywords: Infection control; nosocomial infections; palivizumab; personal protective equipment; respiratory syncytial virus
• Public URL: https://nottingham-repository.worktribe.com/output/779211
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/irv.12379/abstract
• Contract Date: Oct 20, 2016