EPIDEMIC KERATOCONJUNCTIVITIS IN A CHRONIC CARE FACILITY - RISK-FACTORS AND MEASURES FOR CONTROL

Objective: To study patterns of transmission of epidemic keratoconjunc tivitis (EKC) in a chronic care facility and to assess control measure s and prevent future outbreaks in this setting. Design: A retrospectiv e cohort study. Setting: A 120-bed, four-unit, skilled nursing facilit y. Patients: Residents and employees of the above facility. Interventi ons: Increased frequency of cleaning; use of bleach disinfectant; univ ersal precautions in handling eye secretions from residents with conju nctivitis; cohorting residents by unit; suspension of new admissions; closure of common gathering areas. Measurements: Resident demographics ; possible risk factors for infection among residents (including mobil ity, underlying illness, medications, involvement in social activity, level of confusion) and among employees (including co-morbid illnesses and eye conditions, exposures to persons with conjunctivitis, visits to eye care specialists, use of contact lenses or glasses); testing of conjunctival specimens from symptomatic persons for viral and bacteri al agents. Results: Of 95 residents on three chronic care units, 47 (a ttack rate 49%) had onset of eye symptoms consistent with EKC between September 14 and December 7, 1990. Thirty-eight (81 %) of these had on set following the onset of symptoms in a resident with dementia who, d espite habitual eye-rubbing and wandering into other residents' rooms, was not isolated or restricted in any way. Attack rates were higher ( though not statistically significant) among more mobile residents (60% for ambulatory residents) and among those considered by staff to be c onfused (56%). Rapid antigen detection and culture confirmed adenoviru s type 37 as the etiologic agent. Conclusions: Transmission of infecti on with adenovirus type 37 was successfully interrupted following stri ct infection control, suspension of new admissions, cohorting of resid ents by unit, and change to a disinfectant that inactivates adenovirus . Recognition of conjunctivitis as an appropriate reason for restricti ng movement of an infected resident may have prevented extensive viral transmission in this outbreak.