The Los Angeles County Department of Public Health investigated an outbreak of epidemic keratoconjunctivitis secondary to adenovirus linked to an optometry clinic in the summer of 2017.

The team identified suboptimal infection prevention practices, including hygiene policies that are not well enforced, personal protective equipment that is not appropriately used while examining potentially infectious patients, eye drop vials that are not consistently discarded if contaminated with eye secretions and tonometers that are inadequately disinfected.

This study analyzed the results of a 17-question survey on infection prevention practices that yielded 42 responses from a sample of optometrists in Los Angeles.

Of the respondents, 58.5% had no written hand hygiene policy, 46.2% did not wear gloves while examining patients with eye drainage and 48.6% did not use droplet precautions for patients with respiratory symptoms.

While 92.5% used multidose eye drop vials, 41.6% did not discard the vial if the tip came into contact with the patient’s skin or a conjunctival or environmental surface. To ensure a clean tonometer for each patient, 68.4% used 70% isopropyl alcohol, 47.4% used noncontact tonometers, 23.6% used disposable tips and none used bleach.