title: Minimizing the endophthalmitis rate following intravitreal injections using 0.25% povidone-iodine irrigation and surgical mask.
abstract: BACKGROUND
  To examine the efficacy of complying with an infection control manual for intravitreal injection of anti-vascular endothelial growth factor (VEGF) preparations in reducing the rate of endophthalmitis.
  
  
  METHODS
  We retrospectively reviewed intravitreal anti-VEGF injections conducted by vitreoretinal specialists at the outpatient injection room of a single university hospital between July 2009 and July 2012. The injections were conducted following an infection control manual established by our department. Doctors and nurses wore surgical masks, and disinfected the patient's eyelid skin with 10% povidone-iodine and then the conjunctiva with 0.25% povidone-iodine. After putting a drape on the patient's face, a lid speculum was placed. The conjunctival surface was again washed with 5 ml of 0.25% povidone-iodine. After waiting at least 30 seconds, intravitreal injection was performed through povidone-iodine. Following injection, the injection site was again washed with 5 ml of 0.25% povidone-iodine. Patients were treated with topical levofloxacin 4 times a day for 3 days before and after the injection.
  
  
  RESULTS
  A total of 15,144 injections comprising 548 injections of pegaptanib sodium, 846 injections of bevacizumab, and 13,750 injections of ranibizumab were performed. During this period, no case of suspected or proven infectious endophthalmitis occurred. The endophthalmitis rate was 0 per 15,144 injections, (95% confidence interval, 0.0-0.0%).
  
  
  CONCLUSIONS
  The results suggest that endophthalmitis can be reduced to a minimum by preventing normal flora of the conjunctiva and bacteria in the oral cavity from entering the vitreous. For this purpose, an infection control manual that requires nurses and doctors to wear surgical mask and drape the patient's face, irrigate the conjunctiva with 0.25% povidone-iodine and wait at least 30 seconds before performing intravitreal injection is useful.
authors: Department of Ophthalmology, School of Medicine, Surugadai Hospital of Nihon University, 1-8-13 Surugadai, Kanda, Chiyodaku, Tokyo 101-8309, Japan. sshimada@olive.ocn.ne.jp
authors: Hiroyuki
authors: H
authors: Shimada
authors: Takayuki
authors: T
authors: Hattori
authors: Ryusaburo
authors: R
authors: Mori
authors: Hiroyuki
authors: H
authors: Nakashizuka
authors: Kyoko
authors: K
authors: Fujita
authors: Mitsuko
authors: M
authors: Yuzawa
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D052157:Aptamers, Nucleotide / Q000627:therapeutic use; D000068258:Bevacizumab; D003228:Conjunctiva / Q000382:microbiology; D009877:Endophthalmitis / Q000382:microbiology / Q000517:prevention & control*; D015818:Eye Infections, Bacterial / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D058449:Intravitreal Injections; D064704:Levofloxacin / Q000627:therapeutic use; D008397:Masks / Q000706:statistics & numerical data*; D011206:Povidone-Iodine / Q000627:therapeutic use*; D000069579:Ranibizumab; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000068258:Bevacizumab; D064704:Levofloxacin; D011206:Povidone-Iodine; D000069579:Ranibizumab
references: Am J Ophthalmol. 2008 May;145(5):879-82
references: 18329624
references: Arch Ophthalmol. 2005 Feb;123(2):161-5
references: 15710810
references: Ophthalmology. 2006 Jun;113(6):1020-7
references: 16690128
references: Graefes Arch Clin Exp Ophthalmol. 2008 Jan;246(1):81-7
references: 17674014
references: Arch Ophthalmol. 2011 Dec;129(12):1551-4
references: 21825179
references: Retina. 2011 Apr;31(4):662-8
references: 21836400
references: Ophthalmology. 2007 May;114(5):866-70
references: 17324467
references: Retina. 2011 Sep;31(8):1525-33
references: 21878800
references: Ophthalmic Surg Lasers Imaging. 2011 Jul-Aug;42(4):346-9
references: 21366185
references: Arch Ophthalmol. 2011 Dec;129(12):1607-9
references: 22159682
references: Retina. 2013 Jan;33(1):143-51
references: 22972447
references: Retina. 2011 Apr;31(4):669-72
references: 21178659
references: N Engl J Med. 2006 Oct 5;355(14):1419-31
references: 17021318
references: Eye (Lond). 2009 Dec;23(12):2187-93
references: 19218994
references: Retina. 2006 Feb;26(2):191-5
references: 16467677
references: J Ocul Pharmacol Ther. 2007 Feb;23(1):70-7
references: 17341154
references: Ophthalmology. 2012 Jul;119(7):1420-4
references: 22420958
references: Ocul Immunol Inflamm. 2011 Feb;19(1):32-8
references: 21034310
references: Ophthalmology. 2009 Jan;116(1):57-65.e5
references: 19118696
references: Ophthalmology. 2009 Jun;116(6):1225.e1
references: 19486799
references: Am J Ophthalmol. 2011 Feb;151(2):329-32
references: 21168821
references: Retina. 2009 Oct;29(9):1213-7
references: 19934815
references: Acta Ophthalmol Scand. 2007 Dec;85(8):848-51
references: 17459028
references: Am J Ophthalmol. 2011 Jan;151(1):11-17.e1
references: 20970112
references: J Cataract Refract Surg. 2009 Dec;35(12):2109-14
references: 19969216
references: Ophthalmology. 2012 Aug;119(8):1609-14
references: 22480743
references: Ophthalmologica. 2011;226(3):145-50
references: 21811052
references: Curr Eye Res. 1990 Aug;9(8):725-32
references: 2276275
references: J Clin Microbiol. 1982 Apr;15(4):635-9
references: 7040461
references: Ophthalmology. 2009 Aug;116(8):1498-501
references: 19501409
references: Br J Ophthalmol. 2008 Dec;92(12):1606-11
references: 18614570
references: Retina. 2009 May;29(5):601-5
references: 19357558
references: Ophthalmic Surg Lasers Imaging. 2012 Mar-Apr;43(2):115-20
references: 22283227
references: Retina. 2008 Nov-Dec;28(10):1395-9
references: 18827737
references: Cutan Ocul Toxicol. 2009;28(3):119-24
references: 19694608
references: Antimicrob Agents Chemother. 1982 Oct;22(4):593-7
references: 7181472
references: Am J Ophthalmol. 2011 Nov;152(5):717-9.e2
references: 22017840
references: J Cataract Refract Surg. 2009 Sep;35(9):1609-13
references: 19683161
references: Arch Ophthalmol. 2009 Dec;127(12):1581-3
references: 20008710
references: N Engl J Med. 2011 May 19;364(20):1897-908
references: 21526923
references: Ophthalmology. 2011 Oct;118(10):2028-34
references: 21705087
references: Retina. 2008 Apr;28(4):564-7
references: 18398358
references: Br J Ophthalmol. 2006 Nov;90(11):1344-9
references: 16854824
references: Retina. 2012 Mar;32(3):473-6
references: 22374155
references: Retina. 2011 Nov;31(10):1981-2
references: 22027798
references: Retina. 2011 Apr;31(4):654-61
references: 21330939
references: Retina. 2011 Nov;31(10):2032-6
references: 21659941