This article is more than 5 years old. Information may no longer be current.
‘No-talking’ policy may reduce endophthalmitis risk after intravitreal injection
A strict “no-talking” policy during intravitreal injections reduced the risk of endophthalmitis after the injections, according to a study.
“Some studies found that wearing face masks reduces endophthalmitis risk, whereas others suggest that adopting silence or a no-speaking policy may reduce speech-related contamination of the surgical field. However, no study has demonstrated that an intervention designed to reduce transmission of oral flora results in a decreased risk of endophthalmitis,” the study authors said.
The retrospective study conducted at Wills Eye Hospital included 47,155 intravitreal injections performed during a 24-month usual care period and 82,658 injections performed during a 24-month no-talking period.
The average interval between injection and presentation with endophthalmitis was 3.6 days for the usual care and no-talking periods.
During the usual care period, nine culture-positive cases were reported (0.019%), of which seven resulted from oral pathogens (0.015%). During the no-talking period, eight culture-positive cases were reported (0.010%), of which two resulted from oral pathogens (0.002%).
The silence policy was associated with a significant reduction in the risk of endophthalmitis (P = .004) and oral pathogen-associated endophthalmitis (P = .02). – by Matt Hasson
Disclosure: The authors report no relevant financial disclosures.
Perspective
Back to Top
With a goal of reducing endophthalmitis rates, Garg and colleagues introduced a “no-talking” policy. They correctly report that the introduction of their policy “may” reduce endophthalmitis risk. Why do they say “may?” Some reasons include a retrospective study design and a nonrandomized, non-contemporaneous comparison group. Over time things change, for example, antibiotic use changed during the two periods being compared. Their new policy involved other changes as well, as outlined in table 1 in the study. For example, family members were asked not to come in the room, attention was paid to when the needle was uncapped, and the needle was not to be passed over the patient’s nose or mouth.
Reducing endophthalmitis risk is obviously good, but it is only one measure of the success of the procedure. Instructing a patient not to talk and not having family members present might discourage speaking up at the time we confirm which eye is being injected with what drug. It is conceivable that a no-talking policy could raise the risk of a wrong site or wrong drug “never event.” Potential negatives associated with such a policy not measured may include reduced patient satisfaction and, possibly, increased anxiety.
I applaud the very low infection rate, it is very unlikely a no-talking policy causes more never events, and I agree with the authors that such a policy may lower the infection risk.
Collapse
Garg SJ, et al. Ophthalmic Surg Lasers Imaging Retina. 2015;doi:10.3928/23258160-20151027-07.