title: Epidemic keratoconjunctivitis in a chronic care facility: risk factors and measures for control.
abstract: OBJECTIVE
  To study patterns of transmission of epidemic keratoconjunctivitis (EKC) in a chronic care facility and to assess control measures and prevent future outbreaks in this setting.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  A 120-bed, four-unit, skilled nursing facility.
  
  
  METHODS
  Residents and employees of the above facility.
  
  
  METHODS
  Increased frequency of cleaning; use of bleach disinfectant; universal precautions in handling eye secretions from residents with conjunctivitis; cohorting residents by unit; suspension of new admissions; closure of common gathering areas.
  
  
  METHODS
  Resident demographics; possible risk factors for infection among residents (including mobility, 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 bacterial agents.
  
  
  RESULTS
  Of 95 residents on three chronic care units, 47 (attack rate 49%) had onset of eye symptoms consistent with EKC between September 14 and December 7, 1990. Thirty-eight (81%) of these had onset following the onset of symptoms in a resident with dementia who, despite 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 confused (56%). Rapid antigen detection and culture confirmed adenovirus type 37 as the etiologic agent.
  
  
  CONCLUSIONS
  Transmission of infection with adenovirus type 37 was successfully interrupted following strict infection control, suspension of new admissions, cohorting of residents by unit, and change to a disinfectant that inactivates adenovirus. Recognition of conjunctivitis as an appropriate reason for restricting movement of an infected resident may have prevented extensive viral transmission in this outbreak.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333.
authors.forename: J
authors.initials: J
authors.lastname: Buffington
authors.forename: L E
authors.initials: LE
authors.lastname: Chapman
authors.forename: M G
authors.initials: MG
authors.lastname: Stobierski
authors.forename: J C
authors.initials: JC
authors.lastname: Hierholzer
authors.forename: H E
authors.initials: HE
authors.lastname: Gary
authors.forename: L E
authors.initials: LE
authors.lastname: Guskey
authors.forename: R A
authors.initials: RA
authors.lastname: Breitenbach
authors.forename: W N
authors.initials: WN
authors.lastname: Hall
authors.forename: L B
authors.initials: LB
authors.lastname: Schonberger
mesh_terms: D000203:Activities of Daily Living; D000258:Adenovirus Infections, Human / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D000260:Adenoviruses, Human / Q000145:classification*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D004203:Disinfection / Q000379:methods; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007637:Keratoconjunctivitis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D008297:Male; D008824:Michigan; D010343:Patient Admission; D010356:Patient Isolation; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D012703:Serotyping; D012866:Skilled Nursing Facilities; D016635:Universal Precautions; D017201:Virus Shedding