以家庭为中心的出院计划在NICU早产儿中的应用效果

目的观察以家庭为中心的出院计划在新生儿童重症监护(NICU)早产儿中的应用效果。方法 120例早产儿按时间先后分为对照组和观察组。比较两组早产儿出院时家长的家庭照护能力、出院后1周的护理工作满意度和出院后1个月内的再住院率。结果观察组早产儿出院时家长的家庭照护能力明显高于对照组。观察组早产儿出院后1周的护理工作满意度明显高于对照组。观察组早产儿出院后1个月内的再住院率明显低于对照组(P0.05)。结论以家庭为中心的出院计划在早产儿中的应用,能提高早产儿家长的家庭照护能力,降低早产儿出院后1个月内的再住院率,提高家属对护理工作的满意度。     

Does case mix matter for substance abuse treatment? A comparison of observed and case mix-adjusted readmission rates for inpatient substance abuse treatment in the Department of Veterans Affairs.

OBJECTIVE: To develop a case mix model for inpatient substance abuse treatment to assess the effect of case mix on readmission across Veterans Affairs Medical Centers (VAMCs). DATA SOURCES/STUDY SETTING: The computerized patient records from the 116 VAMCs with inpatient substance abuse treatment programs between 1987 and 1992. STUDY DESIGN: Logistic regression was used on patient data to model the effect of demographic, psychiatric, medical, and substance abuse factors on readmission to VAMCs for substance abuse treatment within six months of discharge. The model predictions were aggregated for each VAMC to produce an expected number of readmissions. The observed number of readmissions for each VAMC was divided by its expected number to create a measure of facility performance. Confidence intervals and rankings were used to examine how case mix adjustment changed relative performance among VAMCs. DATA COLLECTION/EXTRACTION METHODS: Ward where care was provided and ICD-9-CM diagnosis codes were used to identify patients receiving treatment for substance abuse (N = 313,886). PRINCIPAL FINDINGS: The case mix model explains 36 percent of the observed facility level variation in readmission. Over half of the VAMCs had numbers of readmissions that were significantly different than expected. There were also noticeable differences between the rankings based on actual and case mix-adjusted readmissions. CONCLUSIONS: Secondary data can be used to build a reasonably stable case mix model for substance abuse treatment that will identify meaningful variation across facilities. Further, case mix has a large effect on facility level readmission rates for substance abuse treatment. Uncontrolled facility comparisons can be misleading. Case mix models are potentially useful for quality assurance efforts.     

Time to Send the Preemie Home? Additional Maturity at Discharge and Subsequent Health Care Costs and Outcomes

Objective. To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs.
Data Sources. One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002.
Study Design/Methods. Using multivariate matching with a time-dependent propensity score we matched 701 "Early" babies to 701 "Late" babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes.
Principal Findings. Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late–Early cost difference was $5,016 ( p <.0001). A sensitivity analysis suggests our conclusions would not easily be altered by failure to match on some unmeasured covariate.
Conclusions. In a large integrated health care system, if a baby is ready for discharge (as defined by the typical criteria), staying longer increased inpatient costs but did not reduce postdischarge costs nor improve postdischarge clinical outcomes.     

An international study of hospital readmissions and related utilization in Europe and the USA

This study concerns a comparative analysis of hospital readmission rates and related utilization in six areas, including three European countries (Finland, Scotland and the Netherlands) and three states in the USA (New York, California, Washington State). It includes a data analysis on six major causes of hospitalization across these areas. Its main focus is on two questions. (1) Do hospital readmission rates vary among the causes of hospitalization and the study populations? (2) Are hospital inpatient lengths of stay inversely related to readmissions rates? The study demonstrated that diagnoses such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) were the major causes of hospital readmission rates. The data showed that (initial) hospital stays were generally longer for patients who were readmitted than for those who were not. As a result, short stays were not associated with a higher risk of readmission, meaning that hospital readmissions were not produced by premature hospital discharges in the study population. Furthermore, the spatial variation in readmission rates within 7 versus 8-30 days showed to be identical. Finally, it was found that countries or states with relatively shorter stays showed higher readmission rates and vice versa. Since patients with readmissions in all of the areas had on average longer initial stays, this finding at country level does illustrate that there seems to be a country specific trade off between length of stay and rate of readmission. An explanation should be sought in differences in health care arrangements per area, including factors that determine length of stay levels and readmission rates in individual countries (e.g. managed care penetration, after care by GP's or home care).     

NICU鲍曼不动杆菌的医院感染与耐药性分析

目的了解新生儿重症监护病房(NICU)鲍曼不动杆菌的临床特征及耐药性。方法对2012年10月—2014年10月某院4个NICU鲍曼不动杆菌医院感染临床分离情况及耐药性进行回顾性分析。结果 4个NICU共收治新生儿11 640例,发生医院感染500例(4.3%),其中鲍曼不动杆菌医院感染51例(10.2%),52例次。鲍曼不动杆菌感染:极早产NICU42例次,早产NICU1例次,足月NICU4例次,儿童外科NICU5例次。4个季节鲍曼不动杆菌医院感染发病率比较,差异具有统计学意义(χ~2=16.05,P0.05),主要发生在春、夏两季。鲍曼不动杆菌对哌拉西林/舒巴坦、头孢吡肟、亚胺培南等β-内酰胺类抗生素以及庆大霉素耐药率较高(90%),对阿米卡星耐药率最低,也高达51.9%。52株鲍曼不动杆菌中,46株为多耐药菌株,3株为广泛耐药菌株。结论 NICU鲍曼不动杆菌医院感染最严重的是极早产NICU,对临床常用抗菌药物均呈现高耐药率。     

Contextual,organizational and ecological effects on the variations in hospital readmissions of rural Medicare beneficiaries in eight southeastern states

The enactment of the Patient Protection and Affordable Care Act (ACA) has been expected to improve the coverage of health insurance, particularly as related to the coordination of seamless care and the continuity of elder care among Medicare beneficiaries. The analysis of longitudinal data (2007 through 2013) in rural areas offers a unique opportunity to examine trends and patterns of rural disparities in hospital readmissions within 30 days of discharge among Medicare beneficiaries served by rural health clinics (RHCs) in the eight southeastern states of the Department of Health & Human Services (DHHS) Region 4. The purpose of this study is twofold: first, to examine rural trends and patterns of hospital readmission rates by state and year (before and after the ACA enactment); and second, to investigate how contextual (county characteristic), organizational (clinic characteristic) and ecological (aggregate patient characteristic) factors may influence the variations in repeat hospitalizations. The unit of analysis is the RHC. We used administrative data compiled from multiple sources for the Centers of Medicare and Medicaid Services for a period of seven years. From 2007 to 2008, risk-adjusted readmission rates increased slightly among Medicare beneficiaries served by RHCs. However, the rate declined in 2009 through 2013. A generalized estimating equation of sixteen predictors was analyzed for the variability in risk-adjusted readmission rates. Nine predictors were statistically associated with the variability in risk-adjusted readmission rates of the RHCs pooled from 2007 through 2013 together. The declined rates were associated with by the ACA effect, Georgia, North Carolina, South Carolina, and the percentage of elderly population in a county where RHC is located. However, the increase of risk-adjusted rates was associated with the percentage of African Americans in a county, the percentage of dually eligible patients, the average age of patients, and the average clinical visits by African American patients. The sixteen predictors accounted for 21.52 % of the total variability in readmissions. This study contributes to the literature in health disparities research from the contextual, organizational and ecological perspectives in the analysis of longitudinal data. The synergism of multiple contextual, organizational and ecological factors, as shown in this study, should be considered in the design and implementation of intervention studies to address the problem of hospital readmissions through prevention and enhancement of disease management of rural Medicare beneficiaries.     

Use of Prolonged Travel to Improve Pediatric Risk-Adjustment Models

Objective. To determine whether travel variables could explain previously reported differences in lengths of stay (LOS), readmission, or death at children's hospitals versus other hospital types.
Data Source. Hospital discharge data from Pennsylvania between 1996 and 1998.
Study Design. A population cohort of children aged 1–17 years with one of 19 common pediatric conditions was created ( N =51,855). Regression models were constructed to determine difference for LOS, readmission, or death between children's hospitals and other types of hospitals after including five types of additional illness severity variables to a traditional risk-adjustment model.
Principal Findings. With the traditional risk-adjustment model, children traveling longer to children's or rural hospitals had longer adjusted LOS and higher readmission rates. Inclusion of either a geocoded travel time variable or a nongeocoded travel distance variable provided the largest reduction in adjusted LOS, adjusted readmission rates, and adjusted mortality rates for children's hospitals and rural hospitals compared with other types of hospitals.
Conclusions. Adding a travel variable to traditional severity adjustment models may improve the assessment of an individual hospital's pediatric care by reducing systematic differences between different types of hospitals.     

Availability of lactation counseling services influences breastfeeding among infants admitted to to neonatal intensive care units

PURPOSE: To assess the association between the presence of international board-certified lactation consultant (IBCLC) services at a delivery hospital and the breastfeeding practices of women whose infants required neonatal intensive care unit (NICU) admission. DESIGN: Cross-sectional study using population-level data. SETTING: Philadelphia, Pennsylvania. SUBJECTS: 2132 infants admitted to the NICU. MEASURES: Breastfeeding at hospital discharge was measured with the question, "Is the infant being breastfed?" Delivery hospitals were dichotomized as to the presence or absence of an IBCLC on staff ANALYSIS: Logistic regression was used to assess the relationship between breastfeeding at discharge and the presence of an IBCLC at the delivery facility while adjusting for maternal characteristics and birth outcomes. RESULTS: Among mothers of infants admitted to the NICU, breastfeeding rates among mothers who delivered at hospitals with an IBCLC were nearly 50% compared with 36.9% among mothers who delivered at hospitals without an IBCLC. The adjusted odds of breastfeeding initiation prior to hospital discharge were 1.34 (95% confidence interval = 1.03, 1.76) times higher for women who delivered at a facility with an IBCLC. CONCLUSIONS: To increase breastfeeding rates among the NICU population, these findings support the need for universal availability of IBCLCs at delivery facilities that have NICUs.     

The "Nursing Home Compare" Measure of Urinary/Fecal Incontinence: Cross-Sectional Variation, Stability over Time, and the Impact of Case Mix

Objectives. To assess the impact of facility case mix on cross-sectional variations and short-term stability of the "Nursing Home Compare" incontinence quality measure (QM) and to determine whether multivariate risk adjustment can minimize such impacts.
Study Design. Retrospective analyses of the 2005 national minimum data set (MDS) that included approximately 600,000 long-term care residents in over 10,000 facilities in each quarterly sample. Mixed logistic regression was used to construct the risk-adjusted QM (nonshrinkage estimator). Facility-level ordinary least-squares models and adjusted R ² were used to estimate the impact of case mix on cross-sectional and short-term longitudinal variations of currently published and risk-adjusted QMs.
Principal Findings. At least 50 percent of the cross-sectional variation and 25 percent of the short-term longitudinal variation of the published QM are explained by facility case mix. In contrast, the cross-sectional and short-term longitudinal variations of the risk-adjusted QM are much less susceptible to case-mix variations (adjusted R ²<0.10), even for facilities with more extreme or more unstable outcome.
Conclusions. Current "Nursing Home Compare" incontinence QM reflects considerable case-mix variations across facilities and over time, and therefore it may be biased. This issue can be largely addressed by multivariate risk adjustment using risk factors available in the MDS.     

The impact of early transfer bias in a growth study among neonatal intensive care units

BACKGROUND AND OBJECTIVE: Transfer of infants between hospitals or their discharge home may bias comparisons of the performance across neonatal intensive care units (NICUs). This study attempts to show the potential size of transfer bias in the context of a large cohort study and describe strategies for minimizing this type of bias. METHODS: To limit transfer bias in a neonatal growth study of extremely premature infants in six tertiary NICUs, we restricted eligibility to infants <30 weeks gestation at birth and substituted matched replacements for early transfers (infants transferred or discharged prior to day of life 16). RESULTS: The restriction strategy was successful, reducing the overall early transfer rate from 16.4 to 3.6% and the range of transfer rates among individual NICUs from 0.6-32.7% to 0-11.0%. Replacement by matched substitutes had a much smaller effect because of the small number of early transfers and our inability to match on all factors distinguishing early transfers. CONCLUSION: Sampling strategies to minimize infants lost to follow-up were more successful than replacement strategies in limiting transfer bias in a NICU growth study. Although complete elimination of bias is likely impossible, valid studies require efforts to minimize, quantify, and test the effect of transfer bias.     

Multi-faceted program cuts HF readmissions

Good Samaritan Hospital Medical Center in West Islip, NY, reduced its heart failure readmission rates from 21.1% to 15.3% in just a few months with a readmission reduction initiative. A multidisciplinary team researched best practices in reducing readmissions and came up with an initiative that includes improving the educational process and facilitating smooth care transitions. Team members standardized educational materials, by working with other hospitals and home care agencies, and they educated the hospital staff and home care agencies on the teach-back method. Team members worked with skilled nursing facilities on ways to avoid sending heart failure patients back to the hospital. They worked with physician offices to ensure that patients obtain a timely followup appointment after discharge.     

Was Breast Conserving Surgery Underutilized for Early Stage Breast Cancer? Instrumental Variables Evidence for Stage II Patients from Iowa

Objective. To estimate the average survival effects of breast conserving surgery plus irradiation relative to mastectomy for marginal stage II breast cancer patients in Iowa from 1989–1994.
Data Sources/Data Setting. Secondary linked Iowa SEER Cancer Registry—Iowa Hospital Association discharge abstract data for women in Iowa with stage II breast cancer from 1989–1994.
Study Design. Observational instrumental variables (IV) analysis.
Data Collection/Extraction Methods. Women with stage II breast cancer from the Iowa SEER Cancer Registry 1989–1994 who received all of their inpatient care in Iowa were linked with their respective hospital discharge abstracts.
Principal Findings. Breast conserving surgery plus irradiation decreased survival relative to mastectomy for marginal stage II breast cancer patients in Iowa during the early 1990s. In this study marginal patients were those whose surgery choices were affected by differences in area treatment rates and access to radiation facilities.
Conclusions. If marginal patients are representative of patients whose treatment choices would be affected by changes in treatment rates, an increase in the breast conserving surgery plus irradiation rate for stage II early stage breast cancer patients would have decreased survival in Iowa during the early 1990s. Further research with newer data and broader samples is needed to make more current and specific assessments.     

Risk-adjusted surveillance of hospital-acquired infections in neonatal intensive care units: a systematic review

Comparisons of bacteraemia incidence between neonatal intensive care units (NICUs) can identify centres with effective infection control, whose practices can be shared with other units. For fair comparisons, infection incidence must be risk-adjusted to control for differences between centres in the vulnerability of babies and the intensity of invasive procedures which can introduce infection. We reviewed risk adjustment methods for between-NICU comparisons of bacteraemia incidence, both in the published literature and in regional and national NICU infection monitoring systems. PubMed and Embase were searched for studies reporting risk-adjusted bacteraemia incidence in more than one NICU. An internet search found NICU infection monitoring systems in Western industrialised countries. In all nine studies that met the inclusion criteria, risk adjustment reduced but did not eliminate variation in bacteraemia incidence between NICUs. In both the studies and the regional monitoring systems, adjustment for baby susceptibility generally involved stratification by factors measured at birth. Adjustment for Length of stay and invasive procedures involved reporting incidence by days with a device, such as central venous catheter days. Methods for NICU infection monitoring lack consistency. Adjustment for factors measured at birth fails to capture changes in susceptibility throughout admission and adjustment for device days does not adequately reflect risk to babies not treated with the device. Further research should address variation in risk for all babies throughout their NICU stay.     

Improving Quality Assessment through Multilevel Modeling: The Case of Nursing Home Compare

Objective. To demonstrate how multilevel modeling and empirical Bayes (EB) estimates can improve Medicare's Nursing Home Compare quality measures (QMs).
Data Sources/Study Setting. Secondary data from July 1 to September 30, 2004. Facility-level QMs were estimated from minimum data set (MDS) assessments for approximately 31,000 Minnesota nursing home residents in 393 facilities.
Study Design. Prevalence and incidence rates for 12 nursing facility QMs (e.g., use of physical restraints, pressure sores, and weight loss) were estimated with EB methods and risk adjustment using a hierarchical general linear model. Three sets of rates were developed: Nursing Home Compare's current method, unadjusted EB rates, and risk-adjusted EB rates. Bayesian 90 percent credibility intervals (CIs) were constructed around EB rates, and these were used to flag facilities for potential quality of care problems.
Data Collection/Extraction Methods. MDS assessments were performed by nursing facility staff, transmitted electronically to the Minnesota Department of Health, and provided to the investigators.
Principal Findings. Facility rates and rankings for the 12 QMs differed substantially using the multilevel models compared with current methods. The EB estimated rates shrank considerably toward the population mean. Risk adjustment had a large impact on some QM rates and a more modest impact on others. When EB CIs were used to flag problem facilities, there was wide variation across QMs in the percentage of facilities flagged.
Conclusions. Multilevel modeling should be applied to Nursing Home Compare and more widely in other health care quality assessment systems.     

Associations between Outpatient and Inpatient Service Use among Persons with HIV Infection: A Positive or Negative Relationship?

Objective. To examine the prospective association between frequency of outpatient visits and subsequent inpatient admissions.
Data Sources. Medical record data on 13,942 patients with HIV infection seen in 10 HIV speciality care sites across the United States.
Study Design. This observational study followed a cohort of HIV-infected patients who were in care in the first half of 2001. Numbers of inpatient admissions and outpatient visits were calculated for each patient for each 3-month period, from 2001 through 2004.
Analysis. Negative binomial and logistic regression analyses using random-effects models examined the effects of inpatient admissions and outpatient visits in the previous period on inpatient and outpatient service utilization, controlling for background characteristics and HIV disease stage.
Results. For 3-month periods, between 5 and 9 percent of patients had an inpatient admission. The linear association between number of outpatient visits and any inpatient admission in the subsequent period was positive (adjusted odds ratio=1.05; 95 percent confidence interval [CI]=1.04, 1.06). However, patients with zero prior outpatient visits had significantly greater admission rates than those with one prior visit. Hospitalization rates were also higher among those with a prior hospitalization and those with more advanced HIV disease.
Conclusions. These results suggest a J-shaped relationship between outpatient use and inpatient use among persons with HIV disease. Those in worse health have greater utilization of both inpatient and outpatient care. However, having no outpatient visits may also increase the likelihood of subsequent hospitalization. Although outpatient care cannot be justified as a cost-saving mechanism, maintaining regular clinical monitoring of patients is important.     

Readmission rate as an indicator of hospital performance: the case of Spain

OBJECTIVES: Hospital readmission rate is currently used as a quality of care indicator, although its validity has not been established. Our aims were to identify the frequency and characteristics of potential avoidable readmissions and to compare the assessment of quality of care derived from readmission rate with other measure of quality (judgment of experts). METHODS: Design: cross-sectional observational study; Setting: acute care hospital located in Marbella, South of Spain; Study participants: random sample of patients readmitted at the hospital within six months from discharge (n = 363); Interventions: review of clinical records by a pair of observers to assess the causes of readmissions and their potential avoidability; Main measures: logistic regression analysis to identify the variables from the databases of hospital discharges which are related to avoidability of readmissions. Determination of sensitivity and specificity of different definitions of readmission rate to detect avoidable situations. RESULTS: Nineteen percent of readmissions were considered potentially avoidable. Variables related to readmission avoidability were (i) time elapsed between index admission and readmission and (ii) difference in diagnoses of both episodes. None of the definitions of readmission rate used in this study provided adequate values of sensitivity and specificity in the identification of potentially avoidable readmissions. CONCLUSIONS: Most readmissions in our hospital were unavoidable. Thus, readmission rate might not be considered a valid indicator of quality of care.     

Birthweight-adjusted mortality rates for assessing the effectiveness of neonatal intensive care.

Mortality rates for very-low-birthweight infants vary significantly among different neonatal intensive care units (NICUs). Computational models and computer simulation are used to predict the performance of an algorithm for identifying individual NICUs within a network that have greater than 110% of the expected birthweight-adjusted mortality risk. The algorithm maintains high sensitivity and specificity with as few as three moderately heterogeneous risk categories when applied to large health care networks; the model parameters were based on preliminary data from a real NICU network. The performance of the algorithm depends on the number of admissions at the individual NICU. A NICU with a center-specific risk 130% of the network average would be correctly identified as an outlier 50% of the time if it had 35 admissions, 59% of the time if it had 70 admissions, and 77% of the time if it had 280 admissions. A NICU with average risk would be incorrectly identified as an outlier 16%, 12%, or 2% of the time if it had 35, 70, or 280 admissions, respectively. Severity-of-illness casemix adjustment did not improve these results. It is concluded that the sensitivity and specificity of the algorithm in determining which facilities have higher-than-expected mortality will be less in typical NICU networks than in large health care networks that treat adult patients. It is unlikely that severity-of-illness adjustments will overcome the problem of the small numbers of admissions at individual NICUs.     

Variation in the use of alternative levels of hospital care for newborns in a managed care organization

OBJECTIVE(S): To assess the extent to which variation in the use of neonatal intensive care resources in a managed care organization is a consequence of variation in neonatal health risks and/or variation in the organization and delivery of medical care to newborns. STUDY DESIGN: Data were collected on a cohort of all births from four sites in Kaiser Permanente by retrospective medical chart abstraction of the birth admission. Likelihood of admission into a neonatal intensive care unit (NICU) is estimated by logistic regression. Durations of NICU stays and of hospital stay following birth are estimated by Cox proportional hazards regression. RESULTS: The likelihood of admission into NICU and the duration of both NICU care and hospital stay are proportional to the degree of illness and complexity of diagnosis. Adjusting for variation in health risks across sites, however, does not fully account for observed variation in NICU admission rates or for length of hospital stay. One site has a distinct pattern of high rates of NICU admissions; another site has a distinct pattern of low rates of NICU admission but long durations of hospital stay for full-term newborns following NICU admission as well as for all newborns managed in normal care nurseries. CONCLUSIONS: Substantial variations exist among sites in the risk-adjusted likelihood of NICU admission and in durations of NICU stay and hospital stay. Hospital and NICU affiliation (Kaiser Permanente versus contract) or affiliation of the neonatologists (Kaiser Permanente versus contract) could not explain the variation in use of alternative levels of hospital care. The best explanation for these variations in neonatal resource use appears to be the extent to which neonatology and pediatric practices differ in their policies with respect to the management of newborns of minimal to moderate illness.     

Neonatal intensive-care unit admission of infants with very low birth weight --- 19 States, 2006

Neonatal mortality is disproportionately common among infants with very low birth weight (VLBW) (<1,500 g [3.3 lbs]). In 2006, the mortality rate among infants with VLBW was 240.4 per 1,000 live births. Because neonatal intensive care has been shown to reduce mortality among infants with VLBW, current standards call for neonatal intensive-care for all infants with VLBW; however, the proportion of infants with VLBW who are admitted to a neonatal intensive care unit (NICU) is not known, nor are the predictors for NICU admission. To estimate the prevalence of admission to NICUs among infants with VLBW and assess factors predicting admission, CDC analyzed birth data from 2006 for 19 states. This report summarizes the results of that analysis, which found that overall, 77.3% of infants with VLBW were admitted to NICUs (range: 63.7% in California to 93.4% in North Dakota). Among infants with VLBW born to Hispanic mothers, 71.8% were admitted to NICUs, compared with 79.5% of those with non-Hispanic black mothers and 80.5% of those with non-Hispanic white mothers. Multivariate analysis of the data indicated that preterm delivery, multiple births, and cesarean delivery all were independently associated with greater prevalence of NICU admission among infants with VLBW. Wide variation was observed among states in the prevalence of NICU admission of infants with VLBW; these state data should be assessed further, and barriers to NICU admission should be identified and addressed.     

Experience with the use of palivizumab together with infection control measures to prevent respiratory syncytial virus outbreaks in neonatal intensive care units

Respiratory syncytial virus (RSV) frequently causes nosocomial outbreaks in general paediatric wards and occasionally in neonatal intensive care units (NICUs). Conventional infection control measures often fail to prevent the spread of RSV, and it can cause significant morbidity especially in preterm and young infants. We report our experience in preventing an outbreak on a NICU after RSV had been detected in a premature infant. The index case was a 34-day-old premature infant who presented with clinical infection and RSV was detected in a clinical specimen. There were 11 patients in the ward at the time including the index case. The RSV-positive patient was isolated, the ward closed to admissions and infection control measures were implemented. Two patients were transferred to another hospital. Palivizumab 15 mg/kg i.m. was given to all patients and no further cases occurred. All subsequent RSV tests on nasal secretions were negative. Palivizumab combined with conventional infection control measures appeared to prevent the spread of RSV in this NICU. Strategies for the prevention of RSV outbreaks on NICUs all recommend the reinforcement of routine infection control measures. Recommendations concerning the use of palivizumab range from monthly prophylaxis to all infants at risk, to prophylaxis of selected cases only. Currently there are no guidelines for the use of palivizumab in NICUs or for the control of RSV outbreaks.