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Silence Is Best Practiced During Eye Injections

For patients who have to receive a drug injection for macular degeneration or other eye conditions, a new study suggests silence for yourself and your doctor during the procedure.

Researchers found that in just a few minutes of talking over an imaginary patient, unmasked volunteers spewed out bacteria which could potentially land on eyes or injection needles and cause infection.

One in every few thousand injections for vision loss results in a serious eye infection called endophthalmitis, which at its worst can cause patients to go blind completely. But because patients typically need frequent injections, as many as 1 in 200 eventually get the infection.

Some of those infections are caused by a type of bacterium, Streptococcus, that's common in the mouth.

Fifteen volunteers were recruited for this study. Each volunteer was positioned over an open plate for culturing bacteria and did the following: read a 5-minute script with a face mask, read a 5-minute script without a face mask, read a 5-minute script with the face turned away from the plate without a face mask, and stood in silence for 5 minutes.

Each volunteer then read a 5-minute script while reclined in a standard ophthalmic examination chair with an open plate secured to the forehead to simulate bacterial dispersal associated with a talking patient. Total numbers of colony-forming bacteria per plate were counted, and the bacteria were identified.

Significantly less bacterial growth occurred in the face mask and silence conditions compared with the no face mask condition. Bacterial growth was significantly greater in the reclined condition compared with the room control.

Oral streptococcal species represented 66.7 to 82.6 percent of bacterial colonies in the no face mask, face turned, and reclined conditions.

During simulated intravitreous injection, wearing a face mask or remaining silent significantly decreases culture plate contamination from talking. Talking from above and talking in the reclined position were associated with a significant increase in culture plate contamination.

That shows that even though the eye injections aren't major procedures and don't happen in an operating room, patients and their doctors should still take the possibility of eye or injection needle contamination seriously, researchers said.

Germs from a chatty doctor or assistant could be a concern in some other instances as well, the researchers wrote in Archives of Ophthalmology. Study author Dr. Colin McCannel, from the Jules Stein Eye Institute at the University of California, Los Angeles, pointed to a few cases where bacteria in a doctor's mouth were linked to meningitis cases in patients who had recently gotten spinal taps.

Physicians performing intravitreous injections should be aware of these patterns of bacterial contamination, should consider either wearing a face mask or minimizing speech, and should encourage patients to minimize speech during the procedure.

The new finding "doesn't prove anything conclusively," said McCannel.
Still, he said, "My advice to patients would be, until the injection is complete ... minimize conversation or talking with the physician."

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.




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