| Methods |
Controlled before and after study conducted in children's hospital of Boston, USA, to determine whether increased compliance with a policy of glove and gown isolation precautions could reduce the high rate of nosocomial RSV infection on an infant and toddler ward. All patients admitted to the 28‐bed infant and toddler medical ward during 3 consecutive RSV seasons (1982 to 1985) were included in the study. When patients with known or suspected RSV infection were admitted, an attempt was made to place them in single rooms or to group them together, but infected patients were frequently required to share rooms with susceptible patients during the winter months, when the prevalence of RSV on the wards is highest. The RSV season was defined as the 24 weeks each year starting at the beginning of November and continuing through the end of April. All the documented cases of RSV infection occurred during that period, and all the patients and patient‐days during that interval on the study ward were recorded. RSV infections were classified as nosocomial if symptoms developed 5 or more days after the patient's admission to the hospital. All cases of RSV infection were confirmed virologically. During the first half of the study nursing staff wore both gloves and gowns for only 20 of 52 observed contacts. During and after the second compliance survey, compliance rapidly increased: nursing staff wore both gloves and gowns for 73 of 90 of their contacts |
| Participants |
695 patients aged from 5 days to 4 years and 11 months. The distribution of ages was similar in the 2 periods. 37 acquired nosocomial RSV infections |
| Interventions |
Infection‐control intervention to increase use of gloves and gowns versus no intervention |
| Outcomes |
Laboratory: yes
Effectiveness: RSV infection
Safety: N/A |
| Notes |
Risk of bias: low
Notes: the authors concluded that the incidence of nosocomial RSV infection rose with the intensity of hospital exposure and that this rise was markedly different in the periods before and after intervention. The use of gloves and gowns can reduce the nosocomial transmission of RSV, particularly with increasing exposure to patients shedding the virus (RR for pre and post‐intervention periods infection rates 2.9, 1.5 to 5.7). Compliance by the staff improved dramatically after the intervention and it continued even after the end of the study, probably because the favourable results of the intervention were well‐publicised, the head nurse introduced an educational programme emphasising the appropriate application of isolation precautions, and gowns and gloves became more accessible to care givers. The study, although prone to selection bias, is better designed than some of it peers as there is an attempt at adjusting for different levels of RSV circulation by sub‐analysis by virus shedding days by the infected participants |
| 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 |
