Infectious Disease

Respiratory virus trends in hospitals during COVID-19 mirrored trends in community

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The authors report no relevant financial disclosures.

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Trends in respiratory viral infections in hospitals mirrored trends in the community during the COVID-19 pandemic, “suggesting that hospital interventions alone did not significantly affect” their incidence, researchers reported.

“We were observing that in general we were seeing fewer hospital-acquired respiratory viral illnesses (HA-RVI) in the time of COVID,” Jessica L. Seidelman MD, MPH, an infectious disease physician at Duke University School of Medicine, told Healio. “The goal was to look at this objectively.”

Box of surgical masks

COVID-19-related infection prevention strategies such as masking and physical distancing in the hospital setting may have impacted hospital-acquired respiratory viral infection incidence. Source: Adobe Stock.

Jessica Seidelman

Seidelman and colleagues retrospectively analyzed respiratory viral tests from April 2017 through September 2021 at two tertiary-care hospitals and two community hospitals in North Carolina to compare the pre-COVID-19 period with the post-COVID-19 period.

The study defined these periods as April 2017 to March 2020 and April 2020 to September 2021, respectively, and HA-RVI as a non-SARS-CoV-2 respiratory virus sample collected on or after hospital day 7.

According to the researchers, the COVID-19 infection prevention bundle in all four of the facilities included universal masking; eye protection; screening health care personnel, patients and visitors for symptoms; contact tracing; admission and pre-procedure testing; visitor restrictions; discouraging presenteeism; limiting crowding and adhering to physical distancing; hand hygiene; personal protective equipment compliance; and environmental cleaning.

According to the study, patients who had subsequent positive viral tests with the same organism within 8 weeks were counted once, whereas patients with multiple pathogens identified on viral testing were counted once for each unique organism. The researchers calculated incidence rates (IRs) for HA-RVIs as cases per 1,000 patient days and compared incidence rate ratios (IRRs) between the two periods.

During the study period, they identified 840 non-SARS-CoV-2 HA-RVIs among 826 patients over more than 3.4 million 3,446,595 hospital days (IR = 0.24 HA-RVIs per 1,000 hospital days). According to the study, 625 patients (76%) had a positive viral test from an upper respiratory tract specimen and 201 patients (24%) had a positive viral test from a lower respiratory tract sample with the median time from admission to specimen collection being 14 days (interquartile range [IQR] = 10-28).

They determined that 723 HA-RVIs occurred over 2,295,939 inpatient days (IR = 0.32 per 1,000 hospital days) in the pre-COVID-19 period and 117 HA-RVIs over 1,150,656 hospital days (IR = 0.10 per 1,000 hospital days) in the post -COVID-19 period (IRR = 0.32; 95% CI, 0.27-0.39). Rhinovirus, influenza and parainfluenza were the most reported HA-RVIs.

The researchers said the peaks and decreases of HA-RVI incident cases generally mirrored the peaks and decreases of the community RVI incident cases.

“Additional hospital infection prevention interventions may have affected the incidence of hospital-acquired respiratory viral illnesses, but this is not the whole story,” Seidelman said. “The role of community prevention strategies and incidence also likely played a role in the incidence of respiratory viral illnesses that we saw in the hospital. Therefore, we need to continue to focus on community surveillance, presenteeism, and PPE if we want to affect HA respiratory viral illnesses.”

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