What precautions are recommended for a patient with a Respiratory Syncytial Virus (RSV) infection?

Infection Control Precautions for RSV Patients

Patients with RSV infection require standard and contact precautions, including strict hand hygiene, glove and gown use upon room entry, private room isolation when possible, and limiting patient movement to essential purposes only. 1, 2

Hand Hygiene (Most Critical Measure)

• Decontaminate hands after any contact with the patient, respiratory secretions, or potentially contaminated surfaces, regardless of glove use 1, 2
• Use alcohol-based hand rub when hands are not visibly soiled 1, 2
• Use soap and water when hands are visibly dirty, contaminated with proteinaceous material, or soiled with blood or body fluids 1
• Hand hygiene is the single most important strategy for reducing RSV transmission 2, 3

Personal Protective Equipment

Gloving

• Wear gloves when entering the room of any patient with confirmed or suspected RSV infection 1, 2
• Wear gloves before handling the patient, their respiratory secretions, or any fomites potentially contaminated with secretions 1
• Change gloves between patients and after handling respiratory secretions before contact with another patient 1
• Decontaminate hands immediately after glove removal 1
• After glove removal and hand decontamination, avoid touching potentially contaminated environmental surfaces in the patient's room 1

Gowning

• Wear a gown when entering the room of any patient with suspected or confirmed RSV infection 1, 2
• Gowning is especially important when soiling with respiratory secretions is anticipated, such as when handling infants with RSV 1
• Change the gown after patient contact and before caring for another patient or leaving the room 1
• After gown removal, ensure clothing does not contact potentially contaminated environmental surfaces 1

Masking and Eye Protection

• Wear a surgical mask and eye protection (or face shield) when performing procedures or patient-care activities that might generate sprays of respiratory secretions 1, 2

Patient Placement and Isolation

• Place patients with diagnosed RSV in a private room whenever possible 1, 2
• If private rooms are unavailable, cohort RSV-positive patients together with no other infections present 1, 2
• Place patients with suspected RSV in a private room pending diagnostic confirmation 1
• Promptly perform rapid diagnostic laboratory tests on patients admitted with RSV symptoms to facilitate early appropriate infection control measures 1, 2

Limiting Patient Movement

• Restrict movement or transport of RSV patients to essential purposes only 1, 2
• When transport is necessary, ensure the patient does not touch other persons' hands or environmental surfaces with hands contaminated by respiratory secretions 1

Healthcare Personnel Restrictions

• Restrict healthcare personnel with acute upper respiratory tract infections from caring for infants and high-risk patients (including children with severe cardiopulmonary conditions, those receiving chemotherapy, premature infants, and immunocompromised patients) 1, 2
• When feasible, perform rapid diagnostic testing on symptomatic healthcare personnel who care for high-risk patients to determine work status promptly 1, 2
• Cohort both patients and personnel when possible during outbreaks to minimize transmission 2

Visitor Restrictions

• Do not allow persons with symptoms of respiratory infection to visit pediatric, immunosuppressed, or cardiac patients 1, 2

Environmental Considerations

• Maintain adequate room ventilation (at least six air exchanges per hour) 4
• Consider negative pressure rooms when available 4
• Implement frequent surface cleaning of potentially contaminated areas 2, 5

Common Pitfalls to Avoid

• Delayed isolation of patients with suspected RSV leads to nosocomial spread 2
• Inadequate hand hygiene is the most common mode of transmission in healthcare settings 2
• Failing to change gloves between patients or after handling respiratory secretions 1
• Touching environmental surfaces after glove removal but before hand decontamination 1

Special Considerations for Ribavirin Administration

If aerosolized ribavirin is being administered, additional precautions are necessary:

• Healthcare workers who are pregnant should consider avoiding direct care of patients receiving aerosolized ribavirin 4
• If close patient contact cannot be avoided, use negative pressure rooms, aerosol scavenging devices, and appropriately fitted respirator masks (surgical masks are inadequate) 4
• Turn off aerosol devices 5-10 minutes prior to prolonged patient contact 4