Isolation Precautions for Community Respiratory Viruses

The advent of nucleic acid amplification testing (NAAT) for community-acquired respiratory viruses (CRVs) has shown the importance of these pathogens in both community- and hospital-acquired pneumonia. Although the Centers for Disease Control recommends isolation practices to prevent nosocomial transmission of these viruses, data on the efficacy of this approach have been limited. Researchers now report a quasi-experimental trial in a children's hospital that compared the incidence of nosocomial respiratory-virus infections (NRVIs) in two 2-year periods. In the first period, droplet precautions were used for patients with influenza and contact precautions for patients with all other CRVs; in the second, subsequent period, contact and droplet precautions were used concurrently for patients admitted with any CRV infection. The rate of nosocomial Clostridium difficile infections was used as a nonequivalent dependent comparator.

The combined rate of nosocomial infections caused by influenza, respiratory syncytial virus, human metapneumovirus, parainfluenza viruses, and rhinovirus/enterovirus decreased a significant 39% from the first 2 study years to the final 2 years after enhanced isolation precautions were enacted (from 0.83 to 0.51 infections per 1000 patient days), with rate reductions in all viruses individually. The findings appeared robust when potential confounders were examined, including the number of patients admitted with CRV infection, the rate of viral testing, the number of available single rooms, the use of visitor restrictions, and the rate of hand hygiene compliance. The rate of C. difficile infections showed a nonsignificant reduction during the study.