The incidence of nosocomial respiratory syncytial virus (RSV) infection in different areas of the world is not well known. However, it is clear that RSV infection of hospitalized infants with congenital heart disease or following preterm birth is highly relevant. Nosocomial RSV infection in these high-risk group infants often follows a severe course of disease, even resulting in mortality. Transmission of RSV mainly occurs through direct contact, but not through inhalation. Consequently, prevention of nosocomial RSV infection should aim to prevent direct contact between non-infected infants and RSV-infected people. Evidence of the role of gowns, masks and gloves is discussed. The effect and safety of cohorting RSV-infected infants is reviewed. International guidelines with respect to RSV prevention and outbreak management are analysed.