EPIDEMIC KERATOCONJUNCTIVITIS OUTBREAK AT A TERTIARY REFERRAL EYE CARE CLINIC

An outbreak of epidemic keratoconjunctivitis (EKC) occurred at a terti ary referral eye care clinic between late September and mid-November 1 995. Before the outbreak, instruments were cleaned with 70% isopropyl alcohol and handwashing between patients was not routine. Infection co ntrol measures were implemented when the outbreak was recognized in mi d-October. Control measures included triaging suspected cases to a sep arate waiting area, cohorting cases to a specific examining room, endo rsing the use of gloves and handwashing during examinations of patient s, and cleaning instruments with a buffered bleach solution. Thirty-si x cases were diagnosed before the infection control measures were take n, and 3 cases were seen after the control measures were taken. Also, numerous secondary cases occurred in the community. No additional case s were diagnosed from December to February 25, 1996. Acquisition of th e infection was linked to visits to 4 of 20 physicians in the eve clin ic with 61% of cases associated with visits to 1 of those 4 physicians . The use of diagnostic lenses applied directly to the eye was associa ted with infection (odds ratio = 2.83, 95% confidence interval = 0.79 to 10.4), although this did not reach statistical significance. The us e of tonometers, ophthalmic solutions, or laser therapy was not associ ated with infection, and all environmental cultures were negative. Thi s outbreak emphasizes the need for implementation of routine infection control guidelines to prevent nosocomial transmission of epidemic ker atoconjunctivitis and stresses the need for appropriate disinfection o f instruments.