579 - Healthcare-Associated Viral Respiratory Infections at a Canadian Tertiary Pediatric Hospital: A Ten-Year Retrospective Analysis

Poster Number: 579
Publication Number: 579.110

Background: Pediatric rates of healthcare-associated viral respiratory infections (HA-VRIs) have been shown to mirror community incidence with increased rates typically seen during the winter viral respiratory season. After the onset of the SARS-CoV-2 pandemic, increased hospital infection control measures and community public health measures were implemented to curb transmission; as a result, there were significantly lower rates of common respiratory pathogens circulating. These enhanced measures were maintained through 2022.

Objective: This study aims to review the incidence of HA-VRIs over the last decade and review the impact of these public health and infection prevention and control measures on HA-VRI incidence.

Design/Methods: We conducted a retrospective review of all HA-VRIs at the Hospital for Sick Children, in Toronto Canada, from January 1, 2010, through December 31, 2022. To define a HA-VRI, patients needed to have been admitted for at least 72 hours and have at least one respiratory symptom with laboratory confirmation of a virus from a patient specimen. We calculated the overall HA-VRI rates per 1000 patient-days.

Results: Over the 2010-2022 study period, 1053 HA-VRIs were documented, of which 406 were rhinovirus/enterovirus, 202 were parainfluenza, 125 were respiratory syncytial virus, 72 influenza, 20 SARS-CoV-2, and 228 were others (Figure 1). We found an overall incidence of 0.868 per 1000 patient days (PD), with a reduction to 0.43 and 0.38 infections per 1000 PD in 2020 and 2021 respectively, which increased to 1.35 per 1000 PD in 2022 (p=0.129). Overall, there was a significant decrease in incidence during the pandemic (p < 0.001). We found an increased incidence of 1.65 per 1000 PD on our mixed medical/surgical unit compared to all other units (p < 0.001). There were no significant trends in the spread of organisms by hospital unit, age group, or length of admission prior to infection. Children were admitted for a mean of 54 days prior to infection (SD: 77.07); 457 (43.4%) took place after 28 days in hospital. Almost half (472, 44.8%) of the HA-VRIs were found in those under 1 year of age, but despite the high proportion of infants who developed a HA-VRI, few of these were in the NICU (6.8%), and the majority of infants who developed a HA-VRI after more than 4 weeks in hospital were non-NICU patients (94.8%).

Conclusion(s): Although we found a significant decrease in HA-VRIs during 2020 and 2021 reflecting the onset of the COVID-19 pandemic, we found a return to pre-pandemic levels of HA-VRIs in 2022 despite minimal changes to enhanced IPAC procedures across the hospital between 2021 and 2022.