| Methods |
Retrospective and prospective cohort study was conducted to evaluate the effectiveness of cohorting and educational programme (handwashing) in reducing the incidence of nosocomial respiratory syncytial virus infections
Data on all children with RSV infection on any of the paediatric wards in winter of 1986 to 1987 were retrospectively collected. In order to define the population at risk of developing RSV infection it was determined the number of children under 2 years of age hospitalised on the 2 paediatric wards and the paediatric intensive care unit and the number they spent in hospital. For the next 2 winters (1987 to 1988 and 1988 to 1989) the same data were prospectively collected. In addition some interventions were made to try to reduce the incidence of hospital‐acquired RSV infection. Children admitted with suspected RSV infection were nursed in a specific area until the result of an indirect immunofluorescent test. It was not possible to cohort babies on the paediatric intensive care unit. Staff were instructed on the importance of handwashing and this was reinforced on ward rounds. An educational leaflet was prepared and given to the parents of every child admitted with the infection |
| Participants |
Children < 2 years of age: 425 in period 1; 840 in period 2; 552 in period 3 |
| Interventions |
Isolation and handwashing versus normal care |
| Outcomes |
Laboratory: indirect immunofluorescence on nasopharyngeal secretions or by culture of secretions
Effectiveness: RSV infection
Safety: n/a |
| Notes |
Risk of bias: high (poor descriptions)
Notes: the authors concluded that handwashing and cohorting reduced at least 66% in the number of hospital acquired infections due to RSV in the 2 intervention winters. One minor problem with cohorting was that babies could not remain in the accident and emergency department until a diagnosis of RSV was virologically confirmed. Hence they were cohorted on the basis of a clinical diagnosis of bronchiolitis. The authors also underline the importance of a more rapid antigen test for RSV. It is doubtful whether the non‐exposed cohort is similar to its hospital peers, especially because there are several cardiac children in the exposed cohort. The biggest limit to this study is mentioned by the authors in the Discussion: the assumption that the circulation of RSV is constant throughout the study period. Exposure however is not the same in the 3 seasons and observed effect may be due to cohorting or to the different viral circulation |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Unclear risk |
N/A |
| Allocation concealment (selection bias) |
Unclear risk |
N/A |
| Blinding (performance bias and detection bias)
All outcomes |
Unclear risk |
N/A |
| Incomplete outcome data (attrition bias)
All outcomes |
Unclear risk |
N/A |
| Selective reporting (reporting bias) |
Unclear risk |
N/A |
