Supportive Care Measures for Respiratory Syncytial Virus (RSV) Infection
Supportive care remains the cornerstone of management for RSV infection, focusing on hydration, oxygenation, and symptom relief, as there is no specific curative treatment available for most patients. 1
General Supportive Care Measures
Hydration: Ensure adequate fluid intake to prevent dehydration, especially in infants who may have difficulty feeding due to respiratory distress and nasal congestion 1
Oxygenation: Monitor oxygen saturation and provide supplemental oxygen when needed to maintain appropriate oxygen levels 1
Nasal suctioning: Gentle suctioning of nasal secretions to improve breathing and feeding, particularly important in infants who are obligate nasal breathers 2
Fever management: Use appropriate antipyretics as needed for fever control 2
Infection Control Measures
Hand hygiene: Decontaminate hands before and after direct patient contact, after contact with items in the patient's vicinity, and after removing gloves. Alcohol-based rubs are preferred when hands are not visibly soiled; otherwise, wash with antimicrobial soap 3
Isolation precautions: Place patients with confirmed or suspected RSV infection in private rooms or cohort with other RSV-positive patients 3
Personal protective equipment:
- Wear gloves when entering the room of patients with RSV infection or when handling patients or their respiratory secretions 3
- Wear gowns when entering the room of a patient with RSV infection and when contact with respiratory secretions is anticipated 3
- Wear a surgical mask and eye protection when performing procedures that might generate respiratory secretion sprays 3
Patient movement: Limit movement or transport of patients with RSV infection to essential purposes only 3
Visitor restrictions: Do not allow persons with symptoms of respiratory infection to visit pediatric, immunosuppressed, or cardiac patients 3
Special Considerations for High-Risk Patients
Premature infants and children with underlying conditions: Consider monthly administration of palivizumab (Synagis) for prophylaxis in:
- Infants born at <32 weeks gestation with bronchopulmonary dysplasia or without chronic lung disease who will be <6 months at the beginning of RSV season 3, 4
- Infants born at 32-35 weeks gestation with at least two risk factors (child-care attendance, school-aged siblings, environmental pollutant exposure, congenital airway abnormalities, or severe neuromuscular disease) 3
Immunocompromised patients: These patients may benefit from ribavirin treatment, though evidence is limited 3, 5
Prevention Strategies
Avoid tobacco smoke exposure: Infants should not be exposed to passive smoking, as it increases the risk of severe RSV infection 3
Breastfeeding: Recommended to decrease a child's risk of having lower respiratory tract disease 3
Education: Healthcare providers should educate personnel and family members on hand sanitation and infection control measures 3
Healthcare Setting Considerations
Staff management: Restrict healthcare personnel with acute upper respiratory tract infections from caring for high-risk infants and children 3
Rapid diagnostic testing: Promptly perform rapid diagnostic tests on patients admitted with symptoms of RSV infection to facilitate appropriate infection control measures 3
Cohorting: During outbreaks, cohort both patients and personnel when possible to minimize transmission 3
Emerging Preventive Options
New monoclonal antibodies: Long-acting monoclonal antibodies like nirsevimab provide season-long protection with a single dose and have shown high efficacy in preventing severe RSV-related lower respiratory tract infections in infants 6
Vaccines: New vaccines targeting older adults have demonstrated significant efficacy in preventing lower respiratory tract infections in clinical trials 6
Common Pitfalls to Avoid
Overuse of antibiotics: RSV is a viral infection; antibiotics should only be used if there is evidence of bacterial co-infection 2
Delayed isolation: Failure to promptly isolate patients with suspected RSV can lead to nosocomial spread 3
Inadequate hand hygiene: This is the most common mode of transmission in healthcare settings 3
Overlooking high-risk patients: Failing to identify patients who qualify for prophylaxis with palivizumab can lead to preventable severe disease 7