Respiratory viruses are important pathogens causing hospital-acquired infections [15, 16]. Several hypothetical explanations were specifically described as the nosocomial extinction of RSV in previous studies. For decades, it has been known that viral nosocomial ARTIs is a particular problem in pediatric patients [17]. In our study, RSV was predominantly (87.5%) associated with nosocomial ARTIs. Detailed studies of non-influenza nosocomial respiratory viral infections are limited. A recent study conducted at nonepidemic settings in the United States found that the rhinovirus and/or enterovirus were the predominant nosocomial viruses in children and adults with ARTIs [18]. A previous prospective cohort study demonstrated that rhinovirus was the most commonly detected virus among children with viral respiratory infections, and approximately 20% of these infections were hospital-acquired [19]. Impact, 73% of nosocomial respiratory infections among children were due to rhinovirus [20]. In here, we haven’t tested rhino and enteroviruses. So, we may have missed a fair amount of nosocomial viral ARTIs. However, another study conducted in children under 5 years of age found that RSV and influenza were associated with 51% and 19% of such cases, respectively [21].
Once considered the risk factors; modifiable risk factors, outdoor air pollution and mode of delivery (following caesarian section) were significantly contributed to the acquisition of HA-RSV [22]. Outdoor dusty nature was predominant in the study period where most of the rural and urban road construction and development were undertaken. Delivery following the caesarian section would lead to a low level of immunity and adaptability thus warrant a higher tendency for the development of infections [23]. Passive smoking and indoor air pollution neither risk or protective factors for the acquisition of HA or CA-RSV. Perhaps these could be risk factors for the occurrence of any viral ARTIs.
More often children get urinary, gastrointestinal tract infections and less frequently get infections in the central nervous system. All conditions could lead to under-nutrition and ended in a low level of immunity thus making vulnerable to respiratory tract infections. Once these children admitted to the health care facility, they are more prone to develop HAI. Children who are having CHD, immunodeficiency, seizure episodes and trisomy 21 would lead to the acquisition of HA-RSV infections in great.
Our study specifically describes the vulnerability of nosocomial RSV infections. Several factors have been discussed about RSV’s high capability of becoming one of the major viral HAI. Outbreaks of RSV infection occur every year and the spread is considerable in the globe. It affects all ages, including healthy and people with underlying conditions. Most bacterial agents causing nosocomial illness, are mostly observed primarily in patients with chronic compromising conditions. The RSV shedding in the respiratory secretions of young children tends to be for longer periods with high titer and in adults shed appreciable quantities of virus for 3 to ≥ 7 days [22, 24]. Finally, RSV in secretions may remain infectious in the environment for periods long enough for transmission on hands and fomites.
Here, children who died from HA-RSV disease had chronic diseases (Down’s syndrome and CHD). Patients with Down’s syndrome are at a greater risk of acquiring RSV-ARTI. Children with Down’s syndrome have an increased rate of comorbidities with both CHD and pulmonary hypertension, which are two independent risk factors for RSV ARTI [25,26,27]. Further, ICU stay is an independent risk factor for RSV-ARTI. Initially presented to inward care for UTI and later admitted to ICU for further care.
Once compared to nosocomial methicillin resistance Staphylococcus aureus and candidiasis, the risk of mortality is less in HA-RSV [28, 29]. Contrary the morbidity is high because the incidence is high and associated burden to the family, the society finally to the country is high. This is mainly because it is prevalent among children so the guardian has to stay with the child and provision of care is demanding [24, 25].
Respiratory syncytial virus is mainly spread following close contact with aerosols of infectious respiratory secretions and medical staff is at risk of acquiring as well as spreading the virus. RSV is a labile virus and is promptly inactivated following contact with alcohol, detergents, and antibacterial soaps [13, 21]. Thus hand-washing probably plays the most important part in infection control. Although there are various barrier methods, the isolation of RSV-positive patients in single rooms or cohorting is recommended [30]. Central to such practice is to make healthcare personnel as well as parents/guardians of patients aware of characteristics, transmission, and risk factors for the occurrence of nosocomial RSV-ARTIs.