Infection Control of Conjunctivitis

Infection Control of Conjunctivitis

Introduction

Conjunctivitis has been recognized for a century as a nonpurulent conjunctivitis associated with a characteristic keratitis that can spread rapidly within a community. Conjunctivitis outbreaks have been reported in health care settings, particularly in eye clinics, where morbidity and lost productivity were considerable due to the large number of affected individuals. (Buehler, Finton, Goodman, Hierholzer, Elsea, 2004, 390-4) Epidemics have been studied to determine clinical symptoms and signs, risk factors for infection, and serotypes of etiologic adenoviruses.

Epidemiological studies of several outbreaks of conjunctivitis in large eye clinics and hospitals have demonstrated that infection control measures alone, including strict handwashing, instrument disinfection, and preventing medication contamination, were insufficient to prevent nosocomial transmission during outbreaks. (Buehler, Finton, Goodman, Hierholzer, Elsea, 2004, 390-4) These outbreaks were brought under control only when effective isolation of affected patients was undertaken. However, no study has demonstrated that the implementation of an ongoing infection control program in a large teaching eye institute was associated with a decrease in the number of recurrent conjunctivitis outbreaks and total conjunctivitis morbidity.

The effect of an ongoing infection control program on rates of nosocomial outbreaks of conjunctivitis in a large teaching hospital was studied. The number of outbreaks, number of patients with nosocomial conjunctivitis, and the total number of patient visits were determined for every year over a 13-year period: eight years pre-infection control (1984-1991) and six years post-infection control (1992-1997). (Buehler, Finton, Goodman, Hierholzer, Elsea, 2004, 390-4) The infection control program that was implemented included mandatory education of resident physicians, strict infection control measures, and routine isolation of patients with possible conjunctivitis.

Administration of infection control The Wilmer Infection Control Committee (WICC) was formed in 1991; it reported to the Johns Hopkins Hospital Infection Control Committee. Its purpose was to coordinate the numerous Hospital and clinic personnel involved in an integrated infection control effort and to develop infection control policies and procedures. The committee was chaired by a senior member of the Cornea and External (Buehler, Finton, Goodman, Hierholzer, Elsea, 2004, 390-4) Disease Service and was comprised of the Director and Associate Director of the Infection Control Department, an Infection Control Epidemiologist (ICE), the Director of Nursing at the Institute, and the nurse managers of the emergency room, the inpatient eye unit, and the eye operating rooms.

The WICC met weekly during outbreaks and monthly otherwise; after outbreaks had not occurred for two successive years, it began to meet every three months. data sources Data on conjunctivitis at the Institute from 1984 to 1989 were gathered from reports of outbreaks in the minutes of meetings of the Hospital Infection Control Committee. From September 1989 to December 1997, data on both community-acquired and nosocomial conjunctivitis cases were collected weekly by the ICE. Total numbers of outpatient visits were obtained from the office of the departmental administrator. (Guyer, OíDay, Hierholzer, Schaffner, 2005,142- 50) Case definitions A case of conjunctivitis was defined as any patient with an acute onset of follicular conjunctivitis with preauricular adenopathy, or characteristic subepithelial ...