Evaluation of an acute point-of-care system screening for respiratory syncytial virus infection

There continues to be a significant risk of children contracting hospital-acquired infections caused by respiratory syncytial virus (RSV). In order to provide 24 h screening, we examined a point-of-care system (near-patient testing) for use by non-laboratory healthcare workers (HCWs) in a short stay unit adjoining the accident and emergency department of a large paediatric hospital. Three studies were conducted over consecutive winter epidemics, in which 2193 nasopharyngeal aspirates were obtained from children < 2 years old. An average of 23 trained HCWs tested aspirates with the Abbott TESTPACK® RSV assay. Material was sent to the virology laboratory for examination for RSV and other respiratory viruses by direct immunofluorescence. The mean performance characteristics of near patient testing were sensitivity 90%, specificity 92%, positive predictive value 92% and negative predictive value 92%. This was acceptable for clinical purposes. The near-patient testing provided a rapid answer and ensured that infants could be segregated according to infection status. Early antiviral treatment could be commenced and needless antibiotics avoided. During the study the hospital-acquired infection rate was the lowest recorded, although this may have been influenced by national trends and lower rates of inpatient care for infants with bronchiolitis.