Detection and Control of a Nosocomial Respiratory Syncytial Virus Outbreak in a Stem Cell Transplantation Unit: The Role of Palivizumab
Detection and Control of a Nosocomial Respiratory Syncytial Virus Outbreak in a Stem Cell Transplantation Unit: The Role of Palivizumab
复制标题
DOI：
10.1016/j.bbmt.2010.03.011
复制
发表时间：
2010-09-01
影响因子：
4.3
通讯作者：
Chemaly, Roy F.
中科院分区：
文献类型：
--
作者：
Kassis, Christelle;Champlin, Richard E.;Chemaly, Roy F.
呼吸道合胞病毒（RSV）是一种常见的社区获得性病毒，可引起儿童、血液恶性肿瘤患者和造血干细胞移植（HSCT）受者的上呼吸道和下呼吸道感染。免疫功能低下患者中 RSV 的院内传播可显着影响发病率、死亡率和住院时间。需要采取严格的感染控制措施来控制进一步的医院传播。研究发现预防性帕利珠单抗可显着降低高危儿童的住院率。在本文中，我们报告了 2004 年 1 月 16 日至 2 月 4 日期间成人 HSCT 病房（4 间）发生的一起院内 RSV 暴发，包括所采用的感染控制干预措施以及对高危患者预防性给予帕利珠单抗。主动监测发现 5 例病例，较前几季大幅增加（每季 2 至 3 例）。所有感染患者均被隔离至 I 护理舱并进行接触隔离。 HSCT 科室的所有患者均使用鼻腔冲洗液进行快速 RSV 抗原筛查；一周后又重复了一遍，并发现了另外的 RSV 病例。确定 RSV 感染风险增加的患者接受了预防性帕利珠单抗治疗。对工作人员和访客进行了例行检查。所有患者和访客区域均用漂白剂彻底清洁。我们对医护人员进行了有关 RSV 传播的教育，强调正确的手部卫生和接触预防措施。 6 名 RSV 感染患者中有 4 名出现 RSV 肺炎，其中 2 名患者死亡。对有上呼吸道症状的工作人员和访客进行了筛查，结果均为 RSV 阴性。 16 名 RSV 检测呈阴性但被认为 RSV 感染风险增加的患者接受了预防性帕利珠单抗治疗。这些患者均未出现 RSV 感染。 RSV 疫情的爆发得到了控制，采取了及时的预防措施，包括将患者与专门的医疗保健人员进行分组；患者接触隔离；严格遵守手部卫生；对访客、家庭成员和医护人员进行上呼吸道感染症状筛查。对高危患者使用帕利珠单抗进行免疫预防，补充了严格的感染控制干预措施。因此，帕利珠单抗在控制 RSV 医院暴发中的作用值得进一步研究。 Biol 血液骨髓移植 16：1265-1271 (2010) (C) 2010 美国血液和骨髓移植学会
Respiratory syncytial virus (RSV) is a common community-acquired virus that causes upper and lower respiratory tract infections in children, hematologic malignancy patients, and hematopoietic stem cell transplant (HSCT) recipients. Nosocomial transmission of RSV in immunocompromised patients can significantly affect morbidity, mortality, and duration of hospitalization. Stringent infection control measurements are needed to control further hospital transmission. Prophylactic palivizumab was found to result in a significant reduction in hospitalization rates in high-risk children. In this article, we report a nosocomial outbreak of RSV in an adult HSCT unit (4 pods) from January 16 to February 4, 2004, including the infection control interventions used and the prophylactic administration of palivizumab in high-risk patients. Active surveillance identified 5 cases, a substantial increase from previous seasons (2 or 3 cases per season). All infected patients were isolated to I nursing pod and placed on contact isolation. All patients on the HSCT unit underwent rapid RSV antigen screening using nasal washes; this was repeated I week later, and I additional RSV case was identified. Patients identified to be at increased risk for RSV infection received prophylactic palivizumab. Routine screenings of the staff and visitors were undertaken. All patient and visitor areas were thoroughly cleaned with bleach. We educated health care workers about RSV transmission, highlighting proper hand hygiene and contact precautions. Four of 6 patients with RSV infection developed RSV pneumonia, and 2 of these patients died. Staff and visitors with upper respiratory symptoms were screened, and all were negative for RSV. Prophylactic palivizumab was administered in 16 patients who tested negative for RSV, but were considered to be at increased risk for RSV infection. None of these patients developed RSV infections. An RSV outbreak was controlled using prompt preventive measures, including cohorting patients, with a dedicated health care staff; contact isolation of patients; strict adherence to hand hygiene; and screening of visitors, family members, and health care staff for upper respiratory infection symptoms. Immunoprophylaxis with palivizumab, administered to high-risk patients, complemented strict infection control intervention. Thus, the role of palivizumab in the control of RSV hospital outbreaks merits further investigation. Biol Blood Marrow Transplant 16: 1265-1271 (2010) (C) 2010 American Society for Blood and Marrow Transplantation