What are the recommended isolation precautions and treatment options for a patient with rhinovirus, particularly for those at high risk of severe illness such as young children, older adults, and individuals with compromised immune systems?

Rhinovirus Isolation and Management

For rhinovirus infections, implement standard contact precautions with rigorous hand hygiene as the cornerstone of prevention, while treatment remains entirely supportive since no antiviral therapy exists for routine use. 1, 2

Isolation Precautions

Standard Contact Precautions

• Implement meticulous hand hygiene before and after all patient contact, regardless of glove use, as this is the single most critical measure to prevent rhinovirus transmission. 3, 2
• Use alcohol-based hand rubs when hands are not visibly soiled; otherwise wash with antimicrobial soap. 4
• Wear gloves when handling patients with respiratory symptoms or touching any potentially contaminated surfaces or secretions. 3
• Change gloves between different patients and after handling respiratory secretions before contacting another patient. 3

Gown and Barrier Precautions

• Wear a gown if clothing could be soiled by respiratory secretions, particularly when handling infants or young children with rhinovirus infection. 3
• Change the gown after such contact and before caring for another patient. 3

Healthcare Worker Restrictions

• Restrict healthcare workers with acute upper respiratory symptoms (sneezing, coughing) from caring for high-risk patients including infants, immunocompromised individuals, children with severe cardiopulmonary conditions, premature infants, and those receiving chemotherapy. 3

Visitor Limitations

• Do not allow persons with respiratory infection symptoms to visit pediatric, immunosuppressed, or cardiac patients. 3

High-Risk Populations Requiring Enhanced Monitoring

The following groups warrant heightened vigilance due to increased risk of severe complications from rhinovirus:

Pediatric High-Risk Groups

• Infants, particularly those under 12 months of age (86% of hospitalized rhinovirus cases occur in this age group). 5
• Premature infants (≤35 weeks gestation, especially ≤28 weeks). 6
• Children with bronchopulmonary dysplasia or chronic lung disease requiring medical treatment. 6
• Children with hemodynamically significant congenital heart disease. 6
• Children with neuromuscular disorders impairing secretion clearance. 6

Adult High-Risk Groups

• Elderly patients. 7
• Patients with asthma or chronic obstructive pulmonary disease (COPD), as rhinovirus commonly triggers exacerbations. 1, 7
• Immunocompromised individuals, including hematopoietic stem cell transplant recipients, solid organ transplant recipients, and those with profound lymphopenia (<100 cells/mm³). 6, 7

Treatment Approach

Supportive Care Only

• No antiviral therapy is recommended for routine rhinovirus infection; treatment is entirely symptomatic and supportive. 1, 7
• Ensure adequate hydration and assess fluid intake in all patients. 6
• Use acetaminophen or ibuprofen for fever or pain management as needed. 6
• Consider nasal saline irrigation for symptomatic relief in adults with upper respiratory symptoms. 6

Oxygen Support for Severe Cases

• Provide supplemental oxygen if oxygen saturation falls persistently below 90% in previously healthy patients. 6
• Monitor oxygen requirements closely in patients with underlying cardiopulmonary disease. 6

What NOT to Do

• Do not routinely prescribe antibacterial agents unless there is specific evidence of bacterial co-infection. 6, 5
• Do not use ribavirin for rhinovirus infection (ribavirin is only indicated for specific RSV cases in severely immunocompromised patients, not for rhinovirus). 6
• Do not use palivizumab, as it has no therapeutic benefit for treating established viral infections and is only approved for RSV prevention in specific high-risk infants. 6

Infection Control in Healthcare Settings

Surveillance and Rapid Diagnosis

• Establish mechanisms to alert hospital personnel promptly about increased rhinovirus activity in the community. 3
• Arrange for rapid diagnostic testing (such as RT-PCR) to be available when clinically indicated, particularly for high-risk patients. 3, 7

Room Assignment and Cohorting

• When possible, admit young children with viral respiratory symptoms to single rooms. 3
• If single rooms are unavailable, perform rapid diagnostic screening and cohort patients according to their specific viral infection status. 3

Patient Transport

• Limit movement or transport of patients with respiratory viral infections to essential purposes only. 3, 4
• If transport is necessary, ensure the patient does not touch other persons' hands or environmental surfaces with contaminated hands. 3

Common Pitfalls to Avoid

• Delayed implementation of hand hygiene protocols, which is the most common mode of nosocomial transmission. 4, 2
• Inadequate hand hygiene compliance among healthcare workers and visitors. 4, 2
• Overuse of antibiotics when there is no documented bacterial co-infection (only 1 of 26 patients treated with antibiotics in one study had confirmed bacterial infection). 5
• Allowing symptomatic healthcare workers or visitors to have contact with high-risk patients. 3
• Failing to recognize that rhinovirus can cause severe lower respiratory tract illness (including bronchiolitis and pneumonia) in young infants and immunocompromised patients, not just mild upper respiratory symptoms. 5, 1, 7

Clinical Presentation Considerations

• Rhinovirus causes bronchiolitis in young infants with similar severity to RSV, though it leads to hospitalization less frequently overall. 5
• In infants under 3 months, rhinovirus can present as suspected sepsis, warranting careful evaluation. 5
• Peak rhinovirus activity often occurs in spring and early summer (58% of hospitalized pediatric cases in one study), not just during traditional "cold season." 5