Surveillance and control of epidemic keratoconjunctivitis

Purpose: The purpose of this study was to determine if the implementation of a formal set of infection-control policy and procedures (ICPPs) can reduce the number of outbreaks of epidemic keratoconjunctivitis (EKC) and the number of nosocomially infected patients in a large teaching eye institute. Methods: A retrospective and prospective study of the incidence of EKC and the number of affected patients was performed for the years 1984 through 1991. Infection-control measures (ICPPs) were formulated in 1992 with regulations implemented for patient control and management, hand washing, instrument disinfection, medication distribution, and employee furloughs. Two levels of ICPPs were established on the basis of nonepidemic or epidemic conditions. After implementation of ICPPs, a prospective 4-year study (1992 through 1995) and statistical analysis were performed to determine whether the number of outbreaks of EKC and affected patients significantly decreased. Results: The incidence of institutional EKC epidemics per year was at least one and as many as three from 1984 through 1991. After implementation of a formal set of ICCPs, no epidemics occurred in 2 of 4 years studied. The number of epidemics and affected patients was significantly less when the years before and after implementation of ICPPs were compared by chi-square analysis (P<.01, respectively). Conclusions: In this first prospective study of institutional outbreaks of EKC, the implementation of ICCPs was demonstrated to be an effective means to decrease the number of EKC outbreaks and nosocomially infected patients for this particular institution. Although several reports of institutional outbreaks of EKC have described infection-control measures that eventually controlled an outbreak well under way, this study provides policies and procedures that may effectively decrease the number and size of nosocomial epidemics of adenoviral conjunctivitis in large teaching eye institutions.