RAPID IDENTIFICATION OF RESPIRATORY VIRUSES - IMPACT ON ISOLATION PRACTICES AND TRANSMISSION AMONG IMMUNOCOMPROMISED PEDIATRIC-PATIENTS

OBJECTIVE: To determine whether empiric isolation of patients with acu te respiratory virus infection symptoms could be discontinued when pre liminary shell vial cultures were negative, and the impact of this app roach on hospital resources. DESIGN: In 1993, we retrospectively revie wed respiratory virus test results from 1992 to 1993 and extended data collection prospectively through the 1993 to 1994 season. The rapid t est and 48-hour shell vial results were com pared to a standard of rap id test plus 5-day shell vial culture results to determine the sensiti vity and specificity of these ''preliminary'' results. SETTING: A 400- bed tertiary referral research hospital. PATIENTS: Patients from any i npatient unit or clinic with acute respiratory virus infection symptom s who had a specimen submitted for respiratory virus culture. Patients were placed on empiric respiratory isolation culture pending culture results. RESULTS: The overall sensitivity of the combined rapid and 48 -hour culture results in adults and children was 97%. All 15 pediatric patients with respiratory syncytial virus infection who had specimens submitted on first suspicion of respiratory virus infection were posi tive by rapid test. Culture results were positive within 48 hours for 100% of patients with influenza A (15 patients), influenza B (6), and parainfluenza (18) viruses. Of 59 pediatric inpatients who were isolat ed empirically awaiting 5-day culture results, 31 (52%) ultimately wer e determined to be culture negative. CONCLUSIONS: Empiric isolation of symptomatic children can be discontinued at 48 hours when both the ra pid test and the early culture results are negative. Our institution w ould have saved 93 days of unnecessary isolation over 2 years had such a policy been in place.