Effect of a Strict ‘No-Talking’ Policy During Intravitreal Injection on Post-Injection Endophthalmitis

Abstract

Clinical Science Sunir J. Garg, MD; Michael Dollin, MD; Jason Hsu, MD; James F. Vander, MD; Philip Storey, MD, MPH To report the effect of a “no-talking” policy during intravitreal injection (IVI) on post-injection endophthalmitis. Retrospective, comparative, consecutive case series of patients receiving IVI between Jan. 1, 2009, and Dec. 31, 2012. A 24-month “usual care” period was compared to a 24-month no-talking period, during which a strategy to further minimize speech during IVI was implemented. During the usual care period, 47,155 IVIs were performed, with nine culture-positive cases (0.019%), including seven due to oral pathogens (0.015%). During the no-talking period, 82,658 IVIs were performed, with eight culture-positive cases (0.010%), including two due to oral pathogens (0.002%). The no-talking policy was associated with a decreased endophthalmitis risk (P = .004), including oral pathogen-associated endophthalmitis (P = .02). This study demonstrates that a more stringent no-talking policy during IVI may reduce the risk of post-injection endophthalmitis. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:1028–1034.] From the Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia. Presented previously as a paper-on-demand at the American Society of Retina Specialists Annual Meeting in San Diego, on August 9–13, 2014. Supported by the J. Arch McNamara Fund for Retinal Research, Philadelphia, and the Retina Service of Wills Eye Hospital, Philadelphia. The authors report no relevant financial disclosures. The authors thank the Post-Injection Endophthalmitis (PIE) Study Team: Sahitya Reddy, BA; Joseph Vojtko, BA; Christopher J. Brady, MD; Francis C. Decroos, MD; Adam T. Gerstenblith, MD; Rajiv Shah, MD; Julia A. Haller, MD; Gary C. Brown, MD, MBA; David H. Fischer, MD; Omesh T. Gupta, MD, MBA; Allen C. Ho, MD; Richard S. Kaiser, MD; Joseph I. Maguire, MD; Carl H. Park, MD; Carl D. Regillo, MD; Arunan Sivalingam, MD; and Marc J. Spirn, MD, of the Mid Atlantic Retina and The Retina Service of Wills Eye Hospital, Philadelphia. Address correspondence to Sunir J. Garg, MD, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1020, Philadelphia, PA 19107; 800-331-6634; fax: 215-825-4723; email: sunirgarg@yahoo.com. 10.3928/23258160-20151027-07 To report the effect of a “no-talking” policy during intravitreal injection (IVI) on post-injection endophthalmitis. Retrospective, comparative, consecutive case series of patients receiving IVI between Jan. 1, 2009, and Dec. 31, 2012. A 24-month “usual care” period was compared to a 24-month no-talking period, during which a strategy to further minimize speech during IVI was implemented. During the usual care period, 47,155 IVIs were performed, with nine culture-positive cases (0.019%), including seven due to oral pathogens (0.015%). During the no-talking period, 82,658 IVIs were performed, with eight culture-positive cases (0.010%), including two due to oral pathogens (0.002%). The no-talking policy was associated with a decreased endophthalmitis risk (P = .004), including oral pathogen-associated endophthalmitis (P = .02). This study demonstrates that a more stringent no-talking policy during IVI may reduce the risk of post-injection endophthalmitis. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:1028–1034.] From the Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia. Presented previously as a paper-on-demand at the American Society of Retina Specialists Annual Meeting in San Diego, on August 9–13, 2014. Supported by the J. Arch McNamara Fund for Retinal Research, Philadelphia, and the Retina Service of Wills Eye Hospital, Philadelphia. The authors report no relevant financial disclosures. The authors thank the Post-Injection Endophthalmitis (PIE) Study Team: Sahitya Reddy, BA; Joseph Vojtko, BA; Christopher J. Brady, MD; Francis C. Decroos, MD; Adam T. Gerstenblith, MD; Rajiv Shah, MD; Julia A. Haller, MD; Gary C. Brown, MD, MBA; David H. Fischer, MD; Omesh T. Gupta, MD, MBA; Allen C. Ho, MD; Richard S. Kaiser, MD; Joseph I. Maguire, MD; Carl H. Park, MD; Carl D. Regillo, MD; Arunan Sivalingam, MD; and Marc J. Spirn, MD, of the Mid Atlantic Retina and The Retina Service of Wills Eye Hospital, Philadelphia. Address correspondence to Sunir J. Garg, MD, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1020, Philadelphia, PA 19107; 800-331-6634; fax: 215-825-4723; email: sunirgarg@yahoo.com.