ABSTRACT
To decrease respiratory infections in senior day care, staff were educated on viral transmission and the value of hand washing. Fanny packs with alcohol foam supplemented hand washing and were alternated monthly between centers. Infection rates were unchanged with alcohol foam use. The intervention year's infection rate was significantly lower than the previous 3 years, suggesting a benefit of education.
Subject(s)
Day Care, Medical , Hand Disinfection , Infection Control/methods , Respiratory Tract Infections/prevention & control , Virus Diseases/prevention & control , Adult , Aged , Female , Humans , Male , New York , Respiratory Tract Infections/virologyABSTRACT
OBJECTIVE: To evaluate the incidence and impact of rhinovirus and coronavirus infections in older persons attending daycare. DESIGN: Prospective descriptive study. SETTING: Three senior daycare centers in Rochester, New York. PATIENTS: Frail older persons and staff members of the daycare centers who developed signs or symptoms of an acute respiratory illness. MEASUREMENTS: Demographic, medical, and physical findings were recorded on subjects at baseline and during respiratory illness. Nasopharyngeal specimens for viral culture as well as acute and convalescent sera for coronavirus 229E enzyme immunoassay (EIA) were obtained for all illnesses. RESULTS: During the 44 months of study, 352 older persons experienced 522 illnesses. Thirty-five (7%) of 522 cultures were positive for rhinovirus and 37 (8%) of 451 serologies were positive for coronavirus 229E infection. The clinical syndromes associated with rhinovirus and coronavirus infection were similar and characterized by nasal congestion, cough, and constitutional symptoms. No patient died or was hospitalized, but approximately 50% had evidence of lower respiratory tract involvement. The average illness lasted 14 days. During the same period, 113 staff developed 338 respiratory illnesses. Eight percent were identified as coronavirus and 9% as rhinovirus. Cough, sputum production, and constitutional symptoms were significantly more common among older persons. CONCLUSIONS: Rhinovirus and coronavirus 229E are common causes of moderately debilitating acute respiratory illnesses among older persons attending daycare.
Subject(s)
Coronavirus 229E, Human , Coronavirus/isolation & purification , Day Care, Medical , Respiratory Tract Infections/virology , Rhinovirus/isolation & purification , Adult , Aged , Female , Health Personnel , Humans , Incidence , Male , Nasopharynx/virology , Prospective Studies , Respiratory Tract Infections/epidemiologyABSTRACT
OBJECTIVE: To evaluate four methods of rapid diagnosis of respiratory syncytial virus (RSV) infection in older adults and to compare sensitivities with serologic analysis. DESIGN: Prospective comparative analysis. SETTING: Two adult daycenters. PATIENTS: Frail older persons attending the daycenter who developed signs or symptoms of acute respiratory illness between the months of December and February. MEASUREMENTS: Viral cultures performed by standard technique and bedside inoculation: antigen detection by indirect immunofluorescence assay (IFA) and Directigen enzyme immunoassay (EIA) on nasal brush samples; serologic analysis of acute and convalescent sera using EIA. RESULTS: RSV infection was documented by serology in 11 of 54 (20%) subjects during the study period. Bedside viral cultures were the most sensitive assay and were positive in 6/9 infections. Standard viral culture detected 5/11 cases. Both methods of rapid antigen detection were found to be insensitive, with 1/11 detected by IFA and 0/11 detected by EIA. CONCLUSION: Rapid antigen tests for the diagnosis of RSV in older persons should be used with caution.
Subject(s)
Antigens, Viral/analysis , Fluorescent Antibody Technique, Indirect , Immunoenzyme Techniques , Respiratory Syncytial Virus Infections/diagnosis , Respiratory Syncytial Viruses/immunology , Aged , Antigens, Viral/blood , Evaluation Studies as Topic , Frail Elderly , Humans , Nose/virology , Prospective Studies , Respiratory Syncytial Virus Infections/virology , Sensitivity and Specificity , Serologic TestsABSTRACT
OBJECTIVE: To evaluate the rate of specific pathogens and clinical syndromes associated with acute respiratory tract infections (ARTI) in frail older persons attending daycare. DESIGN: Prospective descriptive study, without intervention. SETTING: Two sites of a senior daycare program providing all-inclusive care for the older persons in Rochester, New York. PARTICIPANTS: Staff members and participants of the day-care. MEASUREMENTS: Demographic, medical, and physical findings were collected from older subjects at baseline and while ill with respiratory illnesses. Nasopharyngeal specimens for viral and Chlamydia culture and sputum for bacterial culture were obtained from subjects when ill. Acute and convalescent sera were also collected with each illness and examined for viral, chlamydial, and mycoplasma infection. MAIN RESULTS: One hundred sixty-five illnesses were documented in 165 older daycare participants as well as 113 illnesses among 67 staff members during the 15-month study. The rate of ARTI in the elderly group was 10.8 per 100 person months. The most common etiologies in both the staff and elderly participants were respiratory syncytial virus (RSV), Influenza A, and coronavirus. The etiologies of illnesses in the staff compared with those in elderly group were similar except that bacterial infections were significantly more common among the elderly (7% vs. 0, P = 0.05). Multiple pathogens were found to cocirculate within centers, and no clear outbreak of a predominant organism was noted. Cough and nasal congestion characterized most illnesses. The elderly experienced significantly more cough, dyspnea, and sputum production than did the staff. There were 10 hospitalizations related to respiratory infections and four deaths during the acute illness among the elderly group and none in staff.
