Jernigan J A, Lowry B S, Hayden F G, Kyger S A, Conway B P, Gröschel D H, Farr B M
University of Virginia Health Sciences Center, Charlottesville 22908.
J Infect Dis. 1993 Jun;167(6):1307-13. doi: 10.1093/infdis/167.6.1307.
Epidemic keratoconjunctivitis (EKC) due to adenovirus type 8 affected 126 (7%) of 1870 ophthalmology clinic patients during an outbreak. Risk factors and mode of transmission were studied by comparing cases (n = 58) and controls (n = 200) for exposure to risk factors. Pneumotonometry (odds ratio [OR], 10.5; 95% confidence interval [CI], 4.0-27.7), multiple clinic visits (OR, 5.9; 95% CI, 3.3-10.6), and contact with an infected physician (OR, 3.3; 95% CI, 1.2-9.0) were significant risk factors for infection. The hands of 3 patients and 3 physicians with EKC were cultured before and after hand washing to assess adenovirus removal; 3 had hand cultures positive for adenovirus after hand washing. In conclusion, this outbreak appeared to be due to inadequate disinfection of instruments, especially pneumotonometers, and finger-to-eye transmission by health care workers. Hand washing did not reliably remove adenovirus from contaminated fingers. Gloving for exam of eyes with EKC may help prevent transmission. Ophthalmologists with EKC were a significant risk factor for patients and should be furloughed for the duration of communicability.
在一次疫情爆发期间，1870名眼科门诊患者中有126人（7%）感染了由8型腺病毒引起的流行性角结膜炎（EKC）。通过比较病例组（n = 58）和对照组（n = 200）接触危险因素的情况，研究了危险因素和传播方式。眼压测量（优势比[OR]，10.5；95%置信区间[CI]，4.0 - 27.7）、多次门诊就诊（OR，5.9；95% CI，3.3 - 10.6）以及与受感染医生接触（OR，3.3；95% CI，1.2 - 9.0）是感染的重要危险因素。对3例患者和3名患有EKC的医生洗手前后的手部进行培养，以评估腺病毒的清除情况；3人洗手后手部腺病毒培养呈阳性。总之，这次疫情爆发似乎是由于器械消毒不充分，尤其是眼压计，以及医护人员的手指到眼睛的传播所致。洗手并不能可靠地从受污染的手指上清除腺病毒。对患有EKC的患者进行眼部检查时戴手套可能有助于预防传播。患有EKC的眼科医生是患者感染的重要危险因素，在传染期内应暂时停职。
