Ophthalmic equipment cleaning critical for preventing adenovirus outbreaks

This paper describes the investigation, response and successful containment of an adenovirus outbreak in a NICU associated with contaminated handheld ophthalmologic equipment used during retinopathy of prematurity (ROP) screening.

Study design

The authors performed an epidemiologic outbreak investigation of 23 hospitalized neonates, as well as NICU staff and parents of affected infants. Real-time polymerase chain reaction (PCR) for the detection of adenovirus DNA was used for clinical testing and environmental sampling.

Outcomes

Of the 43 neonates examined during ROP rounds in August 2016, 23 (54%) developed adenovirus infection within 14 days. There were 9 secondary cases (i.e., 6 employees and 3 parents).

All affected neonatal patients had respiratory symptoms. Of these, 5 developed pneumonia and 12 required increased respiratory support. Less than half of the cases (48%) had ocular symptoms. Sampling of 2 handheld lenses and 2 indirect ophthalmoscopes revealed adenovirus serotype 3 DNA on each device.

Limitations

This report is limited to a single NICU, so the findings may not be generalizable.

Clinical significance

The handheld lens and the indirect ophthalmoscope tested positive for adenovirus. These are touched by providers but do not make direct contact with patients. This finding is consistent with other reports demonstrating the important role of indirect transmission of infectious diseases from contaminated devices or equipment. Strict infection control protocols should be set up by every hospital and mandated during NICU ROP rounds.