Face Masks and Bacterial Dispersion Toward the Periocular Area

Raevis, Joseph; Gjyzeli, Genti; Mititelu, Mihai; Rogers, Jeremy D.; Lasarev, Michael; Chang, Jonathan S.

doi:10.1016/j.ophtha.2021.01.007

Cited by 27 publications

(34 citation statements)

References 4 publications

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“…Before the COVID-19 pandemic, there was no evidence to support routine use of drapes when performing intravitreal injections [10]. During the pandemic, while taping the top edge of the face mask may be effective, depending on the shape of the face, this practice may not reliably stop airflow towards the ocular surface [23]. We believe that adhesive face drapes that completely block the patient's mouth and ocular surface are necessary to reduce the incidence of endophthalmitis following intravitreal injection during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies have found that after wearing a face mask for more than four hours, the periocular area becomes contaminated with the oral flora, which can spread from the top of the mask to the eye surface, posing a risk for endophthalmitis [20][21][22]. Measures, such as securing the top edge of the face mask with tape, have been reported to prevent the air jet containing bacteria from spreading in the direction of the eye [22][23][24]. Three recent articles compared the incidence of endophthalmitis after intravitreal injections during the COVID-19 pandemic (with implementation of patient masking) with its incidence in the pre-COVID-19 era [25][26][27].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Safety Measures for Maintaining Low Endophthalmitis Rate after Intravitreal Anti-Vascular Endothelial Growth Factor Injection before and during the COVID-19 Pandemic

Takada

Shimada

Mori

et al. 2022

JCM

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During the COVID-19 pandemic, intravitreal injections are performed with patients wearing masks. The risk of endophthalmitis after intravitreal injection is reported to increase due to an influx of exhaled air containing oral bacteria from the upper part of the mask onto the ocular surface. We retrospectively investigated the incidence of endophthalmitis when intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections were performed using the same infection control measures before and during the pandemic. Vitreoretinal specialists performed intravitreal injections of anti-VEGF agents in the outpatient room of a university hospital. Infection control measures before and during the pandemic included covering the patient’s eye with adhesive face drape and irrigating the ocular surface with 0.25% povidone-iodine before draping, and immediately before and after injection. Before the COVID-19 pandemic (February 2016 to December 2019), one case of endophthalmitis occurred among 31,173 injections performed (0.0032%; 95% confidence interval (CI), 0.000008–0.017872%). During the COVID-19 pandemic (January 2020 to August 2021), one case of endophthalmitis occurred among 14,725 injections performed (0.0068%; 95% CI, 0.000017–0.037832%). There was no significant difference between the two periods (Fisher’s exact test: p = 0.5387). Even during the COVID-19 pandemic, very low incidence of endophthalmitis after intravitreal injection can be maintained by implementing basic infection prophylactic measures, including face draping and 0.25% povidone-iodine irrigation, established before COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety Measures for Maintaining Low Endophthalmitis Rate after Intravitreal Anti-Vascular Endothelial Growth Factor Injection before and during the COVID-19 Pandemic

Takada

Shimada

Mori

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“… 16 A similar study using comparable conditions found no significant difference in taping the superior edge of a mask to decrease bacterial dispersal towards the ocular surface when compared with an appropriately worn mask. 17 Both studies used 2 min of talking to simulate the potential dispersion of bacteria, and both had participants in a reclined position to simulate intravitreal injections. A ‘no-talking’ policy during intravitreal injections is widely accepted practice and is supported by the 2018 European Society of Retina Specialists expert consensus recommendations.…”

Section: Discussionmentioning

confidence: 99%

“… 18 However, the studies above chose to have the participants speak for 2 min as this improved their culture yields. 17 The current study evaluated bacterial growth under simulated exhalation scenarios where participants were instructed to exhale forcefully for 5 s while wearing various face masks. Participants in this study were seated in the upright position to simulate postoperative face mask use.…”

Section: Discussionmentioning

confidence: 99%

Potential impact of oral flora dispersal on patients wearing face masks when undergoing ophthalmologic procedures

et al. 2021

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ObjectiveThe purpose of this study is to investigate the amount of oral flora dispersion towards the ocular surface in relation to various face mask scenarios.Methods and analysisThirty participants were recruited for this prospective cross-sectional study. Each participant was seated and instructed to hold a blood agar plate perpendicular to the bridge of their nose and facing downward. Participants then partook in three unique face mask scenarios: no face mask, surgical face mask and surgical face mask with tape securing the superior edge. During each scenario, participants were instructed to forcefully exhale for 5 s three times. The primary outcome measure was the number of colony-forming units (CFUs) grown on each face mask scenario-specific plate.ResultsThirty participants were recruited for the study, and a total of 90 chocolate agar plates were successfully incubated. The proportion of detecting any CFU was 6.67% (95% CI: 0.818% to 22.1%) for no mask scenario, 0% (95% CI: 0% to 11.6%) for mask scenario and 3.33% (95% CI: 0.0844% to 17.2%) for mask-taped scenario. The mean differences in proportion of detecting any CFU were 3.33% (95% CI: 0% to 10%, p=0.309) for no mask versus mask taped, 3.35% (95% CI: 0% to 10%, p=0.307) for mask taped versus mask and 6.68% (95% CI: 0% to 16.7%, p=0.142) for no mask versus mask.ConclusionThis study showed no difference in bacterial dispersion towards the ocular surface when comparing no face mask, a surgical face mask without tape or a surgical face mask with tape.

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“…[3] Furthermore, patients' routine use of face masks may theoretically increase the risk of infections, as the exhalate is directed toward the periocular area during procedures such as intravitreal injections. [4,5] COVID-19 has also indirectly affected ophthalmology patients. The ophthalmology practice necessitates close, in-person visits and carries a high risk of viral transmission.…”

mentioning

confidence: 99%