BACKGROUND: Routine virology testing, with NP swabs, of children admitted with signs of respiratory virus infection is often advocated for infection control and cohorting of children in multiple bed rooms.

QUESTION: What is the impact of a selective NP swab policy on utilization and nosocomial infection on a general ward with single bed rooms?

METHODS: In Dec 94 a new infection control policy with more selective use of NP swab virology testing was instituted. The previous policy required routine testing of symptomatic children. Retrospectively, rates of NP swab utilization and yield, and nosocomial respiratory infections from Oct. to Apr. 94-95, were compared with rates from the same period, prior to the policy change, in 93-94. The new policy specified admission to a single bed room with isolation based on clinical signs. NP swabs were recommended selectively, when therapy would be changed by the results, for nosocomial infections, and for periodic epidemiologic surveillance.

RESULTS: NP swab utilization decreased significantly from 47% in 93-94 to 42% of respiratory admissions in 94-95 (p=0.048). The positive yield of NP swabs increased significantly from 27% to 47% (p=0.009). The nosocomial respiratory infection rate decreased from 1.16 in 93-94 to 0.62 cases per 1000 patient days in 94-95. This was not statistically significant (p=0.383).

CONCLUSIONS: A change in policy requiring isolation for clinical signs, with NP swab tests reserved for specific indications, appears to have resulted in modestly reduced NP swab utilization and increased yield, with no change in nosocomial infection rate on a single bed room general ward. Surveillance testing, and perhaps incomplete compliance with the policy, may account for a limited change in utilization.