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  • Controlling Costs of Adenoviral Conjunctivitis

    By Jean Shaw
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, May 2021

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    Kuo and Gower assessed the cost savings of a “red eye policy” designed to prevent conjunctivitis outbreaks at a major academic medical center. They found that, by furthering accurate diagnosis and infection control, the policy reduces the number of unnec­essary work furloughs, thus leading to substantial cost savings.

    The policy was implemented at Johns Hopkins Medical Center in 2011. Under it, employees can present to the medical center’s occupational health clinic to be immediately evaluated for red eye. Those who have had a red eye for fewer than seven days and have highly suggestive symptoms (e.g., discharge or tearing, contact with a person with adenoviral conjunctivitis, and/or recent cold, cough, or flu-like symptoms) are swabbed by a nurse practitioner. After the employee’s eye is swabbed, the person is temporarily furloughed as the specimen is evaluated with a rapid polymerase chain reaction (PCR) test validated for adenoviral conjunctivitis. Those who test positive remain on furlough, while those with negative test results return to work.

    For this quality improvement study, the researchers assessed the results of this triage system from Nov. 1, 2011, through Oct. 21, 2018. All told, 2,142 employees with red eye presented to the occupational health clinic during this time. Of these, 1,520 were suspected to have adenoviral conjunctivitis and underwent swabbing, and PCR test results were positive for 130 employees. Most of those who tested negative were seen by a comprehensive ophthalmol­ogist within 24 hours; common causes of their red eyes included dry eye and allergic conjunctivitis.

    With regard to cost, furloughing 130 employees—versus all 1,520 of those initially suspected to be affected—re­sulted in an estimated annual savings of $442,073, for a total of $3,094,511 during the seven-year period. The poli­cy has also proved effective from a pub­lic health perspective, as no adenoviral conjunctivitis outbreaks have occurred since it was implemented.

    Of note, the PCR test used at Johns Hopkins was developed and validated there. The researchers expressed hope that these results may provide impetus for the development of a commercial­ly available test that is sensitive and specific for adenoviral conjunctivitis and does not require a specialized laboratory. (Also see related commentary by Amanda K. Bicket, MD, MSE, and Joshua D. Stein, MD, MS, in the same issue.)

    The original article can be found here.