V. Montessori et al., EPIDEMIC KERATOCONJUNCTIVITIS OUTBREAK AT A TERTIARY REFERRAL EYE CARE CLINIC, American journal of infection control, 26(4), 1998, pp. 399-405
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.