Re: Anderson et al.: Ethical considerations for performing intraocular surgery on eyes with no light perception (Ophthalmology. 2019;126:10-12)

Abstract

also had other serious and complex underlying conditions. Additionally, although Dr Kuo reminds us of the importance of reducing employee presenteeism, or the practice of coming to work despite infectious illness, it was not the cause of the adenovirus outbreak at our hospital. In our outbreak, the index case was a patient, not an employee. The first employee case was identified significantly later. As previously shared, the epidemic curve (Fig 1 in the original article) detailed the number of cases identified by day of detection. 1 Affected staff members were promptly identified and furloughed, actions that, along with core infection control measures, were successful in preventing any secondary transmission between patients. As our report addressed, our hospital's most important finding was that handheld ophthalmologic equipment that had no direct patient contact was the unexpected source of this organism and served as a reservoir for silent transmission to patients. This discovery was significant because the vast majority of published outbreaks of adenovirus implicated sick providers or contaminated equipment or solutions that directly touch the ocular surface of a patient. This novel finding, coupled with the fact that experienced ophthalmologists had been performing retinopathy of prematurity rounds at our institution for decades without an analogous incident, made this an important investigation to share more broadly with others. It is our hope that future health care providers might now have a more complex database from which to deduce solutions to unconventional sources of outbreaks.