Introduction

Respiratory Syncytial Virus(RSV) is a common virus that infects the lungs and respiratory tract and is the primary cause of respiratory illness in young children. Most children will have been infected with RSV by the age of 2 years.¹ In most people, the infection causes mild cold-like symptoms, runny nose, coughs, sneezing, fever, and wheezing, but in a small section of the community, symptoms can be so severe they will need hospitalisation. 

Infants under the age of 6 months can develop Bronchiolitis or Pneumonia following an RSV infection, which could lead to hospitalisation. 

Daycare settings are high-risk environments for the spread of RSV due to close contact between children and the sharing of toys and other items. Infants and young children frequently attend these facilities, and as they are the most vulnerable to this virus, it is crucial to implement preventive measures to protect them against RSV.

Understanding RSV transmission

RSV is highly contagious and can be passed from person to person through droplets. It can stay on surfaces for up to 24 hours.²

Modes of transmission 

RSV spreads through:

• Direct contact with an infected person, such as touching, hugging, and kissing
• Indirect contact through contaminated surfaces such as toys, doorknobs and bedding   
• Respiratory droplets from coughs or sneezes, which can be inhaled by others

The incubation period and the contagious period

The incubation period(the time from infection to the manifestation of symptoms) for RSV is typically 4-6 days.³ A person who has contracted the virus can be contagious for 3-8 days and can be spreading the virus before their symptoms start. In some cases, infants and people with weakened immune systems may be contagious for up to 4 weeks.

Preventive measures in daycare settings

To prevent the spread of RSV to children, staff, and parents, the chain of infection needs to be broken by following the measures below.^4,5

Hygiene practices

• Staff and children should wash their hands with soap and water for at least 20 seconds throughout the day, particularly after nose-wiping, nappy changes, and before meals
• Children should be taught from an early age the importance of thoroughly washing and drying their hands
• Use hand sanitisers with at least 60% alcohol when soap and water are not available    
• Teach children to cover their mouth and nose with a tissue or elbow when coughing or sneezing
• Dispose of tissues immediately and wash hands
• Use foot-operated bins lined with a plastic bag for disposal of tissues
• Keep contaminated hands away from their eyes, mouth, and nose
• Clean hands after contact with respiratory secretions and contaminated objects and materials. Discourage spitting

Cleaning and disinfection

The daycare setting should have cleaning guidelines covering the following:

• Regularly cleaning toys, surfaces, and common areas with appropriate disinfectants
• Particular attention should be paid to hand-touch surfaces that can be easily contaminated, such as door handles, toilet flushes, taps, and communal touch areas
• Ensuring disinfectants are effective against RSV and safe for children
• Implement deep cleaning of the entire facility, especially during and after an RSV outbreak

A comprehensive schedule should indicate when and how often different areas and objects need to be cleaned. These schedules should include daily, weekly, and periodic cleaning guidelines.

Daily health checks for children and staff 

The daycare setting should  

• Conduct daily health checks of staff and infants during an RSV outbreak, which can break the chain of infection
• Have clear policies for excluding sick children and staff from the setting until they are no longer contagious

As RSV symptoms are similar to cold symptoms, excluding the child before a diagnosis may not be appropriate. Once a diagnosis of RSV has been made, then the child should be excluded from the setting until they no longer have a fever and can engage in normal activities.

Environmental controls

• Ensure proper air circulation in indoor spaces by opening windows where possible and using fans    
• Air purifiers with HEPA filters can be considered to reduce airborne particles
• There should be adequate spacing between the cots, beds, and play areas
• A designated area for sick children should be set up to prevent
  • The spread of infection

Training and education

Staff

Regular staff training is needed to prevent the spread of infection in a daycare setting.

Training sessions on infection prevention and control should include hand hygiene, cleaning practices, and managing sick children.

Updated guidelines and procedures received from the health authorities need to be circulated among the staff, and the policies of the settings need to be changed accordingly.

Parents

Developing an effective communication strategy is key to informing parents about RSV measures and policies. Communication can be via email, newsletter, notice board, or social media announcements.

Daycare settings can offer educational materials for parents to break the chain of infection at home and decrease the spread of infection to vulnerable family members.

Policy implementation and compliance 

All daycare settings should have policies and procedures to prevent and control the spread of infection, as well as training policies to ensure staff are kept up to date. An audit system should also ensure compliance throughout the setting. 

Regular reviews and updates are needed after the audits to ensure best practices and guidelines from health authorities are followed. Regulatory bodies conduct routine inspections to ensure compliance with infection prevention and control policies. These inspections also establish feedback mechanisms for continual improvement and to address any issues promptly.

Collaborating with health authorities

All local health departments have a reporting system for infectious diseases, which also applies to RSV. The setting should follow the local authorities' reporting and monitoring guidelines for RSV. The health authority will provide resources and support for managing any RSV outbreak and preventing RSV.

By collaborating with these health authorities, the setting will stay informed about public health guidelines and adapt practices accordingly. 

The setting is in a prominent position to participate in any public health campaign to raise awareness about RSV and its prevention.

Conclusion

Respiratory Syncytial Virus (RSV) is highly contagious and primarily affects young children, causing severe respiratory illnesses like bronchiolitis and pneumonia. Preventive measures in daycare settings include rigorous hygiene practices, regular cleaning and disinfection, daily health checks for symptoms, proper ventilation, staff training on infection control, effective communication with parents, and coordination with local health departments. These efforts aim to create a safer and healthier environment for children, reducing the spread of RSV and protecting vulnerable infants from severe health complications.