PURPOSE Outbreaks of adenovirus in neonatal intensive care units (NICUs) can lead to widespread transmission and serious adverse outcomes. We describe 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. DESIGN Epidemiologic outbreak investigation. PARTICIPANTS A total of 23 hospitalized neonates, as well as NICU staff and parents of affected infants. MAIN OUTCOME MEASURES Routine surveillance identified an adenovirus outbreak in a level IV NICU in August 2016. Epidemiologic investigation followed, including chart review, staff interviews, and observations. Cases were defined as hospital-acquired adenovirus identified from any clinical specimen (NICU patient or employee) or compatible illness in a family member. Real-time polymerase chain reaction (PCR) and partial- and whole-genome sequencing assays were used for testing of clinical and environmental specimens. RESULTS We identified 23 primary neonatal cases and 9 secondary cases (6 employees and 3 parents). All neonatal case-patients had respiratory symptoms. Of these, 5 developed pneumonia and 12 required increased respiratory support. Less than half (48%) had ocular symptoms. All neonatal case-patients (100%) had undergone a recent ophthalmologic examination, and 54% of neonates undergoing examinations developed adenovirus infection. All affected employees and parents had direct contact with infected neonates. Observations revealed inconsistent disinfection of bedside ophthalmologic equipment and limited glove use. Sampling of 2 handheld lenses and 2 indirect ophthalmoscopes revealed adenovirus serotype 3 DNA on each device. Sequence analysis of 16 neonatal cases, 2 employees, and 2 lenses showed that cases and equipment shared 100% identity across the entire adenovirus genome. Infection control interventions included strict hand hygiene, including glove use; isolation precautions; enhanced cleaning of lenses and ophthalmoscopes between all examinations; and staff furlough. We identified no cases of secondary transmission among neonates. CONCLUSIONS Adenovirus outbreaks can result from use of contaminated ophthalmologic equipment. Even equipment that does not directly contact patients can facilitate indirect transmission. Patient-to-patient transmission can be prevented with strict infection control measures and equipment cleaning. Ophthalmologists performing inpatient examinations should take measures to avoid adenoviral spread from contaminated handheld equipment.

中文翻译：

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新生儿重症监护病房中腺病毒的爆发：住院眼科检查期间设备清洁的至关重要。

目的新生儿重症监护病房（NICUs）爆发腺病毒可导致广泛传播和严重不良后果。我们描述了早产儿视网膜病变（ROP）筛查中使用的与污染的手持眼科设备相关的NICU中腺病毒暴发的调查，响应和成功遏制。设计流行病学暴发调查。参加者共有23名住院新生儿，NICU工作人员和患病婴儿的父母。主要观察指标常规监测于2016年8月在IV级重症监护病房中发现了腺病毒暴发。随后进行了流行病学调查，包括图表审查，工作人员访谈和观察。病例定义为从任何临床标本（NICU患者或雇员）或家庭成员的相配疾病中识别出的医院获得性腺病毒。实时聚合酶链反应（PCR）以及部分基因组测序和全基因组测序分析用于临床和环境标本的测试。结果我们确定了23例新生儿原发病例和9例继发病例（6名雇员和3名父母）。所有新生儿病例患者都有呼吸道症状。其中，5例发展为肺炎，12例需要增加呼吸支持。不到一半（48％）有眼部症状。所有新生儿病例患者（100％）最近都接受了眼科检查，接受检查的新生儿中有54％患了腺病毒感染。所有受影响的雇员和父母都与感染的新生儿直接接触。观察发现床边眼科设备消毒不一致，手套使用受限。对2个手持式透镜和2个间接检眼镜的采样显示每个设备上的腺病毒血清型3 DNA。对16例新生儿病例，2名雇员和2副镜片的序列分析表明，整个腺病毒基因组中的病例和设备具有100％的同一性。感染控制干预措施包括严格的手卫生，包括戴手套；隔离预防措施；在所有检查之间加强镜片和检眼镜的清洁；和员工休假。我们没有发现新生儿之间发生二次传播的情况。结论使用受污染的眼科设备可导致腺病毒暴发。即使不直接与患者接触的设备也可以促进间接传播。严格的感染控制措施和设备清洁措施可以防止患者之间的传播。进行住院检查的眼科医生应采取措施，避免受污染的手持设备传播腺病毒。