title: Epidemic adenoviral keratoconjunctivitis possibly related to ophthalmological procedures in a neonatal intensive care unit: lessons from an outbreak.
abstract: OBJECTIVE
  Epidemic adenoviral keratoconjunctivitis can spread rapidly among preterm infants who frequently undergo ophthalmological examination. Here we present our experience on a nosocomial outbreak that affected 8 nursery staff members and 26 premature infants. We focus on the presentation and progress of the outbreak, the diagnosis of the disease and the measures taken for its control.
  
  
  METHODS
  Data were collected from patients' files and records of the infection control team. Conjunctival swabs were collected to perform direct fluorescent assay (DFA) and viral culture. Diagnosis was made according to clinical evidence and/or detection of the virus. Statistical analysis was performed using SPSS 15.0 statistical software.
  
  
  RESULTS
  Infection was introduced to our unit after a laser photocoagulation procedure of a 28-week gestational infant and circulated rapidly within the unit due to direct transmission through contaminated medical equipment, fomites and hands of nursery staff members. Neither the patients, nor the nursery staff members developed systemic symptoms. While DFA tests were positive in seven infants, culture positivity could be demonstrated in only three infants. Contact and droplet precautions were implemented with the recommendation of the infection control team. No recurrence occurred after definition of the last case on the 32nd day.
  
  
  CONCLUSIONS
  Ophthalmologic procedures continue to be a potential source of adenovirus outbreaks. However, negligence of contact measures during routine daily nursing care seems to be a more important contributing factor for rapid spread. Strict adherence to appropriate aseptic procedures is required to prevent this potentially hazardous infection in preterm infants.
authors.affiliation: Neonatal Intensive Care Unit, Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: Sebnem
authors.initials: S
authors.lastname: Calkavur
authors.forename: Ozgur
authors.initials: O
authors.lastname: Olukman
authors.forename: Arif Taylan
authors.initials: AT
authors.lastname: Ozturk
authors.forename: Fatma Kaya
authors.initials: FK
authors.lastname: Kilic
authors.forename: Gamze
authors.initials: G
authors.lastname: Gulfidan
authors.forename: Ilker
authors.initials: I
authors.lastname: Devrim
authors.forename: Rana
authors.initials: R
authors.lastname: Malatyali
authors.forename: Yeliz
authors.initials: Y
authors.lastname: Oruc
authors.forename: Fusun
authors.initials: F
authors.lastname: Atlihan
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology* / Q000821:virology; D000260:Adenoviruses, Human / Q000302:isolation & purification; D000328:Adult; D001724:Birth Weight; D003228:Conjunctiva / Q000821:virology; D003428:Cross Infection / Q000453:epidemiology* / Q000821:virology; D004196:Disease Outbreaks; D005260:Female; D005865:Gestational Age; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007637:Keratoconjunctivitis / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D017075:Laser Coagulation / Q000009:adverse effects; D008297:Male; D009305:Nasopharynx / Q000821:virology; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D014421:Turkey / Q000453:epidemiology