Failure to Institute Appropriate Isolation Precautions for Suspected Respiratory Syncytial Virus (RSV) Infection: Frequency and Identification of Risk Factors

BACKGROUND: RSV, spread by contaminated secretions, is an important cause of respiratory illness among children, particularly in winter months. To prevent nosocomial spread, infants and young children with suspected RSV infection should be placed on contact isolation. However, the frequency with which such precautions are not appropriately implemented and the factors that influence the likelihood of effective isolation are not known. METHODS: To determine the frequency with which children with suspected RSV infection are not appropriately isolated, daily prospective surveillance was done of all children younger than 5 years old admitted to a pediatric hospital with respiratory symptoms and/or who had a specimen sent for RSV testing. Results were expressed as a percentage of all admissions eligible for isolation. A case-control study was used to identify risk factors for the failure to appropriately isolate. RESULTS: Of the 598 patients meeting isolation criteria, 211(35%) were not isolated appropriately. After multivariable analysis, significant risk factors for the failure to appropriately isolate were: admission to a Stepdown unit (OR = 1.77, CI = 1.03–3.04), age between 3 and 4 years (OR = 4.21, CI = 1.94–9.16), age between 4 and 5 years (OR = 7.35, CI = 3.08–17.51), admission in October (OR = 13.29, CI = 4.13–42.73), November (OR = 4.86, CI = 2.12–11.16), and December (OR = 3.84, CI = 1.93–7.65). CONCLUSIONS: Patients with suspected RSV infection are frequently not appropriately isolated. Risk factors for the failure to isolate offer targets for future interventions, including earlier awareness campaigns and targeted education to high-risk units.