Prophylaxis and Screening for Prevention of Viral Respiratory Infections in Neonatal Intensive Care Unit Patients: A Systematic Review
Healthcare-associated infections, including those caused by viral respiratory pathogens, are substantial sources of morbidity and mortality in neonatal intensive care unit (NICU) patients. The frequency of these infections is unknown, but they are not uncommon.1 A review found that when infants hospitalized in the NICU were evaluated for late-onset sepsis, the incidence of respiratory virus infections was reported to be 6.6–8.0%.2
Premature infants in the NICU are at high risk for healthcare-associated infections due to their immunologic immaturity at birth.3-5 For the purposes of this document, healthcare-associated infections are infections acquired after admission to, or birth in, a healthcare facility. In addition, a child’s length of stay in the NICU is typically longer than other pediatric healthcare settings and is most strongly influenced by gestational age at birth and birth weight.6 The earliest gestational age for a preterm infant deemed “viable” was previously 26 weeks of gestation. With advances in neonatology, babies born at 22 weeks of gestation are now deemed viable,7 leading to longer NICU lengths of stay and a longer window of potential exposure to respiratory viral pathogens.
A number of factors may increase a NICU patient’s risk for healthcare-associated viral respiratory infections. The physical design of the NICU can drive increased risk of patient-to-patient transmission. Newer units may have single patient rooms; however, traditional NICU designs include close proximity of open bassinets, patient crowding in “open pod” designs, and shared patient equipment.8-10 Another challenge in NICUs, is prolonged and close exposure to visitors. Parents, siblings, and other visitors can be the source of viral respiratory infections if visiting while asymptomatic or mildly symptomatic.2,11 Notwithstanding, family members are not the only source of respiratory viral pathogens; sick healthcare personnel (HCP) also play a role in spreading diseases to premature infants. Presenteeism and ill HCP can increase the likelihood of outbreaks in the NICU setting.8,12,13 Outbreaks of influenza and pertussis in NICUs with low healthcare worker immunization rates have been reported.14,15 Thus, a robust HCP immunization program is an important prevention strategy component in this setting. The CDC provides recommendations for HCP immunizations.16
Large outbreaks of respiratory syncytial virus (RSV), varicella, and influenza have occurred in NICU settings and are challenging to detect and mitigate.8-10,17,18 The initial asymptomatic contagious period and seasonality of some respiratory viruses cause challenges in symptom screening and transmission prevention.2,11 Pertussis is also a challenge for detection since it can cause mild disease in adults, but easily transmit to children and NICU patients, causing outbreaks.19,20 Adenoviruses can also lead to outbreaks in the NICU settings.12,21,22 In one outbreak, adenovirus was introduced to a NICU by an ophthalmologist using contaminated multi-patient ophthalmologic equipment during infant eye exams for retinopathy of prematurity.12 Additional multi-patient use equipment, including shared stethoscopes, can become contaminated and are an important part of the indirect transmission chain.9,23,24
Guidance exists for prevention of viral respiratory infections in healthcare settings.25-27 The CDC Isolation Precautions Guideline provides important information about transmission-based precautions, appropriate use of personal protective equipment, cleaning and disinfection of patient care equipment, and other key elements for preventing healthcare-associated viral respiratory infections.28 The guideline Appendix also includes the type and duration of precautions recommended for selected infections and conditions. In addition, the American Academy of Pediatrics Red Book provides some pathogen-specific guidance on management of exposed patients. The Red Book also provides guidance for high-risk infants who should receive monthly palivizumab immunoprophlaxis during RSV season to reduce the risk of RSV lower respiratory tract disease. While all of these provide recommendations specific to viral respiratory infections and various populations, no evidence-based NICU-specific infection prevention and control recommendations currently exist on this topic. Clinically relevant guidelines are needed to inform the best strategies to prevent viral respiratory infections in NICU settings. This review will not cover the topic of prevention and control of SARS-CoV2 infections in the NICU setting. CDC has SARS-CoV-2 specific guidance for newborns.
This systematic review aimed to evaluate available evidence related to the prevention and control of transmission of viral respiratory infections in NICUs. For the purposes of this review, a NICU was defined as level III care; however, it is important to acknowledge that many NICUs have level II units for step down care in adjoining space, sharing the same personnel.29 Additionally, healthcare-associated viral respiratory infection may be defined as a viral respiratory illness or infection acquired >72 hours after admission.30
The topics were determined by the workgroup, vetted at national infectious disease society meetings, and refined based on input received from the Healthcare Infection Control Practices Advisory Committee (HICPAC) at public meetings occurring from November 2010 to December 2022.
This is a targeted, systematic review of the best available evidence on the prevention and control of respiratory viral infections (excluding COVID-19), in NICUs.
C.1. Development of Key Questions
In order to inform the development of the viral respiratory infections Key Questions, electronic searches were conducted to retrieve existing relevant guidelines and to identify gaps and areas where new evidence may have been published. Gaps where the subject matter experts believed there would be sufficient evidence to answer the question were included in this effort. Additional gaps were identified where there was believed to be no relevant evidence to answer these questions, and these are further elaborated in the discussion section. The strategies used for the guideline searches and results can be found in the Appendix. The results of this initial review informed the development of a preliminary list of Key Questions. Key Questions were finalized after vetting them with HICPAC. The four questions are:
- Key Question 1: In neonatal intensive care unit patients, does prophylaxis after viral exposure (e.g., palivizumab, oseltamivir), compared to no prophylaxis, prevent the transmission of infection?
- Key Question 2: In neonatal intensive care unit patients, does prophylactic administration of palivizumab, compared with no palivizumab, prevent the transmission of RSV during RSV season?
- Key Question 3: In neonatal intensive care unit patients, does prophylactic administration of palivizumab, compared to no palivizumab, prevent the transmission of RSV during an RSV outbreak?
- Key Question 4: In neonatal intensive care unit patients, does screening exposed patients who are asymptomatic, compared with no screening of asymptomatic exposed patients, prevent the transmission of viral respiratory infections during an outbreak?
C.2. Systematic Literature Search
A list of search terms was developed to identify the literature most relevant to the Key Questions. The terms were incorporated into search strategies, and these searches were performed in MEDLINE, EMBASE, CINAHL, and the Cochrane Library. Subject matter experts supplemented the literature search results by recommending relevant references published prior to November 2022.
C.3. Study Selection
Titles and abstracts from references were screened by dual review (A.E., C.H., J.H., M.I., J.K.K., D.O.S., K.T.R., S.S., or E.C.S.). Full-text articles were retrieved if they were:
- Relevant to one or more Key Question;
- Primary research, systematic reviews, or meta-analyses; and
- Written in English.
The Appendix presents the full list of exclusion criteria. (Appendix Section B) The full texts of selected articles were then screened by two independent reviewers, and disagreements were resolved by discussion (A.E., C.H., J.H., M.I., J.K.K., D.O.S., K.T.R., S.S., or E.C.S.). However, no studies were retrieved that answered the key questions for NICU patients. A list of select excluded studies is included in the Appendix. The results of the study selection process are depicted in Figure 1.
Figure 1. Results of the Study Selection Process
A flow chart that describes the number of studies that are included at each phase in the review. Screening began with 2,103 potentially relevant titles and abstracts. After exclusion of articles that were not relevant to the question (2,001), authors screened 102 full-text articles which resulted in 0 studies included in the final analysis.
This systematic review identified several studies related to the key questions, but none directly addressed the questions related to preventing viral respiratory pathogen transmission or controlling outbreaks of respiratory viral infections in the NICU setting. Thus, the evidence was not sufficient to make evidence-based recommendations about the following issues:
- Administering post-exposure antiviral prophylaxis after a respiratory virus exposure to prevent hospital transmission;
- Routine use of prophylactic palivizumab during respiratory virus season to prevent RSV transmission among NICU patients;
- Use of palivizumab for post-exposure prophylaxis during an RSV outbreak in the NICU setting; and
- Screening exposed asymptomatic patients, to prevent the transmission of viral respiratory infections during an outbreak?
Additional questions considered during the scoping phase of this project include:
- How are potential respiratory pathogen exposures defined in the NICU setting?
- For infants in “open pod” NICUs, what is the optimal distance between bassinets when a patient requires contact and/or droplet isolation precautions for a respiratory viral infection?
- What is the best method to screen visitors for viral respiratory infection prior to NICU entry?
The NICU setting has unique aspects that can impact the patients’ exposure risks. As stated previously, some units have open “pod” configurations with several infants in a large, shared space, while newer NICUs have private rooms. In open pod units, shared equipment is common. In addition, different types of patient beds exist in the NICU: open warmers, enclosed isolettes for thermoregulation, bassinets, and traditional cribs. These differences can impact an infant’s level of exposure to a respiratory pathogen. Finally, admission and visitor policies may vary across NICUs. It is unclear how to measure the impact of each variable on exposure risks in the NICU, and how to define virus exposures when these factors are taken into consideration. Similarly, high-quality evidence is not available to inform detailed recommendations on patient placement (e.g., distance between bassinets) when an infant is placed in isolation precautions.
Finally, as NICUs follow the family-centered care model, family members and visitors can be screened for viral respiratory infection and educated about their role in infection prevention. Evidence suggests that screening and education are both important in infection prevention in NICUs, .31,32 However, the best approach to visitor education and screening is not established.
- Bennett NJ, Tabarani CM, Bartholoma NM, et al. Unrecognized Viral Respiratory Tract Infections in Premature Infants during their Birth Hospitalization: A Prospective Surveillance Study in Two Neonatal Intensive Care Units. The Journal of Pediatrics. 2012;161(5):814-818.e3. doi:10.1016/j.jpeds.2012.05.001
- Pichler K, Assadian O, Berger A. Viral Respiratory Infections in the Neonatal Intensive Care Unit—A Review. Review. Frontiers in Microbiology. 2018-October-19 2018;9doi:10.3389/fmicb.2018.02484
- Ofman G, Pradarelli B, Caballero MT, et al. Respiratory Failure and Death in Vulnerable Premature Children With Lower Respiratory Tract Illness. The Journal of Infectious Diseases. 2020;222(7):1129-1137. doi:10.1093/infdis/jiaa046
- Levy O. Innate immunity of the newborn: basic mechanisms and clinical correlates. Nature Reviews Immunology. 2007;7(5):379-390. doi:10.1038/nri2075
- Stoll BJ, Hansen N. Infections in VLBW infants: studies from the NICHD Neonatal Research Network. Semin Perinatol. Aug 2003;27(4):293-301. doi:10.1016/s0146-0005(03)00046-6
- Eichenwald EC, Zupancic JA, Mao WY, Richardson DK, McCormick MC, Escobar GJ. Variation in diagnosis of apnea in moderately preterm infants predicts length of stay. Pediatrics. Jan 2011;127(1):e53-8. doi:10.1542/peds.2010-0495
- Cummings J, Watterberg K, Eichenwald E, et al. Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation. Pediatrics. 2015;136(3):588-595. doi:10.1542/peds.2015-2336
- Cunney RJ, Bialachowski A, Thornley D, Smaill FM, Pennie RA. An outbreak of influenza A in a neonatal intensive care unit. Infect Control Hosp Epidemiol. Jul 2000;21(7):449-54. doi:10.1086/501786
- Vain NE. Nosocomial Respiratory Viral Infection in the Neonatal Intensive Care Unit. American Journal of Perinatology. 2020;37(S 02):S22-S25. doi:10.1055/s-0040-1714081
- Friedman CA, Temple DM, Robbins KK, Rawson JE, Wilson JP, Feldman S. Outbreak and control of varicella in a neonatal intensive care unit. Pediatr Infect Dis J. Feb 1994;13(2):152-4.
- Peluso AM, Harnish BA, Miller NS, Cooper ER, Fujii AM. Effect of young sibling visitation on respiratory syncytial virus activity in a NICU. Journal of Perinatology. 2015;35(8):627-630. doi:10.1038/jp.2015.27
- Adenovirus-associated epidemic keratoconjunctivitis outbreaks–four states, 2008-2010. MMWR Morb Mortal Wkly Rep. Aug 16 2013;62(32):637-41.
- Groothuis J, Bauman J, Malinoski F, Eggleston M. Strategies for prevention of RSV nosocomial infection. Journal of Perinatology. 2008;28(5):319-323. doi:10.1038/jp.2008.37
- Tsagris V, Nika A, Kyriakou D, et al. Influenza A/H1N1/2009 outbreak in a neonatal intensive care unit. Journal of Hospital Infection. 2012;81(1):36-40. doi:10.1016/j.jhin.2012.02.009
- Milupi M, Madeo M, Brooke N, Ahmad SJ. Neonatal influenza A/H1N1/2009 outbreak in a UK district general hospital. Journal of Hospital Infection. 2012;81(2):131-133. doi:10.1016/j.jhin.2012.04.005
- Centers for Disease Control and Prevention. Recommended Vaccines for Healthcare Workers. Centers for Disease Control and Prevention. Updated May 2, 2016. Accessed August 20, 2022. https://www.cdc.gov/vaccines/adults/rec-vac/index.html
- Heerens AT, Marshall DD, Bose CL. Nosocomial Respiratory Syncytial Virus: A Threat in the Modern Neonatal Intensive Care Unit. Journal of Perinatology. 2002;22(4):306-307. doi:10.1038/sj.jp.7210696
- Munoz FM, Campbell JR, Atmar RL, et al. Influenza A virus outbreak in a neonatal intensive care unit. Pediatr Infect Dis J. Sep 1999;18(9):811-5. doi:10.1097/00006454-199909000-00013
- Vranken P, Pogue M, Romalewski C, Ratard R. Outbreak of pertussis in a neonatal intensive care unit–Louisiana, 2004. American Journal of Infection Control. 2006/11/01/ 2006;34(9):550-554. doi:https://doi.org/10.1016/j.ajic.2006.01.008
- Bryant KA, Humbaugh K, Brothers K, et al. Measures to control an outbreak of pertussis in a neonatal intermediate care nursery after exposure to a healthcare worker. Infect Control Hosp Epidemiol. Jun 2006;27(6):541-5. doi:10.1086/505666
- Sammons JS, Graf EH, Townsend S, et al. Outbreak of Adenovirus in a Neonatal Intensive Care Unit: Critical Importance of Equipment Cleaning During Inpatient Ophthalmologic Examinations. Ophthalmology. 2019/01/01/ 2019;126(1):137-143. doi:https://doi.org/10.1016/j.ophtha.2018.07.008
- Faden H, Wynn RJ, Campagna L, Ryan RM. Outbreak of adenovirus type 30 in a neonatal intensive care unit. J Pediatr. Apr 2005;146(4):523-7. doi:10.1016/j.jpeds.2004.11.032
- Hall CB. Nosocomial respiratory syncytial virus infections: the “Cold War” has not ended. Clin Infect Dis. Aug 2000;31(2):590-6. doi:10.1086/313960
- Wright IM, Orr H, Porter C. Stethoscope contamination in the neonatal intensive care unit. J Hosp Infect. Jan 1995;29(1):65-8. doi:10.1016/0195-6701(95)90294-5
- Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Public Health Foundation. Accessed August 18, 2022. https://www.cdc.gov/vaccines/pubs/pinkbook/index.html
- Centers for Disease Control and Prevention. Transmission-based Precauations. Centers for Disease Control and Prevention Accessed August 18, 2022. https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html
- Pediatric Infectious Diseases Society (PIDS). Handbook of Pediatric Infection Prevention and Control. Oxford University Press; 2019:0.
- Centers for Disease Control and Prevention. Guideline for Isolation Precautions: Prevening Transmission of Infectious Agents in Healthcare Settings. Centers for Disease Control and Prevention. Accessed August 20, 2022. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html
- FETUS CO, NEWBORN, Barfield WD, et al. Levels of Neonatal Care. Pediatrics. 2012;130(3):587-597. doi:10.1542/peds.2012-1999
- Paquette M, Shephard A, Bedard P, Thampi N. Viral Respiratory Infections in Hospitalized Children With Symptomatic Caregivers. Hospital Pediatrics. 2022;12(4):e124-e128. doi:10.1542/hpeds.2021-006108
- Linam WM, Marrero EM, Honeycutt MD, Wisdom CM, Gaspar A, Vijayan V. Focusing on Families and Visitors Reduces Healthcare Associated Respiratory Viral Infections in a Neonatal Intensive Care Unit. Pediatr Qual Saf. Nov-Dec 2019;4(6):e242. doi:10.1097/pq9.0000000000000242
- Hei H, Bezpalko O, Smathers SA, Coffin SE, Sammons JS. Development of a novel prevention bundle for pediatric healthcare-associated viral infections. Infection Control & Hospital Epidemiology. 2018;39(9):1086-1092. doi:10.1017/ice.2018.149
Judith Guzman-Cottrill, DOa, Kristina A. Bryant, MDb, Michael T. Brady, MDc, Kendra Myers Cox, MAd, Loretta L. Fauerbach, MS, CICe, Jamesa Hogges, MPHf, W. Charles Huskins, MD, MScg, Jill Kumasakad, Brian Leas, MA, MSh, Aaron M. Milstone, MD, MHSi, Kristin Tansil Roberts, MSWj, Nalini Singh, MD, MPHk, Devon Okasako-Schmucker, MPHf, Christine So, MPHf, Erin Stone, MPHd, Craig A. Umscheid, MD, MSCEl, and Alexis Elward, MDm, for the Healthcare Infection Control Practices Advisory Committeen
aOregon Health and Science University, Portland, OR; bUniversity of Louisville, Louisville, KY, cNationwide Children’s Hospital, Columbus, OH; dDivision of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA; eFauerbach & Associates, LLC, Gainesville, FL; fChenega Enterprise Systems and Solutions (CHESS), Atlanta, GA; gMayo Clinic, Rochester, MN; hCenter for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, PA; iJohns Hopkins University School of Medicine, Baltimore, MD; Translation and Evaluation Branch (TEB)/ Division of HIV Prevention (DHP)/ National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention; kformerly Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Department of Pediatrics, Department of Global Health and Epidemiology, George Washington University, Washington DC); lformerly Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, PA (now with the Agency for Healthcare Research and Quality, Rockville, MD); mWashington University School of Medicine, St. Louis, MO; and nthe Healthcare Infection Control Practices Advisory Committee
HICPAC Members: Hilary M. Babcock, MD, MPH, Washington University School of Medicine; Judene Bartley, MS, MPH, CIC, VP Epidemiology Consulting Services, Inc.; Dale W. Bratzler, DO, MPH, The University of Oklahoma Health Sciences Center; Patrick J. Brennan, MD, University of Pennsylvania Health System; Vickie M. Brown, RN, MPH, WakeMed Health & Hospitals; Kristina Bryant, MD, University of Louisville School of Medicine; Lillian A. Burns, MT, MPH, Greenwich Hospital; Ruth M. Carrico, PhD, RN, CIC, University of Louisville School of Medicine; Sheri Chernetsky Tejedor, MD, Emory University School of Medicine; Vineet Chopra, MBBS, MD, MSc, FACP, FHM, The University of Michigan Health System; Elaine Dekker, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital & Trauma Center; Daniel J. Diekema, MD, University of Iowa Carver College of Medicine; Alexis Elward, MD, Washington University School of Medicine; Jeffrey Engel, MD, North Carolina State Epidemiologist; Loretta L. Fauerbach, MS, CIC, Fauerbach & Associates, LLC; Neil O. Fishman, MD, University of Pennsylvania Health System; Ralph Gonzales, MD, MSPH, University of California, San Francisco; Mary K. Hayden, MD, Rush University Medical Center; Michael D. Howell, MD, MPH, Google Research, Google; Susan Huang, MD, MPH, University of California Irvine School of Medicine; W. Charles Huskins, MD, MSc, Mayo Clinic College of Medicine; Lynn Janssen, MS, CIC, CPHQ, California Department of Public Health; Tammy Lundstrom, MD, JD, Providence Hospital; Lisa Maragakis, MD, MPH, The Johns Hopkins University School of Medicine; Yvette S. McCarter, PhD, University of Florida Health Science Center; Denise M. Murphy, MPH, RN, CIC, Main Line Health System; Russell N. Olmsted, MPH, St Joseph Mercy Health System; Stephen Ostroff, MD, US Food and Drug Administration; Jan Patterson, MD, University of Texas Health Science Center, San Antonio; David A. Pegues, MD, David Geffen School of Medicine at UCLA; Peter J. Pronovost, MD, PhD, The Johns Hopkins University; Gina Pugliese, RN, MS, Premier Healthcare Alliance; Keith M. Ramsey, MD, The Brody School of Medicine at East Carolina University; Selwyn O. Rogers Jr, MD, MPH, The University of Chicago; William P. Schecter, MD, University of California, San Francisco; Kurt Brown Stevenson, MD, MPH, The Ohio State University Medical Center; Tom Talbot, MD, MPH, Vanderbilt University Medical Center; and Deborah S. Yokoe, MD, MPH, University of California, San Francisco.
HICPAC ex officio Members: Elizabeth Claverie-Williams, MS, US Food & Drug Administration; Nicole Haynes, MD, Health Resources & Services Administration; David Henderson, MD, National Institutes of Health; Stephen Kralovic, MD, MPH, US Department of Veterans Affairs; Dan Mareck, MD, Health Resources & Services Administration; Jeannie Miller, RN, MPH, Centers for Medicare & Medicaid Services; Melissa Miller, BSN, MD, MS, Agency for Healthcare Research and Quality; Paul D. Moore, PhD, Health Resources & Services Administration; Sheila Murphey, MD, US Food & Drug Administration; Tara Palmore, MD, National Institutes of Health; Gary Roselle, MD, US Department of Veterans Affairs; Daniel Schwartz, MD, MBA, Centers for Medicare & Medicaid Services; Judy Trawick, RN, BSN, Health Resources & Services Administration; Kim Willard-Jelks, MD, MPH, Health Resources & Services Administration; Rebecca Wilson, MPH, Health Resources & Services Administration.
HICPAC Liaison Representatives: Kathy Aureden, MS, MT(ASCP), SI, CIC, Association of Professionals of Infection Control and Epidemiology, Inc.; Elizabeth Bancroft, MD, Council of State and Territorial Epidemiologists; Nancy Bjerke, BSN, RN, MPH, CIC, Association of Professionals of Infection Control and Epidemiology, Inc.; Joan Blanchard, RN, BSN, Association of Perioperative Registered Nurses; Debra Blog, MD, MPH, Association of State and Territorial Health Officials; William A. Brock, MD, Society of Critical Care Medicine; Michelle Cantu, MPH, National Association of County and City Health Officials; Darlene Carey, MSN, RN, CIC, NE-BC, FAPIC, Association of Professionals of Infection Control and Epidemiology, Inc.; Holly Carpenter, BSN, RN, American Nurses Association; Paul Conway, American Association of Kidney Patients; Craig Coopersmith, MD, FACS, FCCM, Society of Critical Care Medicine; Barbara DeBaun, MSN, RN, CIC, Association of Professionals of Infection Control and Epidemiology, Inc.; Elaine Dekker, RN, BSN, CDC, America’s Essential Hospitals; Louise M. Dembry, MD, MS, MBA, Society for Healthcare Epidemiology of America; Kathleen Dunn, BScN, MN, RN, Public Health Agency of Canada; Kris Ehresmann, RN, MPH, Association of State and Territorial Health Officials; Beth Feldpush, PhD, American Hospital Association; Sandra Fitzler, RN, American Health Care Association; Scott Flanders, MD, Society of Hospital Medicine; Janet Franck, RN, MBA, CIC, DNV Healthcare, Inc.; Diana Gaviria, MD, MPH, National Association of County and City Health Officials; Jennifer Gutowski, MPH, BSN, RN, CIC, National Association of County and City Health Officials; Lisa Grabert, MPH, American Hospital Association; Valerie Haley, PhD, Association of State and Territorial Health Officials; Lori Harmon, RRT, MBA, Society of Critical Care Medicine; Patrick Horine, MHA, DNV Healthcare, Inc.; Michael D. Howell, MD, MPH, Society of Critical Care Medicine; W. Charles Huskins, MD, MSc, Infectious Diseases Society of America; Marion Kainer, MD, MPH, Council of State and Territorial Epidemiologists; Lilly Kan, DrPH, MA, National Association of County and City Health Officials; Alan Kliger, MD, American Society of Nephrology; Evelyn Knolle, American Hospital Association; Jacqueline Lawler, MPH, CIC, CPH, National Association of County and City Health Officials; Chris Lombardozzi, MD, America’s Essential Hospitals; Emily Lutterloh, MD, MPH, Association of State and Territorial Health Officials; Lisa Maragakis, MD, Society for Healthcare Epidemiology of America; Michael McElroy, MPH, CIC, America’s Essential Hospitals; Lisa McGiffert, Consumers Union; Jennifer Meddings, MD, MSc, Society of Hospital Medicine; Richard Melchreit, MD, Council of State and Territorial Epidemiologists; Sharon Morgan, MSN, RN, NP-C, American Nurses Association; Silvia Muñoz-Price, MD, America’s Essential Hospitals; Dana Nguyen, BSN, RN, CIC, National Association of County and City Health Officials; Shirley Paton, RN, MN, Public Health Agency of Canada; Kelly Podgorny, DNP, MS, CPHQ, RN, Joint Commission; Michael Anne Preas, RN, CIC, Association of Professionals of Infection Control and Epidemiology, Inc.; Mark E. Rupp, MD, Society for Healthcare Epidemiology of America; Mark Russi, MD, MPH, American College of Occupational and Environmental Medicine; Sanjay Saint, MD, MPH, Society of Hospital Medicine; Robert G. Sawyer, MD, Surgical Infection Society; Andi Shane, MD, MPH, Pediatric Infectious Disease Society; Roslyne Schulman, MHA, MBA, American Hospital Association; Barbara M. Soule, RN, MPA, CIC, The Joint Commission; Kathryn Spates, The Joint Commission; Linda Spaulding, RN, CIC, DNVGL Healthcare; Lisa Spruce, RN, DNP, ACNS, ACNP, ANP, Association of PeriOperative Registered Nurses; Rachel Stricof, MPH, Advisory Council for the Elimination of Tuberculosis; Sheri Chernetsky Tejedor, MD, Society of Hospital Medicine; Donna Tiberi, RN, MHA, Healthcare Facilities Accreditation Program; Margaret VanAmringe, MHS, The Joint Commission; Valerie Vaughn, MD, Society of Hospital Medicine; Stephen Weber, MD, Infectious Diseases Society of America; Elizabeth Wick, MD, American College of Surgeons; Robert Wise, MD, The Joint Commission; Amber Wood, MSN, RN, CNOR, CIC, CPN, Association of PeriOperative Registered Nurses.
The Centers for Disease Control and Prevention thanks the many individuals and organizations who provided valuable feedback on and support of this document during the development process: Sonya Arundar, MS; Wanda Barfield, MD, MPH; Wendy Bruening, PhD; Meredith Noble Calloway, MS; Mahnaz Dasti, MPH; Susan Dolan, RN, MS, CIC; Joann Fontanarosa, PhD; Suzanne Frey, BSN, RN; Rachel Gorwitz, MD, MPH; David Ham, MD, MPH, Charlalynn Harris, PhD; Martha Iwamoto, MD, MPH; David Kaufman, MD; Gretchen Kuntz, MSW, MSLIS; Amanda Paschke, MD, MSCE; Richard Polin, MD; Lisa Saiman, MD; Pablo Sanchez, MD; Karen Schoelles, MD, SM; and Gautham Suresh, MD.
Additionally, Michael Bell, MD, and L. Clifford McDonald, MD, Centers for Disease Control and Prevention, and Jeffrey Hageman, MHS, formerly Centers for Disease Control and Prevention, provided technical advice during various stages of document development.
Finally, William B. Baine, MD, formerly of the Agency for Healthcare Research and Quality and Michael L. Tapper, MD, formerly of Lenox Hill Hospital, are acknowledge, in memoriam, for their contributions to this effort.
None of the workgroup members reported financial or intellectual interests related to the topics in this review except for the following:
- Dr. Bryant: Reports receiving research support from Pfizer, Gilead and Enanta
- Dr. Milstone: Reports receiving research support from Sage Products and MITRE Corporation
- Dr. Huskins: Reports serving on an endpoint adjudication committee for Pfizer, serving as a consultant to ADMA Biologics, and owning stock in Pfizer and Bristol Myers Squibb
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
Food and Drug Administration
Food and Drug Administration
(United States Department of) Health and Human Services
(United States Department of) Health and Human Services
Healthcare Infection Control Practices Advisory Committee
Healthcare Infection Control Practices Advisory Committee
Neonatal Intensive Care Unit
Neonatal Intensive Care Unit