Comparison of disinfection effect between benzalkonium chloride and povidone iodine in nasotracheal intubation: a randomized trial

Aiji Sato-Boku,Minhye So,Yushi Adachi,Naoko Tachi,Masahiro Okuda,Keiji Nagano,Yuji Kamimura,Hidekazu Ito,Kazuya Sobue,Yoshiaki Hasegawa,Eisuke Kako,Yoshiki Sento

doi:10.1186/s12871-019-0839-y

Abstract

BackgroundNasotracheal intubation can potentially result in microbial contamination from the upper respiratory tract to the lower respiratory tracts. However, an ideal nasotracheal disinfection method is yet to be determined. Therefore, we compared the disinfection effects between benzalkonium chloride and povidone iodine in nasotracheal intubation.MethodsOverall, this study enrolled 53 patients aged 20–70 years who were classified into classes 1 and 2 as per American Society of Anesthesiologists-physical status and were scheduled to undergo general anesthesia with NTI. Patients who did not give consent (n = 2) and who has an allergy for BZK or PVI were excluded from the study. The patients were randomly divided into two groups on the basis of the disinfection method: BZK (n = 26, one patient was discontinued intervention) and PVI (n = 25). 50 patients were assessed finally.The subjects’ nasal cavities were swabbed both before (A) and after disinfection (B), and the internal surface of the endotracheal tube was swabbed after extubation (C). The swabs were cultured on Brain heart infusion agar and Mannitol salt agar. The number of bacteria per swab was determined and the rates of change in bacterial count (B/A, C/B) were calculated. The growth inhibitory activity of the disinfectants on Staphylococcus aureus were also investigated in vitro.ResultsAlthough the initial disinfection effects (B/A) were inferior for benzalkonium chloride compared with those for povidone iodine, the effects were sustained for benzalkonium chloride (C/B). In the in vitro growth inhibitory assay against S. aureus, benzalkonium chloride showed higher inhibitory activity than povidone iodine.ConclusionAlthough both disinfectants were inactivated or diffused/diluted over time, benzalkonium chloride maintained the threshold concentration and displayed antimicrobial effects longer than povidone iodine; therefore, benzalkonium chloride appeared to show a better sustained effect. Benzalkonium chloride can be used for creating a hygienic nasotracheal intubation environment with sustained sterilizing effects.Trial registrationUMIN-CTR (Registration No. UMIN000029645). Registered 21 Oct 2017.

Highlights

Nasotracheal intubation can potentially result in microbial contamination from the upper respiratory tract to the lower respiratory tracts
Dental procedures under general anesthesia with NTI demonstrate a higher incidence of bacteremia compared with those conducted under local anesthesia [3]; patients with prosthetic heart valves, immunodeficient patients, diabetic patients, and patients taking steroids are at an increased risk of bacteremia, and such patients require antibiotic prophylaxis [11]
We focused on how much bacteria that invaded from the upper airway to the lower airway during intubation was suppressed by long-term disinfection effect

Summary

Introduction

Nasotracheal intubation can potentially result in microbial contamination from the upper respiratory tract to the lower respiratory tracts. Nasotracheal intubation (hereafter referred to as “NTI”) is frequently necessary during dental, maxillofacial, and oropharyngeal surgeries. This method is useful while operating on patients with respiratory insufficiency, patients who require long-term maintenance of the airway in the intensive care unit and patients in whom orotracheal intubation is difficult because of trismus. Some complications associated with NTI include epistaxis [1, 2], bacteremia [3], retropharyngeal perforation [4], and partial or complete obstruction of the tube [5, 6]. Several effective preventive measures against epistaxis and retropharyngeal perforation have been reported [8,9,10], an effective disinfection method during NTI is yet to be determined. The disinfection of the nasal mucosa before nasal intubation is crucial for avoiding the contamination of respiratory organs by nasal microorganisms

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