Betadine Solution Research Articles

Comparing sterile bag rubbing and paint on technique in skin preparation of the hands

The aim of this study was to compare two techniques for surgical site skin preparation in hand surgery. We compared the standard sponge paint technique versus a plastic bag immersion technique using a 10% povidone-iodine with alcohol solution (Betadine, ORION Laboratories Pty Ltd, Balcatta,WA,Australia) to prepare surgical site skin for hand surgery. This sterile bag rubbing technique involves using a sterile plastic bag filled with 60 mL of Betadine solution to immerse the subjects' hand. Samples were taken from 10 subjects for bacteria colony-forming unit (CFU) counts before and 3 min after surgical site preparation in each group. Outcome measures were preparation time and CFU reduction with a plate impression test using commercially available agar slides. The sterile bag rubbing technique significantly reduced (P < 0.0001) the time required for surgical site skin preparation (28 s) compared with the standard technique (86 s). Both techniques were found to have similar efficacy in the reduction of CFU. The sterile bag rubbing technique is a quicker alternative method for surgical site preparation in hand surgery and has comparable efficacy to the widely practised standard paint-on technique.

Vaginal vault dehiscence with evisceration after total laparoscopic hysterectomy

Vault dehiscence and evisceration of peritoneal contents is a rare complication following total hysterectomy. A 43-yearold lady presented with history of something soft coming out per vaginum. She underwent total laparoscopic hysterectomy 2 months back for 16-week fibroid uterus. The surgery was uneventful, vaginal vault was sutured laparoscopically with no 1 polyglactin, interrupted figure of eight sutures. She was discharged after 48 h with uneventful recovery and subsequently presented with mass protruding per vaginum. Speculum examination showed loops of small bowel protruding in the vagina (Fig. 1). She was hospitalized and scheduled for reduction of the prolapsed bowel with vault repair. On examination under anaesthesia, there was complete dehiscence of the vaginal vault with loops of small bowel protruding through the defect. To maintain the pneumoperitoneum vagina was blocked using a simple vaginal tampon soaked in betadine solution (Fig. 2) [1]. On Laparoscopic evaluation the entire vault was deficient. There were no bowel, bladder or omental adhesions to the vault. The prolapsed ileal loops were seen just at the vault, with healthy pink colour and regular peristalsis. On giving Trendelenburg’s position the reposition was smooth. After confirming that the vault was free of any adhesions, the vault was closed vaginally using interrupted no 1 Polydioxone II sutures (Fig. 3). Patient was discharged on the third post-operative day and is asymptomatic at 6-month follow-up. Vaginal vault dehiscence with evisceration posthysterectomy can occur up to few weeks to even few years after hysterectomy. The commonest organ to eviscerate is small bowel, particularly terminal ileum. Several factors which may contribute to weakness of vaginal apex are poor surgical techniques, post-operative wound haematoma and cuff infection, post-menopausal status, any activity resulting in increased intra-abdominal pressure, early resumption of sexual activity, chronic steroid administration, history of previous radiotherapy in cases of radical hysterectomy [2] and systemic illness like diabetes mellitus and immunecompromised status [3].

The Influence of Perioperative Risk Factors and Therapeutic Interventions on Infection Rates After Spine Surgery

Systematic review. The objectives of this systematic review were to determine the patient and perioperative risk factors that contribute to infections after spine surgery and to examine the level of evidence to support the use of therapeutic interventions to reduce infection rates. Infection continues to be one of the most common and feared complications after spine surgery. As such, it is used as a sentinel event for quality assurance processes. It is clear that the causes of infections after spine surgery are multifactorial and numerous patient- and procedure-related factors have been proposed as contributory elements. In addition, numerous perioperative adjuncts have been suggested to reduce infection rates. A systematic review of the English-language literature (published between January 1990 and June 2009) was undertaken to identify articles examining risk factors associated with and adjunct treatment measures for preventing surgical-site infections. Two independent reviewers assessed the level of evidence quality using the Grading of Recommendations Assessment, Development, and Evaluation criteria, and disagreements were resolved by consensus. Of the 127 articles identified, 32 met the criteria to undergo full-text review. Individual patient, operative, and perioperative variables have been identified that are associated with increased infection rates (i.e., older age, obesity, diabetes, malnutrition, higher American Society of Anesthesiologists score, posterior approaches, and blood transfusions) but these variables have not been combined to provide individual patient risks based on a composite of factors (e.g., risk stratification). Of the surgical adjuncts investigated, only irrigation with dilute betadine solution showed moderate support for reducing infection rates. It is clear that the causes of postoperative spinal site infections are multifactorial and related to a complex interplay of patient and procedural influences. Because of these complexities, for any individual and surgical procedure, predictable infection rates likely exist that do not extrapolate to 0. Although we have identified factors associated with increased infection rates, further studies will be required to allow multifactorial risk stratification for individual patients and to further investigate the use of therapeutic adjuncts.

HS07 COMPARISON OF BETADINE PAINT AND PLASTIC BAG IMMERSION TECHNIQUES FOR SURGICAL SITE SKIN PREPARATION IN HAND SURGERY

Introduction: The aim of this study was to compare two techniques for surgical site skin preparation in hand surgery.Methods: We compared the standard sponge paint technique versus a plastic bag immersion technique using a 10% povidone iodine with alcohol solution (Betadine) to prepare surgical site skin for hand surgery. This plastic bag immersion technique involves using a sterile plastic bag filled with 60 ml of Betadine solution to immerse the subjects’ hand. Samples were taken from ten subjects for bacteria colony forming unit (CFU) counts before and three minutes after surgical site preparation in each group. Outcome measures were preparation time and CFU reduction with a finger impression test using commercially available agar slides.Results: The plastic bag immersion technique significantly reduced (p &lt; 0.0001) the time required for surgical site skin preparation (28 seconds) compared to the standard technique (86 seconds). Both techniques were found to have similar efficacy in the reduction of CFU.Discussion: The plastic bag immersion technique is a quicker alternative method for surgical site preparation in hand surgery and has comparable efficacy to the widely practiced standard paint‐on technique. This technique can be applied across the disciplines of orthopaedic, plastic and vascular surgery involving the hand.

Povidone–iodine (Betadine) solution: a simple protectant in surgical gloves

Povidone–iodine (Betadine) solution: a simple protectant in surgical gloves

SURGICAL TREATMENT IN TURTLE CLOACAL PROLAPSE

SUMMARY A seven years old turtle (Testudo hermani) was diag nosed with cloacal prolapse. General anesthesia was performed using ketamine 50mg/kg I.M. Induction time was 45 minutes. The prolapsed tissue was lavaged with ster ile saline solution and Betadine solution. Using a forceps all cloacal tissue was reposed in n ormal position. A continue suture with silk was applied at cloacal area. Complete recovery after general anesthesia was afte r 24 hours. All this time the turtle was kept in warm conditions (24 O C).

Accidental Burns During Surgery

The purpose of this report is to increase awareness of intraoperative burns during standard procedures, to discuss their possible causes and warning signs and to provide recommendations for prevention and procedures to follow after their occurrence. A total of 19 patients associated with intraoperative burn accidents were treated surgically and analyzed after a mean follow-up of 5 +/- 3.5 months. Review included retrospective patient chart analysis, clinical examination, and technical device and equipment testing. A total of 15 patients recently underwent cardiac surgery, and 4 pediatric patients recovered after standard surgical procedures. A total of 15 patients had superficial and 4 presented with deep dermal or full-thickness burns. The average injured TBSA was 2.1 +/- 1% (range, 0.5-4%). Delay between primary surgery and consultation of plastic surgeons was 4.5 +/- 3.4 days. A total of 44% required surgery, including débridment, skin grafting or musculocutaneous gluteus maximus flaps, and the remaining patients were treated conservatively. Successful durable soft-tissue coverage of the burn region was achieved in 18 patients, and 1 patient died after a course of pneumonia. Technical analysis demonstrated one malfunctioning electrosurgical device, one incorrect positioned neutral electrode, three incidents occurred after moisture under the negative electrode, eight burns occurred during surgery while fluid or blood created alternate current pathways, five accidents were chemical burns after skin preparation with Betadine solution, and in one case, the cause was not clear. The surgical team should pay more attention to the probability of burns during surgery. Early patient examination and immediate involvement of plastic and burn surgeons may prevent further complications or ease handling after the occurrence.

When the Bone Flap Hits the Floor

There is no published data in the neurosurgical literature describing the incidence, treatment, or outcome of contaminating a bone flap. We reviewed our departmental experience to determine methods of prevention and assess our treatment strategies. We retrospectively reviewed all incidents of dropped bone flaps during a craniotomy at a single medical center during a 16-year period. In addition, a questionnaire was mailed to neurosurgeons in the United States and abroad asking their own experience and method of management. Fourteen incidents of dropped bone flaps occurred during a 16-year period. Follow-up varied from 2 to 176 months. The bone flap was dropped while elevating the bone (n = 4), when handing the bone off the field (n = 4), and during plating (n = 4). The context was unknown in two cases. Management included soaking the flap in betadine and/or antibiotic solution (n = 8), autoclaving (n = 2), or discarding the bone flap and replacing with a mesh cranioplasty (n = 3). The treatment remains unknown in one case. No instances of infection were noted in follow-up. In response to the survey, 66% (33 out of 50) of the polled neurosurgeons had experienced this complication during their practice, and 83% would replace the bone flap after disinfection. Dropping a bone flap during neurosurgery remains an uncommon but preventable complication. Treatment options include discarding the bone followed by cranioplasty versus replacing the bone after treatment with antibiotic irrigation, betadine, and/or autoclaving. Replacement after disinfection is an appropriate option for contaminated bone flaps that avoids the expense and time of cranioplasty.

Efficacy of Dilute Betadine Solution Irrigation in the Prevention of Postoperative Infection of Spinal Surgery

Prospective, single-blinded, randomized study. To evaluate the efficacy of dilute betadine irrigation of spinal surgical wounds in prevention of postoperative wound infection. Deep wound infection is a serious complication of spinal surgery that can jeopardize patient outcomes and increase costs. Povidoneiodine is a widely used antiseptic with bactericidal activity against a wide spectrum of pathogens, including methicillin-resistant Staphylococcus aureus. The aim of this study was to evaluate the efficacy of dilute betadine solution in the prevention of wound infection after spinal surgery. Four hundred and fourteen patients undergoing spinal surgery were randomly assigned to two groups. In group 1 (208 patients), surgical wounds were irrigated with dilute betadine solution (3.5% betadine) before wound closure. Betadine irrigation was not used in group 2 (206 patients). Otherwise, perioperative management was the same for both groups. Mean length of follow-up was 15.5 months in both groups (range, 6-24 months). No wound infection occurred in group 1. One superficial infection (0.5%) and six deep infections (2.9%) occurred in group 2. The differences between the deep infection rate (P = 0.0146) and total infection rate (P = 0.0072) were significant between the two groups. Our report is the first prospective, single-blinded, randomized study to evaluate the clinical effectiveness of dilute betadine solution irrigation for prevention of wound infection following spinal surgery. We recommended this simple and inexpensive measure following spinal surgery, particularly in patients with accidental wound contamination, risk factors for wound infection, or undergoing surgery in the absence of routine ultraviolet light, laminar flow, and isolation suits.

Cervical pregnancy after in vitro fertilization and embryo transfer successfully treated with methotrexate and intracervical injection of vasopressin

Cervical pregnancy after in vitro fertilization and embryo transfer successfully treated with methotrexate and intracervical injection of vasopressin

Cervical pregnancy after in vitro fertilization and embryo transfer successfully treated with methotrexate and intracervical injection of vasopressin.

(2004). Cervical pregnancy after in vitro fertilization and embryo transfer successfully treated with methotrexate and intracervical injection of vasopressin. Acta Obstetricia et Gynecologica Scandinavica: Vol. 83, No. 1, pp. 112-114.

Betadine (povidone-iodine) is toxic to murine embryogenesis

Exposure of gametes or embryos to potential toxins at any point during the IVF cycle may have a detrimental effect on embryogenesis and consequent pregnancy rates. Developmental rates of a single-cell (1) and 2-cell (2) mouse embryo system have evolved into the standard bioassay used for quality control in clinical IVF laboratories (3). This system was used in the current study, designed to evaluate the in vitro effects of betadine on murine embryogenesis and to assess the potential embryo toxic effect of the common practice of painting the external introitus with betadine solution before starting ultrasound-guided oocyte retrieval.

Efficacy of Disinfectants for Sanitizing Boots Under Dairy Farm Conditions

Ampicillin-resistant Escherichia coli (AR-E. coli), suspended in a manure slurry, was placed on rubber and plastic boot material surfaces to determine survival time. In addition, rubber boots were immersed in the bacteria- manure slurry, placed in water, and then several disinfectants were applied to the boots to determine the bacterial kill time. In the second phase of the study, boots were contaminated with the bacteria-manure slurry, and plastic and concrete surfaces were walked on to determine how far the bacteria could be tracked.AR-E. coli was isolated from the surfaces of both rubber and plastic strips for up to one day after the strips were inoculated with in the AR-E. coli slurry, with the exception of rubber strips at the highest temperature tested. Alcohol and Roccal-D Plus appeared to be the most effective disinfectants used on rubber, followed by bleach. Betadine Solution, Nolvasan Solution and water showed similar efficacy. AR-E. coli could be isolated from boot tracks on plastic for nearly 400 ft (121.9 m) and from a concrete surface for up to 150 ft (47.7 m).Results of this study emphasize the importance of time and temperature on the ability of disinfectants to eliminate bacterial contamination in manure and supports the use of biosecurity Good Management Practices (GMP’s) to control the movement of potentially pathogenic bacteria on dairies.

The effect of lavage on intraabdominal cell burden.

Abdominal lavage is a common surgical practice, but few studies have been conducted to assess its efficacy at removing cells from the abdominal cavity, particularly during laparoscopic surgery. After three 12-mm trocars were inserted into six female 30-kg pigs at the umbilicus left and right iliac fossae, the abdomen was insufflated with carbon dioxide. The pelvis of each pigs was injected with 6 million radiolabeled LIM 1215 cells. Then the abdominal cavity was irrigated with either 500 ml 0.9% saline, 500 ml 10% betadine solution, or 1 L 0.9% saline. A maximum of 5 L of solution was used for each animal. The lavage fluid was suctioned into separate containers after each aliquot, and each container was measured for radioactivity. Significantly greater numbers of cells were removed by lavage by the first to third lavage cycle; however, after four lavage cycles, relatively few cells were removed by each further cycle. No difference was observed between 500-ml and 1-L aliquots. Additionally, the mechanical efficacy of 0.9% saline and 10% betadine solution appeared similar. These findings suggest that optimal lavage consists of four irrigation/suction cycles utilizing 500-ml aliquots.

A new, water-resistant, film-forming, 30-second, one-step application iodophor preoperative skin preparation

Background: A 1-step, film-forming iodophor preoperative skin preparation, Prevail-Fx, was developed. It forms a water-resistant film once dried on skin. To evaluate the partially water-soluble formulation, the testing method was validated with spore-challenge techniques and the efficacy was studied microbiologically and chemically. The importance of method validation and the presence of free iodine as criteria for product evaluation of partially water-soluble or water-insoluble skin preparations are discussed. Methods: The test methods outlined in the Federal Register, 21 CFR Parts 333 and 369 (Monograph), were used. Twenty-five American Type Culture Collection (Rockville, Md) species of organisms and 25 correspondent clinical isolates were tested in vitro. FDA In the clinical studies, the skin normal flora of the inguinal and abdominal sites were evaluated in a 30-second, single-step application. Betadine (Purdue Frederick Co, Norwalk, Conn) on scrub (7.5%) and Betadine solution (10%) were tested as controls in a 5-minute, 2-step application. Results: Prevail-Fx solution showed a broad spectrum in a minimum inhibitory concentration test. It delivered rapid bactericidal activity in a time-kill test, reducing 5 to 6 log of challenging organism in 3 minutes, as required by the Federal Drug Administration (FDA). In an in vivo clinical test with a single-step, 30-second application, Prevail-Fx effectively reduced greater than 4 log or greater than 3 log of normal skin flora in inguinal and abdominal testing sites, respectively. The bacterial levels remained significantly less than the baseline for 6 to 24 hours. These results meet and exceed the Federal Drug Administration's requirements. The efficacy of Prevail-Fx in a 30-second, single application is as effective as Betadine scrub and Betadine solution applied in a traditional 5-minute, 2-step scrubbing and painting. Conclusion: The Prevail-Fx film-forming formulation delivered rapid antimicrobial activity against a broad spectrum of micro-organisms in vitro and a rapid, persistent bactericidal activity in vivo in a 30-second, 1-step application against normal skin flora. This study also found that the spore-challenge validation of the testing methods and the evidence of free iodine are 2 indispensable criteria for the efficacy evaluation of the film-forming iodophor skin preparations. (Am J Infect Control 2001;29:370-6.)

Betadine (povidone-iodine) is toxic to murine embryogenesis.

Objective: Exposure of gametes or embryos to potential toxins at any point during the IVF cycle—from vaginal egg retrieval to embryo transfer—may have a detrimental effect on embryogenesis and consequent pregnancy rates. Toxicity testing of a wide range of such factors, among which are: vaginal-disinfecting solutions; media; disposable equipment and ambient air, is the backbone of any stringent quality control program in IVF. Developmental rates of a single-cell and two-cell mouse embryo system have evolved into the “gold-standard” of quality control for IVF. This system was utilized in the current study, designed to assess the potential embryo toxic effect of the common practice of painting the external introitus with betadine solution prior to commencing ultrasound-guided oocyte retrieval.

Povidone-iodine related burns

Skin preparation burns associated with chemical agents are uncommon. They occur most frequently in patients placed in the lithotomic position undergoing gynaecologic or urologic operations, the burn being on the buttocks, and in those undergoing orthopaedic operations, the burn being on the extremities and under a tourniquet. The basic mechanism involves irritation coupled with maceration and pressure. If the betadine solution has not been allowed to dry and has been trapped under the body of the patient in a pooled dependent position, such as the buttocks or under a tourniquet, the solution may irritate the skin and result in a skin burn. The irritation coupled with pressure leads to a situation analogous to that seen in the development of an acute accelerated decubitus ulcer; irritation, maceration, friction and pressure compounding each other to result in a skin burn or superficial ulcer in the skin. Our experience with three illustrative patients who presented with various burns following exposure to povidone-iodine (betadine) is described below.

A comparison of chlorhexidine and povidone-iodine skin preparation for surgical operations

The purpose of this study was to determine if 2 paints of chlorhexidine as a skin preparation was as effective as a 5-minute povidone-iodine scrub followed by 2 paints of Betadine solution (Betadine solution, povidone-iodine 10% equal to 1% available iodine; Purdue Frederick, Norwalk, Connecticut). In the first trial involving 10 volunteers, one side of the back was painted with 2 coats of chlorhexidine and the other side of the back was scrubbed with povidone-iodine for 5 minutes, left to dry, and then painted with Betadine. Cultures were obtained using the membrane filter adsorption method before the skin preparation and at 30, 60, and 120 minutes after the preparation. In the second trial, both the Betadine and chlorhexidine paints were dried. Bacterial counts were then obtained at 48 hours. There was no difference between the number of colonies cultured from the povidone-iodine/Betadine compared with the chlorhexidine skin preparation. This finding suggests that chlorhexidine is as effective as 5 minutes of povidone-iodine scrub with 2 paints of povidone-iodine solution.

Difficult Airway Management in a Patient with Traumatic Asphyxia

Difficult Airway Management in a Patient with Traumatic Asphyxia

Toxic Effects of Wound Irrigation Solutions on Cultured Tibiae and Osteoblasts

Irrigating wounds with solutions of antiseptic or antibiotic agents is routinely performed in orthopaedic surgery to reduce the incidence of microbial infection. The effects of these agents on healthy bone tissue is unknown. Three commonly employed antiseptic agents (hydrogen peroxide, Betadine solution, Betadine scrub) and one antibiotic solution (bacitracin) were tested on tibiae and osteoblasts isolated from embryonic chicks. Osteoblast function was evaluated by glycolytic energy metabolism (lactate production), cell number (DNA content), and collagen synthesis ([3H]proline hydroxylation). Two series of experiments were performed. To study concentration-related effects, tibiae or cells were exposed to a range of concentrations of the agents (diluted in saline, 0.9% NaCl) for 2 min, rinsed with saline, and incubated for 24 h in medium containing [3H]proline. For the recovery study, the cells were exposed to an effective, but nonlethal, concentration of the antiseptic agents for 2 min, rinsed with saline, and the incubation was continued in complete culture medium for 6, 12, 24, 48, or 72 h with [3H]proline added for the final 6 h. Solutions containing the antiseptic agents were cytotoxic to both bones and cells at concentrations well below those used clinically in irrigation solutions. In contrast, bacitracin at the concentrations tested was safe for osteoblasts and tibiae. These results suggest that the use of irrigation solutions containing H2O2, Betadine solution, or Betadine scrub on exposed bone tissue should be considered with caution.