RSV Isolation Duration
Patients with RSV should remain in isolation for at least 7-8 days from symptom onset in most cases, but immunocompromised patients require extended isolation of at least 20 days or more due to prolonged viral shedding. 1
Standard Isolation Duration for Immunocompetent Patients
- The typical isolation period is 7-8 days from symptom onset, as infectiousness generally declines within this timeframe in immunocompetent individuals 1
- Viral shedding in community studies shows a mean duration of approximately 4.5 days (median 4 days, range 1-14 days) in children with RSV 2
- Most RSV infections are self-limited and resolve within 1-2 weeks 3, 4
Extended Isolation for Immunocompromised Patients
- Immunocompromised patients with RSV must be isolated for at least 20 days or more following symptom onset due to documented prolonged viral shedding 1
- This extended duration applies to patients with hairy cell leukemia, those receiving chemotherapy, hematopoietic stem cell transplant recipients, and other immunosuppressed individuals 1
- Prolonged shedding of viral RNA has been consistently observed in immunocompromised populations, necessitating longer quarantine periods 1
Hospital and Healthcare Settings
- Isolation and/or cohorting of RSV-positive patients is effective in reducing nosocomial transmission, though may not always be feasible 1
- Droplet precautions should be implemented for all children less than 2 years old with respiratory symptoms during RSV season until RSV is ruled out 1
- Healthcare workers and visitors must practice strict hand decontamination before and after direct patient contact, after contact with objects near the patient, and after removing gloves 1
- Alcohol-based hand rubs are preferred for hand decontamination unless hands are visibly soiled 1
Infection Control Measures During Isolation
- Hand hygiene is the single most important measure to prevent RSV transmission, as the virus spreads through respiratory droplets and contaminated surfaces 1, 5
- RSV can remain viable on fomites (beds, crib railings, tabletops, toys) for several hours 1
- Gowns and gloves should be used for direct patient contact, with frequent changes to prevent organism spread 1
- RSV RNA has been detected in air samples up to 22 feet from the patient's bedside 1
Special Considerations
- Children may have prolonged viral shedding compared to adults, particularly young children in daycare settings 2
- Patients with a history of prior RSV infection show shorter duration of viral shedding (40% increased rate of recovery) compared to primary infections 2
- Individuals are considered infectious even before symptomatic presentation begins and throughout the period of viral shedding 6
Common Pitfalls to Avoid
- Do not discontinue isolation prematurely in immunocompromised patients based on clinical improvement alone—extend to at least 20 days 1
- Do not rely solely on symptom resolution to determine end of isolation, as viral shedding patterns vary by immune status 1, 2
- Do not neglect hand hygiene even when using gloves, as this remains the most critical transmission prevention measure 1