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Respiratory Virus Shedding in a Cohort of On-Duty Healthcare Workers Undergoing Prospective Surveillance

Published online by Cambridge University Press:  02 January 2015

Jennifer C. Esbenshade
Affiliation:
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
Kathryn M. Edwards
Affiliation:
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
Adam J. Esbenshade
Affiliation:
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
Vanessa E. Rodriguez
Affiliation:
Vanderbilt University School of Medicine, Nashville, Tennessee
H. Keipp Talbot
Affiliation:
Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Marlon F. Joseph
Affiliation:
Vanderbilt University School of Medicine, Nashville, Tennessee
Samuel K. Nwosu
Affiliation:
Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
James D. Chappell
Affiliation:
Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
James E. Gern
Affiliation:
Departments of Pediatrics and Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
John V. Williams
Affiliation:
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
Thomas R. Talbot
Affiliation:
Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Corresponding
E-mail address:

Abstract

Background.

Healthcare-associated transmission of respiratory viruses is a concerning patient safety issue.

Design.

Surveillance for influenza virus among a cohort of healthcare workers (HCWs) was conducted in a tertiary care children's hospital from November 2009 through April 2010 using biweekly nasal swab specimen collection. If a subject reported respiratory symptoms, an additional specimen was collected. Specimens from ill HCWs and a randomly selected sample from asymptomatic subjects were tested for additional respiratory viruses by multiplex polymerase chain reaction (PCR).

Results.

A total of 1,404 nasal swab specimens were collected from 170 enrolled subjects. Influenza circulated at very low levels during the surveillance period, and 74.2% of subjects received influenza vaccination. Influenza virus was not detected in any specimen. Multiplex respiratory virus PCR analysis of all 119 specimens from symptomatic subjects and 200 specimens from asymptomatic subjects yielded a total of 42 positive specimens, including 7 (16.7%) in asymptomatic subjects. Viral shedding was associated with report of any symptom (odds ratio [OR], 13.06 [95% confidence interval, 5.45–31.28]; P< .0001) and younger age (OR, 0.96 [95% confidence interval, 0.92–0.99]; P = .023) when controlled for sex and occupation of physician or nurse. After the surveillance period, 46% of subjects reported working while ill with an influenza-like illness during the previous influenza season.

Conclusions.

In this cohort, HCWs working while ill was common, as was viral shedding among those with symptoms. Asymptomatic viral shedding was infrequent but did occur. HCWs should refrain from patient care duties while ill, and staffing contingencies should accommodate them.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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