NOSOCOMIAL RESPIRATORY SYNCYTIAL VIRUS-INFECTION IN CANADIAN PEDIATRIC HOSPITALS - A PEDIATRIC INVESTIGATORS COLLABORATIVE NETWORK ON INFECTIONS IN CANADA STUDY

Objective. To determine nosocomial transmission of respiratory syncyti al virus (RSV) in Canadian pediatric hospitals, outcomes associated wi th nosocomial disease, and infection control practices. Design. A pros pective cohort study in the 1992 to 1994 winter respiratory seasons. S etting. Nine Canadian pediatric university-affiliated hospitals. Parti cipants. Hospitalized children with symptoms of lower respiratory trac t infection (at least one of cough, wheezing, dyspnea, tachypnea,and a pnea) and RSV antigen identified in a nasopharyngeal aspirate. Results . Of 1516 children, 91 (6%) had nosocomial RSV (NRSV), defined as symp toms of lower respiratory tract infection and RSV antigen beginning >7 2 hours after admission. The nosocomial ratio (NRSV/[community-acquire d RSV {CARSV})] + NRSV) varied by site from 2.8% to 13%. The median le ngth of stay attributable to RSV for community-acquired illness was 5 days, but 10 days for nosocomial illness. Four children with NRSV (4.4 %) died within 2 weeks of infection, compared with 6 (0.42%) with CARS V (relative risk = 10.4, 95% confidence interval: 3.0, 36.4). All site s isolated RSV-positive patients in single rooms or cohorted them. In a multivariate model, no particular isolation policy was associated wi th decreased nosocomial ratio, but gowning to enter the room was assoc iated with increased risk of RSV transmission (incidence rate ratio 2. 81; confidence interval: 1.65, 4.77). Conclusions. RSV transmission ri sk in Canadian pediatric hospitals is generally low. Although use of b arrier methods varies, all sites cohort or isolate RSV-positive patien ts in single rooms. Children with risk factors for severe disease who acquire infection nosocomially have prolonged stays and excess mortali ty.