Autor:innen:
Michèle Birrer (Bern | CH)
Martin Perrig (Bern | CH)
Fabienne Hobi (Bern | CH)
Christina Gfeller (Bern | CH)
Andrew Atkinson (Bern | CH)
Martin Egger (Langnau | CH)
Corinne Bartholdi (Bern | CH)
Drahomir Antonin Aujesky (Bern | CH)
Jonas Marschall (Bern | CH)
Rami Sommerstein (Bern | CH)
Background and aim
Current guidelines recommend a pathogen-based isolation precautions strategy for patients hospitalized with respiratory virus infection (RVI). Our aim was to assess the effect of droplet precautions on-site (DroPS) versus the traditional private room droplet (influenza) or contact (RSV) precautions strategy on the rate of nosocomial RVI.
Materials and Methods
Single center, 3:1 controlled non-randomized intervention study during the 2018/19 influenza season, at the Department of General Internal Medicine, Bern University Hospital, Switzerland. The intervention ward introduced the DroPS strategy while the control ward used the traditional isolation precautions. DroPS included nurse-driven initiation of precautions based on respiratory symptoms, signage of the patient bed, surgical masks for patient contact < 1.5m, and enforcement of standard hygiene precautions. Patients on both wards were screened for the onset of respiratory symptoms on a daily basis. For each newly initiated respiratory precaution of a patient admitted > 48 hours, an influenza/RSV molecular rapid test was performed. If negative, this was followed by a multiplex respiratory virus PCR.
The primary outcome was the rate of laboratory-confirmed nosocomial RVI, compared between the two strategies. Patients with nosocomial respiratory symptoms and no laboratory tests were considered having a nosocomial RVI.
Results
We included 1230 hospitalizations. In the DroPS ward, 250/933 (26.8%) patients were set on precautions due to respiratory symptoms, versus 9/297 (3.0%) in the control ward. Influenza/RSV molecular rapid testing detected 117/933 (12.5%) infections in the DroPS ward and 8/297 (2.7%) in the control ward (between group difference, 9.8%; 95% CI, 6.8 to 12.9; p < 0.001).
In the DroPS ward, the nosocomial infection rate was 8/933 (0.86%; 1x influenza A, 1x RSV, 3x coronavirus, 3x laboratory tests incompletely performed), compared to 2/297 (0.67%; 2x influenza A) in the control ward. The difference between the groups was 0.19% (95% CI;
–1.10 to 1.47; p = 0.9).
Conclusion
DroPS represents a safe, simple and resource-saving alternative to the traditional strategy for RVI. The difference in the rate of respiratory precautions between the two groups indicated a preferred admission of patients with suspected RVI to the DroPS ward.