Abstract :
BACKGROUND: Conjunctivitis, or “pinkeye,” can be either infectious (bacterial or viral), allergic, or an irritant (caused by something in the eye). Bacterial conjunctivitis may be caused by several different types of bacteria, including Haemophilus influenzae, Pneumococci, Staphylococci, or Streptococci. This long-term-care skilled nursing facility has five units (Avenues) and a total of 188 beds. The Avenue affected by this outbreak contains 39 beds.
OBJECTIVE: To investigate and control an outbreak of conjunctivitis and/or respiratory infections.
METHODS: Cases were retrospectively and prospectively identified and were defined as acute once there were signs of pinkeye or eye drainage and/or respiratory symptoms. Eye cultures and sputum cultures were obtained from residents and healthcare workers and sent for viral and bacterial testing. Residents were placed on contact precautions, and healthcare workers were not permitted to work until they were free of respiratory illness or their pinkeye had resolved. Residents and staff were treated with antibiotics and/or eye drops. Increased frequency of environmental cleaning of all contact points was instituted. During this outbreak period, residents and staff were not permitted to travel to other Units (Avenues) for meals or common activities. Floating was strongly discouraged.
RESULTS: A total of 18 residents and 11 healthcare workers were identified over a 3–4 week period. Eleven cultures were positive for Haemophilus influenzae and three grew out coagulase-negative staph.
CONCLUSIONS: Haemophilus influenzae outbreaks can present a challenge to the elderly in long-term-care settings. Healthcare workers can be the source of your outbreak and your index case. In this outbreak, although cultures were not obtained on most of the healthcare workers, two healthcare workers were the first individuals to become ill and two healthcare workers grew out Haemophilus influenzae on their cultures. Control of conjunctivitis and respiratory illness in long-term-care settings requires quick identification of healthcare workers and residents who have pinkeye and/or respiratory symptoms. Culturing for pathogen identification is important to determine a bacterial or viral source.
