Direct Costs And Clinical Impact Of Adenovirus Genotype 8 Conjunctivitis Outbreak In A Neonatology Unit

Objective:To report a conjunctivitis outbreak in a neonatology intensive care unit (NICU) and determine the associated economic impact.Design:Prospective observational study.Setting:Centro de Educacion Medica e Investigaciones Clinicas (CEMIC) University Hospital, a private, tertiary-care healthcare institution in Buenos Aires, Argentina.Participants:The study included 52 NICU neonates and 59 NICU-related healthcare workers (HCWs) from CEMIC hospital.Methods:Neonates and HCWs were swabbed for real-time polymerase chain reaction (PCR) testing, viral culture, and typing by sequencing. Infection control measures, structural and logistic changes were implemented. Billing records were analyzed to determine costs.Results:From January 30 to April 28, 2018, 52 neonates were hospitalized in the NICU. Among them, 14 of 52 (21%) had bilateral conjunctivitis with pseudomembranes. Symptomatic neonates and HCWs were HAdV-D8 positive. Ophthalmological symptoms had a median duration of 18 days (IQR, 13-24.5). PCR positivity and infectious range had a median duration of 18.5 days. As part of containment measures, the NICU and the high-risk pregnancy unit were closed to new patients. The NICU was divided into 2 areas for symptomatic and asymptomatic patients; a new room was assigned for the general nursery, and all deliveries from the high-risk pregnancy unit were redirected to other hospitals. The outbreak cost the hospital US$205,000: implementation of a new nursery room and extra salaries cost US$30,350 and estimated productivity loss during 1 month cost US$175,000.Conclusions:Laboratory diagnosis confirmed the cause of this outbreak as HAdV-D8. The immediate adoption and reinforcement of rigorous infection control measures limited the nosocomial viral spread. This outbreak represented a serious institutional problem, causing morbidity, significant economic loss, and absenteeism.