Management of a respiratory syncytial virus outbreak in a memory care unit at a long-term care facility

Abstract

Background: Respiratory syncytial virus (RSV), although frequently reported in pediatric populations, is also associated with significant morbidity and mortality in vulnerable adults. From an Infection Control perspective, it is therefore of particular concern in hospital and long-term care settings.

Objective: We report an RSV outbreak that occurred in the memory care unit of a Veterans Affairs-affiliated long-term care facility where the characteristics of the resident population posed unique challenges to halting transmission.

Setting: The outbreak occurred in a 30-bed unit within a 230-bed Veterans Affairs-affiliated long-term care facility in Florida.

Methods: An investigation was performed in coordination with the local Department of Health. All residents on the affected unit had dementia with resulting difficulty participating in infection prevention measures, including isolation, masking, and hand hygiene. Interventions implemented included twice weekly RSV testing, enhanced cleaning protocols, staggered mealtimes/outdoor dining, and cancellation of group activities, visitations, and new admissions. A retrospective case-control study was performed to assess for potential risk factors for acquiring RSV.

Results: Over a 21-day period in 2022, 20 out of 29 residents tested positive for RSV within the affected unit. No other units were involved. Univariate analysis did not find any statistically significant risk factors for acquiring RSV infection, although small sample size may have impacted the results.

Conclusions: A multifaceted approach was ultimately successful in preventing ongoing transmission of RSV within and beyond the unit. The infection control techniques utilized in this unique patient population could potentially be applicable to challenging outbreak situations at other facilities.

Figure 1.

Epidemiological curve of the RSV outbreak in 2022. Symptomatic cases are depicted in red, and asymptomatic cases are in blue.

Figure 2.

Floor plan layout of the affected LCTF unit. The day each positive RSV test occurred is listed. Day 1 *** is the index case.