We wish to thank Dr. Sahjid Mukhida and colleagues for their response to our concise communication “Dodging the bundle—Persistent health care-associated rhinovirus infection (HAVI) throughout the pandemic.”
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In this letter, they astutely highlight the importance and, perhaps until recently somewhat less prioritized, emphasis on prevention of healthcare-associated viruses in low-middle income countries (LMIC). They also query the ideal approach to the prevention of health care-associated rhinovirus infections that, despite heightened awareness surrounding bundle practices throughout the COVID-19 pandemic, seems to have evaded typical measures and continued to circulate within hospital settings.Highlighting importance in low-middle income countries (LMIC)
Despite the clear risks of HAVI in hospitalized patients in LMIC, particularly shared by vulnerable NICU and PICU populations, there are documented gaps in infection prevention and control (IPC) practices.
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This is likely multifactorial, including both insufficient education on core IPC practices, as well as insufficient resources (including supplies, time and staffing) to carry out bundle elements. For example, for a practice such as hand hygiene to be effective, health care workers need to understand its importance, have sufficient access to alcohol-based hand rub (AHBR) or soap, water and towels, and sufficient time between patients to complete hand hygiene. Despite this, solutions can and have been increasingly used recognizing these limitations, adapted to these unique settings and need to continue to be enforced.4
Approach to health care-associated rhinovirus prevention
The ideal approach to HAVI prevention in all settings is demonstrated by the use of bundled IPC practices that have documented reduction in transmission, particularly when used collectively.
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In settings where all bundle elements may not be available, we believe that the following should be prioritized specifically for rhinovirus prevention:Evidence-Based Care Bundles. Institute for Healthcare Improvement. 2022. Accessed October 27, 2022. http://www.ihi.org/Topics/Bundles/Pages/default.aspx.
- 1.Hand hygiene – this core bundle element is likely underestimated in efficacy, particularly for both asymptomatic caregivers and staff who may be shedding virus unknowingly and represent the biggest risk factor in perpetuating transmission.
- 2.Consistent environmental cleaning given the durability of rhinovirus fomites on surfaces. While data on this is limited, 1 modeling study showed significant success with this element of prevention, particularly when combined with additional high yield bundle elements. A 15% increase in hand hygiene and 2 surface cleanings decreased viral infection risk by 21%-48%.7
- 3.Visitor screening and engagement of caregivers in prevention practices. Supporting families through their child's hospitalization while simultaneously partnering and educating them on awareness of even mildly symptomatic caregivers and siblings is an effective strategy to sustain prevention in long term patients.8
The COVID-19 pandemic has had the silver lining of highlighting many respiratory viral transmission dynamics that we now know can be prevented successfully in healthcare settings both locally and internationally. With ongoing education on importance of key bundle elements, ensuring training to carry out the IPC practices effectively, and maintaining supplies such as ABHR and cleaning supplies that are cost effective, we can continue to keep high-risk populations harm free in settings of varying resources.
References
- Dodging the bundle-Persistent healthcare-associated rhinovirus infection throughout the pandemic.Am J Infect Control. 2022; 50: 1140-1144
- Gap analysis of infection control practices in low- and middle-income countries.Infect Control Hosp Epidemiol. 2015; 36: 1208-1214
- Global infection prevention gaps, needs, and utilization of educational resources: a cross-sectional assessment by the International Society for Infectious Diseases.Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2019; 82: 54-60
- Keeping it real: infection prevention and control problems and solutions in low- and middle-income countries.Pediatr Infect Dis J. 2022; 41: S36-S39
- Development of a novel prevention bundle for pediatric healthcare-associated viral infections.Infect Control Hosp Epidemiol. 2018; 39: 1086-1092
Evidence-Based Care Bundles. Institute for Healthcare Improvement. 2022. Accessed October 27, 2022. http://www.ihi.org/Topics/Bundles/Pages/default.aspx.
- Estimating the effect of hand hygiene compliance and surface cleaning timing on infection risk reductions with a mathematical modeling approach.Am J Infect Control. 2019; 47: 1453-1459
- Focusing on families and visitors reduces healthcare associated respiratory viral infections in a neonatal intensive care unit.Pediatr Qual Saf. 2019; 4: e242
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© 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
