RSV outbreak in a paediatric intensive care unit

Thorburn, Kentigern; Kerr, Steve; Taylor, Nia; Saene, H. K. F. van

doi:10.1016/j.jhin.2004.03.013

Cited by 78 publications

(47 citation statements)

References 26 publications

(15 reference statements)

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“…This is borne out by the longer length of stay in the group of RSV deaths with its high incidence of both pre-existing disease and nosocomial RSV infection. Previous studies have described an increased incidence of nosocomial RSV infection in children with congenital heart disease, chronic lung disease and immunodeficiency 7 13 14 20 21 27 28. It highlights not only their vulnerability to nosocomial infection, but also its potential devastating impact on these children.…”

Section: Discussionmentioning

confidence: 94%

“…Some of the data presented have been used in previous publications on the incidence of pulmonary bacterial co-infection in severe RSV bronchiolitis (three RSV seasons: 2002–2005)19 and a description of an RSV outbreak (RSV season 2002) 14…”

Section: Resultsmentioning

confidence: 99%

“…The prolonged days of RSV positivity in the group of RSV deaths may also relate to the high incidence of pre-existing diseases. It has been recognised that patients with underlying conditions may excrete virus/RSV for longer periods 14 21 22 27 28. So, in addition to susceptibility to nosocomial infection, once infected they constitute a prolonged source for potential cross-infection within the unit.…”

Section: Discussionmentioning

confidence: 99%

“…The reported mortality rate for those hospitalised may be as low as 1%–3%, but the mortality rate increases in those with severe bronchiolitis requiring intensive care management 10 – 14…”

mentioning

confidence: 99%

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Pre-existing disease is associated with a significantly higher risk of death in severe respiratory syncytial virus infection

Thorburn¹

2008

Archives of Disease in Childhood

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Section: Discussionmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pre-existing disease is associated with a significantly higher risk of death in severe respiratory syncytial virus infection

Thorburn¹

2008

Archives of Disease in Childhood

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196

138

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“…4,15,16 Admissions for bronchiolitis increased from 21,330 in 2004/5 to 33,472 in 2010/11, 17 placing enormous strains on paediatric services and intensive care units (ICUs) 4,8,18 which sometimes have to close because of the number of infants with acute bronchiolitis. [18][19][20] Despite many putative candidates, including antiviral agents, inhaled steroids and bronchodilators, no treatment other than oxygen therapy has been shown to have an impact on the course of the acute illness and an effective vaccine still appears some way off. The median duration of hospitalisation in the UK is around 3 days, which compares with a median of 1 day for all acute paediatric admissions.…”

Section: Chapter 1 Introductionmentioning

confidence: 99%

Saline in Acute Bronchiolitis RCT and Economic evaluation: hypertonic saline in acute bronchiolitis – randomised controlled trial and systematic review

Everard

Hind

Ugonna

et al. 2015

Health Technol Assess

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BackgroundAcute bronchiolitis is the most common cause of hospitalisation in infancy. Supportive care and oxygen are the cornerstones of management. A Cochrane review concluded that the use of nebulised 3% hypertonic saline (HS) may significantly reduce the duration of hospitalisation.ObjectiveTo test the hypothesis that HS reduces the time to when infants were assessed as being fit for discharge, defined as in air with saturations of > 92% for 6 hours, by 25%.DesignParallel-group, pragmatic randomised controlled trial, cost–utility analysis and systematic review.SettingTen UK hospitals.ParticipantsInfants with acute bronchiolitis requiring oxygen therapy were allocated within 4 hours of admission.InterventionsSupportive care with oxygen as required, minimal handling and fluid administration as appropriate to the severity of the disease, 3% nebulised HS every ± 6 hours.Main outcome measuresThe trial primary outcome was time until the infant met objective discharge criteria. Secondary end points included time to discharge and adverse events. The costs analysed related to length of stay (LoS), readmissions, nebulised saline and other NHS resource use. Quality-adjusted life-years (QALYs) were estimated using an existing utility decrement derived for hospitalisation in children, together with the time spent in hospital in the trial.Data sourcesWe searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and other databases from inception or from 2010 onwards, searched ClinicalTrials.gov and other registries and hand-searchedChest,PaediatricsandJournal of Paediatricsto January 2015.Review methodsWe included randomised/quasi-randomised trials which compared HS versus saline (± adjunct treatment) or no treatment. We used a fixed-effects model to combine mean differences for LoS and assessed statistical heterogeneity using theI2statistic.ResultsThe trial randomised 158 infants to HS (n = 141 analysed) and 159 to standard care (n = 149 analysed). There was no difference between the two arms in the time to being declared fit for discharge [median 76.6 vs. 75.9 hours, hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.75 to 1.20] or to actual discharge (median 88.5 vs. 88.7 hours, HR 0.97, 95% CI 0.76 to 1.23). There was no difference in adverse events. One infant developed bradycardia with desaturation associated with HS. Mean hospital costs were £2595 and £2727 for the control and intervention groups, respectively (p = 0.657). Incremental QALYs were 0.0000175 (p = 0.757). An incremental cost-effectiveness ratio of £7.6M per QALY gained was not appreciably altered by sensitivity analyses. The systematic review comprised 15 trials (n = 1922) including our own. HS reduced the mean LoS by –0.36 days (95% CI –0.50 to –0.22 days). High levels of heterogeneity (I2 = 78%) indicate that the result should be treated cautiously.ConclusionsIn this trial, HS had no clinical benefit on LoS or readiness for discharge and was not a cost-effective treatment for acute bronchiolitis. Claims that HS achieves small reductions in LoS must be treated with scepticism.Future workWell-powered randomised controlled trials of high-flow oxygen are needed.Study registrationThis study is registered as NCT01469845 and CRD42014007569.Funding detailsThis project was funded by the NIHR Health Technology Assessment (HTA) programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 66. See the HTA programme website for further project information.

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Reasons Why Physicians and Advanced Practice Clinicians Work While Sick

et al. 2015

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IMPORTANCE When clinicians work with symptoms of infection, they can put patients and colleagues at risk. Little is known about the reasons why attending physicians and advanced practice clinicians (APCs) work while sick.OBJECTIVE To identify a comprehensive understanding of the reasons why attending physicians and APCs work while sick. DESIGN, SETTING, AND PARTICIPANTS We performed a mixed-methods analysis of a cross-sectional, anonymous survey administered from January 15 through March 20, 2014, in a large children's hospital in Philadelphia, Pennsylvania. Data were analyzed from April 1 through June 1, 2014. The survey was administered to 459 attending physicians and 470 APCs, including certified registered nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. MAIN OUTCOMES AND MEASURES Self-reported frequency of working while experiencing symptoms of infection, perceived importance of various factors that encourage working while sick, and free-text comments written in response to open-ended questions. RESULTS Of those surveyed, we received responses from 280 attending physicians (61.0%) and 256 APCs (54.5%). Most of the respondents (504 [95.3%]) believed that working while sick put patients at risk. Despite this belief, 446 respondents (83.1%) reported working sick at least 1 time in the past year, and 50 (9.3%) reported working while sick at least 5 times. Respondents would work with significant symptoms, including diarrhea (161 [30.0%]), fever (86 [16.0%]), and acute onset of significant respiratory symptoms (299 [55.6%]). Physicians were more likely to report working with each of these symptoms than APCs (109 [38.9%] vs 51 [19.9%], 61 [21.8%] vs 25 [9.8%], and 168 [60.0%] vs 130 [50.8%], respectively [P < .05]). Reasons deemed important in deciding to work while sick included not wanting to let colleagues down (521 [98.7%]), staffing concerns (505 [94.9%]), not wanting to let patients down (494 [92.5%]), fear of ostracism by colleagues (342 [64.0%]), and concern about continuity of care (337 [63.8%]). Systematic qualitative analysis of free-text comments from 316 respondents revealed additional reasons why attending physicians and APCs work while sick, including extreme difficulty finding coverage (205 [64.9%]), a strong cultural norm to come to work unless remarkably ill (193 [61.1%]), and ambiguity about what constitutes "too sick to work" (180 [57.0%]). CONCLUSIONS AND RELEVANCE Attending physicians and APCs frequently work while sick despite recognizing that this choice puts patients at risk. The decision to work sick is shaped by systems-level and sociocultural factors. Multimodal interventions are needed to reduce the frequency of this behavior.

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RSV outbreak in a paediatric intensive care unit

Cited by 78 publications

References 26 publications

Pre-existing disease is associated with a significantly higher risk of death in severe respiratory syncytial virus infection

Pre-existing disease is associated with a significantly higher risk of death in severe respiratory syncytial virus infection

Saline in Acute Bronchiolitis RCT and Economic evaluation: hypertonic saline in acute bronchiolitis – randomised controlled trial and systematic review

Reasons Why Physicians and Advanced Practice Clinicians Work While Sick

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