Meltem KARABAY, Hande TOPTAN, Ertuğrul GÜÇLÜ, Burçin Köklü ÇAKIR, İbrahim CANER

Bir Yenidoğan Yoğun Bakım Ünitesinde Çıkan Adenovirüs Konjonktiviti Salgınının Analizi

Amaç Bu araştırmada prematüre retinopatisi ‘’retinopathy of prematurity’’ (ROP) muayenesi sırasında kullanılan tıbbi aletlerle ilişkili gelişen Adenovirus konjonktiviti (AK) salgın analizinin sunulması amaçlanmıştır. Gereç ve Yöntemler Bu çalışmada; retrospektif olaraK Sakarya Eğitim ve Araştırma Hastanesinde meydana gelen yenidoğan AK salgını incelendi. Hasta verileri dosyalardan ve enfeksiyon sürveyans kayıtlarından elde edildi. Hastalara ait göz sürüntü örneklerinden ve ROP muayenesi sırasında kullanılan on adet tıbbi aletten (blefarosta, indirekt oftalmoskop, skleral depresör ve 20-28 diyoptrilik mercekler) bakteriyolojik kültür ve Adenovirus için polimeraz zincir reaksiyon (PZR) incelemeleri yapıldı. Bulgular Yenidoğan yoğun bakım ünitesinde (YYBÜ) çalışan bir hemşirenin gözünde AK tespit edildikten sonra yatan bir bebekte ve daha sonrasında üç bebekte daha AK gelişti. AK gelişen dört bebeğin hepsi de aynı gün ROP muayenesi olmuştu. Göz muayenelerinin steril ya da tek kullanımlık aletlerle yapılamadığı, bir bebeğin muayenesinden diğerine geçerken %10 povidon iyotla dezenfeksiyon yapıldığı ve sonrasında ROP muayenesinde tekrar kullanıldığı anlaşıldı. Göz sürüntü örneklerinin bakteriyolojik kültüründe patojen bakteri üremedi. Dört yenidoğan ve hemşirenin göz sürüntü örneklerinde ve ROP muayenesinde kullanılan dört tane blefarosta adlı cihazda PZR ile Adenovirüs DNA'sı saptandı. Sonuç YYBÜ de yatan bebeklerde standart önlemlere uyulmadığında AK salgınları gelişebilir. Dezenfeksiyon süreçleri standardize uygulamalarla yapılmalı, standartlardan ödün verilmemeli ve bu uygulamalar sürekli olarak kontrol edilmelidir.

Anahtar Kelimeler:

Adenovirüs, dezenfeksiyon, konjonktivit, prematüre

Analysis of Adenovirus Conjunctivitis Outbreak in a Neonatal Intensive Care Unit

Objective In this study, it is aimed to present the outbreak analysis of Adenovirus conjunctivitis (AC) that develops associated with medical devices used during retinopathy of prematurity (ROP) examination for retinopathy of prematurity. Materials and Methods In this study; The neonatal AK outbreak that occurred at the Sakarya Training and Research Hospital was retrospectively analyzed. Patient data were obtained from files and infection surveillance records. Bacteriological culture and polymerase chain reaction (PCR) examinations for Adenovirus were performed from the eye swab samples of the patients and ten medical instruments (blepharosta, indirect ophthalmoscope, scleral depressor and 20-28 diopters) used during ROP examination. Results After AK was detected in the eyes of a nurse working in a neonatal intensive care unit (NICU), one inpatient baby and three more babies developed AK. All four babies who developed AK had ROP examination on the same day. It was understood that eye examinations could not be performed with sterile or disposable instruments, disinfection was performed with 10% povidone iodine while passing from one baby's examination to another, and then it was used again in ROP examination. No pathogenic bacteria were grown in the bacteriological culture of eye swab samples. Adenovirus DNA was detected by PCR in eye swab samples of four newborns and nurses and in four devices called blepharosta used for ROP examination. Conclusion AC outbreaks develop in infants hospitalized in the NICU when standard precautions are not followed. Disinfection processes should always be carried out with standardized practices, standards should not be compromised and these practices should be constantly monitored.

Keywords:

Adenovirus;, disinfection;, conjunctivitis;, premature,

PDF

___

Kaynaklar 1 Jones NK, Ranellou K, Zhang H, Jalal H. Adenovirus pseudo-outbreak in a large UK neonatal intensive care unit. Am J Infect Control 2018; 46: 1411–1413.
2 Fierson WM; American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2018;142(6):e20183061. Pediatrics 2019; 143.
3 Koç E, Baş AY, Özdek Ş, Ovalı F, Başmak H. Turkish Neonatal and Turkish Ophthalmology Societies consensus guideline on the retinopathy of prematurity. Turk Pediatri Ars 2018; 53: S151–160.
4 Ersoy Y, Otlu B, Türkçüoğlu P, Yetkin F, Aker S, Kuzucu C. Outbreak of adenovirus serotype 8 conjunctivitis in preterm infants in a neonatal intensive care unit. Journal of Hospital Infection. 2012; 80: 144–149.
5 Domínguez-Berjón MF, Hernando-Briongos P, Miguel-Arroyo PJ, Echevarría JE, Casas I. Adenovirus Transmission in a Nursing Home: Analysis of an Epidemic Outbreak of Keratoconjunctivitis. Gerontology. 2007; 53: 250–254.
6 Chaberny IF, Schnitzler P, Geiss HK, Wendt C. An Outbreak of Epidemic Keratoconjunctivitis in a Pediatric Unit Due to Adenovirus Type 8. Infection Control & Hospital Epidemiology. 2003; 24: 514–419.
7 Chen Y, Liu F, Wang C, et al. Molecular Identification and Epidemiological Features of Human Adenoviruses Associated with Acute Respiratory Infections in Hospitalized Children in Southern China, 2012-2013. PLoS One 2016; 11: e0155412.
8 O’Brien TP, Jeng BH, McDonald M, Raizman MB. Acute conjunctivitis: truth and misconceptions. Current Medical Research and Opinion. 2009; 25: 1953–1961.
9 Rutala WA, Weber DJ. Disinfection and sterilization in health care facilities: what clinicians need to know. Clin Infect Dis 2004; 39: 702–709.
10 Bigliardi PL, Alsagoff SAL, El-Kafrawi HY, Pyon J-K, Wa CTC, Villa MA. Povidone iodine in wound healing: A review of current concepts and practices. Int J Surg 2017; 44: 260–268.
11 Faden H, Wynn RJ, Campagna L, Ryan RM. Outbreak of adenovirus type 30 in a neonatal intensive care unit. The Journal of Pediatrics. 2005; 146: 523–527.
12 Kaleli I, Demir M. The effect of chlorhexidine gluconate and povidone-iodine on various bacteria. ANKEM Dergisi 2000; 14: 92–97.
13 Hysmith ND, Tanner MR, Arnold SR, et al. Use of real-time semiquantitative PCR data in management of a neonatal intensive care unit adenovirus outbreak. Infect Control Hosp Epidemiol 2018; 39: 1074–1079.