Influenza and RSV

Ordering respiratory viral tests in EPIC

Special thanks to the pediatric infectious disease division for providing a list of the various viral respiratory tests available for all patients throughout the OHSU system.

Available viral respiratory testing at OHSU

About influenza

Influenza is a contagious respiratory disease transmitted from person to person primarily via virus-laden droplets. Viral shedding starts 24 to 48 hours after infection, and typically 24 hours before the onset of symptoms. Shedding normally persists less than 5 days but can be longer in children and in those who are immunocompromised.

Signs and symptoms of flu include:

  • Fever or felling feverish/chills
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle of body aches
  • Headaches
  • Fatigue
  • Some people may have vomiting and diarrhea (though this is more common in children)

Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions (e.g. congestive heart failure, asthma, or diabetes).

About RSV

Respiratory syncytial virus, or RSV, is a respiratory virus that infects the lungs and breathing passages.  Like influenza, RSV is transmitted via virus-laden droplets.  People infected with RSV are usually contagious for 3 to 8 days, although some infants or immunocompromised people can be contagious for several weeks.  

Signs and symptoms of RSV include:

  • Runny nose
  • Cough
  • Fever
  • Decrease in appetite

Influenza vaccination policy

Annual influenza vaccination is the most important measure to prevent seasonal influenza infection.  OHSU's goal of achieving high vaccination rates is a critical step in preventing healthcare transmission of influenza from healthcare workers to patients, and vice versa.    Furthermore, Oregon State law requires that health care facilities annually report the total number of employees who received the vaccine as well as information about why those who declined vaccination chose to do so.  In addition to reporting to the state, CMS will begin collecting influenza vaccination rates for hospitals in 2013 and will publish these rates beginning in 2014.  

All OHSU employees must receive the seasonal influenza vaccination through Occupational Health (formally 'Employee Health') or complete and submit an Attestation/Declination Form.  All healthcare workers who do not receive the vaccination, regardless of reason, must wear a surgical mask within six feet of a patient in patient care areas during the influenza season. 

For more information, check out the staff news blog on O2, or contact Occupational Health.

Infection prevention and control

Outbreaks of healthcare-associated influenza and RSV can occur and affect both patients and personnel. Respiratory hygiene/cough etiquette, standard precautions, and
droplet precautions are effective infection prevention methods used to prevent respiratory viral transmission in healthcare facilities. The most effective form of prevention against influenza is to get vaccinated.

Hospital in-patients with confirmed or suspected RSV or influenza should be placed in a private room on contact and droplet precautions. When a single patient room is not available, consultation with infection control personnel is recommended to assess the risks associated with other patient placement options. Isolation precautions should be maintained based on the patient and the organism:

  • For Influenza in immuncompetent pediatrics and adults, precautions should be implemented for duration of illness or at least 7 days after onset of signs and symptoms (whichever is longer) while the patient is in the hospital
  • For RSV in immunocompetent pediatrics and adults, precautions should be implemented for duration of illness or at least 14 days from onset of signs and symptoms (whichever is longer), and patient has had 1 negative RSV antigen test obtained on day 14 or later
  • For any viral respiratory illness in an immunocompromised pediatric or adult, precautions should be implemented for duration of illness AND for at least 14 days from onset of signs and symptoms AND patient has 1 negative respiratory viral PCR

In some cases, IPC may advise continued precautions for longer periods based on clinical judgment, such as in the case of young children or severely immunocompromised patients, who may shed influenza or RSV virus for longer periods of time.

OHSU healthcare providers who continue to work while ill may deliver suboptimal care and represent a significant morbidity risk to their co-workers, patients, and visitor. The ill provider should restrict his/her activities to prevent spread of the infecting agent to others. For more information, refer to the ill provider policy. 

Visitors with influenza-like illness (fever and cough or sore throat) should defer their visit until they are no longer ill. Visitors with confirmed or suspected influenza should follow the visitor precautions as outlined in the influenza entry in the 
isolatable infections and conditions policy. If there is widespread influenza activity in the community or ongoing nosocomial transmission of influenza requiring an activation of the emergency operations center, enhanced visitor screening and restriction may be initiated.

Standard cleaning and disinfection procedures are adequate for influenza and RSV virus environmental control in all settings within the healthcare facility, including those patient-care areas in which aerosol-generating procedures are performed. Management of laundry, food service utensils, and medical waste should also be performed in accordance with standard precautions.