In a session at the Society for Healthcare Epidemiology of America (SHEA) Spring 2017 Conference, on March 30, 2017, co-chair of Scientific Spring Program at the SHEA Spring Meeting, Matthew Linam, MD, MS, associate professor, Department of Pediatrics at the University of Arkansas, and medical director of Hospital Epidemiology and Infection Control at Arkansas Children’s Hospital (ACH), examined methods to prevent the spread of respiratory viral healthcare-associated infections (HAIs) by healthcare workers in healthcare settings.
Respiratory viral HAIs are a growing threat in healthcare facilities. At ACH, the second highest cause of HAIs was found to be respiratory viral HAIs, which accounted for approximately 20% of the total HAIs at the facility. These infections occurred most often in the Neonatal Intensive Care Unit, Cardiovascular Intensive Care Unit, and Intensive Therapy Unit. In addition, these infections occurred mostly in long-term care patients who “had cardiopulmonary issues that placed them at increased risk for morbidity related to these infections.”
A special infection prevention team was formed at ACH specifically to reduce respiratory viral HAIs in the hospital by 25% over the course of the year, according to Dr. Linam. The team focused on several primary sources of transmission of respiratory viral HAIs, including healthcare workers, family members, and visitors.
“Within preventing healthcare worker transmission, we’ve really been focused on four areas: hand hygiene, using syndrome-based isolation precautions, healthcare worker influenza vaccination, and getting our healthcare workers to not come to work when they are ill,” Dr. Linam said.
In a surveillance study of respiratory viral shedding at another healthcare facility, researchers enrolled 170 healthcare workers who were employed at the hospital during the time of the study. The study was designed to focus on the spread of influenza in a year with relatively low case prevalence. Using a multiplex polymerase chain reaction (PCR) panel, the researchers tested for other respiratory viruses. They then collected 119 specimens from 83 symptomatic healthcare workers. These specimens were compared with 200 specimens from 160 healthcare workers “obtained at a time when various healthcare workers were asymptomatic.”
The results showed that, of the specimens collected from the symptomatic healthcare workers, 39 were positive for a virus, while a smaller number of specimens from asymptomatic healthcare workers were found to be positive for a virus. These findings show that, on occasion, healthcare workers who do not present with symptoms are still shedding viruses, said Dr. Linam. “The majority of these specimens were positive for human rhinovirus,” he continued. Rhinovirus is the usual cause of the common cold, and while it is not harmful to healthcare workers, it does have a “significant impact on high-risk patients.”
Approximately half of the healthcare workers enrolled in the study “admitted coming to work in the past year with an influenza-like illness.” In those who were positive for a virus, these healthcare workers were “significantly more likely to have symptoms of any kind,” although fever was not significant between the symptomatic or asymptomatic groups.