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just standard precautions.”
Nyquist observed,“ In pediatrics, children [ produce secretions ], and you talked a little bit about the decreasing vaccination rates, and so our focus is on transmission-based precautions; any kind of snotty nose requires droplet plus contact precautions. There are some data people talk about RSV only requiring contact isolation, but given a snotty-nosed child, we kind of focus on wearing a mask as well as wearing gowns and gloves for interacting with the patient. The other thing I think we should delve into is the whole diagnostic stewardship of when you need the multiplex. One of the challenges that we’ ve had is some of the respiratory virus epidemiology isn’ t as accurate throughout the U. S. because it’ s not shared or it’ s kind of not collated well and some states have a better access to the data. We’ ve only really asked people coming in with respiratory illness to do a COVID / influenza test for admission. We’ re trying to eliminate the respiratory panel unless you really need that information, as it’ s been a significant cost savings and has not impacted care.”
Talbot then directed the conversation toward the issue of testing and auditing such practices.“ To Marci’ s comment about N95s and bronchoscopy, have we audited practices and how reliably we are doing that? Are we conducting excessive testing? We suspect we are still not being great stewards of that, but I think we have moved away from wider RSV testing because for many patients there’ s not really a change in interventions.”
Drees elaborated on her institution’ s policy by explaining,“ Our go-to test is flu / RSV / COVID, which is what most everyone receives, the turnaround time for that is very quick; if they want to do an extended panel, it’ s a much longer turnaround time. We also recommend the larger panel if they are immunocompromised, if they’ re going to the ICU and they don’ t have a known diagnosis. For people who are positive for influenza, and they go to the ICU, we do the multiplex to make sure it’ s an H 1 or an H 3 strain. So far, we haven’ t found any
that are non-typeable.”
Passaretti concurred, noting,“ Very similar to what Marci just said; we went live recently with an EMR intervention, and we were seeing not only the cost to patients of sending that broader RPP but throughput issues because the RPP was pending for a while. So, trying to drive to that place of either not testing, using the rapid test as first line and RPP only for the highest risk population, similar to what others on the panel have said.”
The threshold for testing, especially during the respiratory virus season and with symptomatic patients, is a bit lower in the long-term care setting, Siegel emphasized.“ For COVID and influenza there are treatment interventions, so I think one has to look at the season, what we’ re seeing in the community, and make a decision about testing.”
Talbot then addressed precautions for RSV.“ I believe the isolation guidelines say contact, Red Book says contact and droplet. In my institution, we do contact for RSV but request the pediatric world to broaden both because that seems to be the practice in pediatric settings,” he said.
Chiming in with the pediatric viewpoint, Nyquist said,“ If you have a snotty-nosed kid snorting things out, that really makes sense to follow droplet plus contact. You think about standard precautions, wearing eye protection when there’ s stuff flying and wearing a mask so you don’ t touch your face and then washing your hands.”
Adding the long-term perspective, Siegel noted,“ There was an old study and also a more recent study from Boston indicating that contact precautions were sufficient; however, I think it’ s important to remember that the current isolation guidance is old, published in 2007 and while many parts of it still apply, many sections need to be updated. I think the feeling is that droplet is important to add, and for adults, if they have control of their respiratory secretions, then I don’ t think contact is as important. However, if they don’ t have control of those secretions, then contact would be more important.”
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26 • www. healthcarehygienemagazine. com • march-april 2026