Abstract :
BACKGROUND: This 160-bed pediatric acute care facility in Minneapolis, Minnesota, identified a cluster of nosocomially transmitted RSV in the level II/III nursery in December 2003. Using electronic surveillance methods, the infection control staff was able to rapidly react to accurate data and conduct an epidemiological investigation in hours/days rather than days/weeks to determine the level and extent of transmission and control measures required.
OBJECTIVE: To rapidly identify patients who were RSV positive and those who may have been exposed in order to provide appropriate prophylaxis and implement appropriate precautions.
METHODS: Utilizing an electronic surveillance service provides access to all positive culture results from all inpatient and outpatient locations. In December 2003, a case of nosocomial RSV was identified in the 26-bed neonatal intensive care unit (NICU). A single nosocomial case of RSV in the NICU is considered a sentinel event. The electronic surveillance system provides immediate information regarding the unit census for any given day. Using this system, the IC team was able to rapidly identify all infants who met our definition of potentially exposed, to develop a stepwise method for surveillance, to implement testing, and to appropriately cohort patients.
RESULTS: Seven of 28 patients tested or became RSV positive, for an attack rate of 25%. All RSV-positive patients were immediately placed into contact precautions. First-ring testing found two of four roommates of the index to be RSV positive. Second-ring testing consisted of all infants who were on the unit for more than 3 days prior to index positive test. When RSV was identified in this second group, contact precautions were implemented for the entire population. RSV-positive cases were cohorted together, RSV-negative patients who had been on the unit for 3 or more days were cohorted together, and infants who were not on the unit prior to implementation of unit-wide contact precautions were cohorted together.
CONCLUSION: The index case was identified on December 22, and all epidemiological testing and grouping was rapidly completed by December 25, due to the availability of electronic demographic information for each child. Control measures defined by infection control and implemented/enforced by nursery staff were effective in stopping further transmission of RSV in this unit.
