Povidone-iodine Research Articles

BD Chloraprep™ (“2 % chlorhexidine with 70 % isopropyl alcohol”) versus povidone iodine plus alcohol, for prevention of blood culture contamination at children: An investigator-initiated, open-label, single centre, randomized controlled trial

IntroductionOne of the important problems that lower the diagnostic value of blood culture is contamination with skin organisms. The povidone-iodine, alcohol, and chlorhexidine gluconate alcohol are used for disinfection prior to blood sampling for culture. MethodsThe investigator-initiated, open label, single centre, randomised trial compared blood culture contamination rates between two groups of patients in which using a povidone iodine skin-preparation process with the contamination rate for using “2 % chlorhexidine with 70 % isopropyl alcohol” skin-disinfection. The patients who required sampling for blood cultures were included in the study and study period was from 15 March 2023 to 15 July 2023. ResultsA total of 400 blood cultures were obtained during the study, including 133 in the study group and 267 in the control group. In the total blood cultures, 11.75 % (n = 47) had microorganism isolation. Among them 39 (9.75 %) were contaminants and 8 (2 %) of them were true pathogens. The contaminant microorganisms were as following; 34 coagulase-negative Staphylococci, 3 Micrococcus spp, and 2 Streptococci viridans. The blood culture contamination rate in the study group was 5.3 % (n = 7) and 12.0 % (n = 32) in the control group, and significantly lower in the study group (p = 0.033). There is no significant difference regarding skin related side effects between two groups. ConclusionsThis study, showed that 2 % chlorhexidine gluconate in 70 % isopropyl alcohol is more efficacious in children than 10 % povidone-iodine preparations for disinfecting the skin prior to blood specimen collection for prevention of blood culture contamination.

Effect of herbal mouthrinsein dental ultrasonic scalers among Indians.

The use of herbal mouthrinse is gaining momentum in recent years. Therefore, it is of interest to evaluate the effect of 2 herbal mouthrinse (curcumin, cinnamon) in comparison with2 conventional mouthrinse (povidone iodine, chlorhexidine) when used as coolant in dental ultrasonic scalers. Hence, 200 participants were included in this study. Analysis of gingival index, periodontal index at baseline and one month follow up was completed. The inhibitory effects of both conventional and herbal mouth rinse in gingival health are similar. However, cinnamon and curcumin owing to its minimal adverse effects and low cost is useful as an alternative to chlorhexidine for reducing bacterial load in dental aerosols produced due to ultrasonic scalers.

The stability of Staphylococcal bacteriophages with commonly used prosthetic joint infection lavage solutions.

The aim of this study was to assess the viability of four Staphylococcal bacteriophages when exposed to different concentrations of commonly used lavage solutions in the surgical treatment of prosthetic joint infections (PJI). Four tailed Staphylococcal bacteriophages and six different lavage solutions (chlorhexidine 4%, hydrogen peroxide 3%, acetic acid 3%, povidone iodine 10%, sodium hypochlorite 0.5%, and Vashe solution) at 100%, 1%, and 0.01% concentrations were used in this experiment. In addition, the temporal impact of exposing bacteriophages to these lavage solutions was also evaluated at 5-min exposures and 24-h exposures. The results show that the titers of the four bacteriophages were statistically significantly decreased for all lavage solutions (100% and 1%) at 5-min exposures and 24-h exposures. However, with 0.01% concentrations of the lavage solutions, only acetic acid caused a statistically significant decrease in bacteriophage titers compared to normal saline control. Our findings suggest that tailed Staphylococcal bacteriophages do not remain stable in high concentrations of the most commonly used lavage solutions. However, at very dilute concentrations the bacteriophages do remain viable. This has important clinical ramifications in that it shows when using bacteriophage therapy for PJI it is critical to thoroughly wash out any lavage solutions before the introduction of therapeutic bacteriophages especially when acetic acid is used.

TRANSCONJUNCTIVAL ENUCLEATION OF PROLAPSE BULBUS OCULI SINISTRA IN A FEMALE PERSIAN CAT

A Persian cat named Mochi, one and a half years old, female and not yet sterilized, experienced a condition where her eyeballs popped out of the orbital cavity due to trauma from fighting. Based on the history and results of physical examination, the animal was diagnosed with left bulbus oculi prolapse with an infausta prognosis. The action taken to handle this case is the transconjunctival enucleation operation of the bulbus oculi sinistra which aims to remove blind and sick eyes as a last option when the disease cannot be cured with drug therapy. Postoperative systemic therapy by giving the antibiotic cefotaxime injection at a dose of 0.65 mg, via intravenous (IV), given twice a day for three days, then followed by oral antibiotic cefixime trihydrate at a dose of 25 mg, given twice daily for five days to prevent secondary infection. Analgesic and anti-inflammatory tolfenamic acid was given at a dose of 0.26 mg, by subcutaneous (SC), given once a day for five days. In addition, the oral vitamin Livron B.plex® is given as much as one tablet per day, given for seven days. The surgical wound was also cleaned using chlorhexidine, then smeared with Bioplacenton® ointment containing placenta extract 10% neomycin sulfate, applied sufficiently to the surgical wound at intervals of twice a day and also applied povidone iodine once a day until the wound dries. The process of recovering animals after enucleation surgery takes 10 days and shows good wound healing results and conditions. After treatment, it is necessary to routinely examine the suture wound and provide Elizabeth's collar so that the stitches are not scratched.

Preoperative vaginal wash with povidone iodine solution to reduce post caesarean infectious morbidity

Post-operative infection is frequently seen in Caesarean section. Vaginal wash with 10% povidone iodine & Antibiotic prophylaxis may have significant impact in reduction of infections and thus the need to study their roles in sepsis prevention systematically.

Association between vaginal microbiome alteration and povidone iodine use during delivery

BackgroundThe vaginal microbiome is a dynamic community of microorganisms in the vagina. Its alteration may be influenced by multiple factors, including gestational status, menstrual cycle, sexual intercourse, hormone levels, hormonal contraceptives, and vaginal drug administration. Povidone iodine has been used before delivery to reduce infection that may be caused by the ascendance of pathogenic and opportunistic bacteria from the vagina to the uterus. This study aimed to elucidate the impact of povidone iodine use during delivery on the vaginal microbiome.MethodsThis study enrolled a total of 67 women from maternity services in three hospitals. During the delivery process, we have applied povidone iodine in three doses such as low dose, medium dose, and high dose based on the amount of povidone iodine administered, thus, we studied the three groups of women based on the doses applied. Vaginal swab samples were collected both before and immediately after delivery, and the microbial communities were characterized using 16 S rRNA sequencing. The identification of differentially abundant microbial taxa was performed using ZicoSeq software.ResultsBefore delivery, the vaginal microbiome was dominated by the genus Lactobacillus, with different percentage observed (86.06%, 85.24%, and 73.42% for the low, medium, and high dose groups, respectively). After delivery, the vaginal microbial community was restructured, with a significant decrease in the relative abundance of Lactobacillus in all three groups (68.06%, 50.08%, and 25.89%), and a significant increase in alpha diversity across all 3 groups (P < 0.01). Furthermore, as the dose of povidone iodine used during delivery increased, there was a corresponding decrease in the relative abundance of Lactobacillus (P < 0.01). Contrary, there was an increase in microbial diversity and the relative abundances of Pseudomonas (0.13%, 0.26%, and 13.04%, P < 0.01) and Ralstonia (0.01%, 0.02%, and 16.07%, P < 0.01) across the groups. Notably, some functional metabolic pathways related to sugar degradation were observed to have significant change with increasing use of povidone iodine.ConclusionPovidone iodine was associated with the vaginal microbiome alterations after parturition, and its significant change was associated to the dosage of povidone iodine administered. The escalation in iodine dosage was linked to a decrease in Lactobacilli abundance, and elevated prevalence of Pseudomonas and Ralstonia. There is a need for longitudinal studies to clearly understanding the effect of povidone iodine use on maternal and infant microbiome.

Fabrication of innovative wound exudates dissolvable electrospun povidone-iodine loaded poly (Ɛ-caprolactone)-poly (ethylene oxide) composite nanofiber mat based wound bandages

Changing of bandage when nursing chronic wounds is a necessary exercise that encourages effective wound healing but often the bandage gets stuck to the wound, making changing it painful and uncomfortable. Furthermore, most of the wound medicine that is usually smeared on the bandage gets thrown away with the removed bandage unused. To deal with these challenges, we fabricated an innovative, dissolvable, drug releasing bandage based on electrospun povidone iodine (pvpi) blended poly (Ɛ-caprolactone), PCL-poly (ethylene oxide), PEO, composite nanofiber mats. From the experiments, smooth, yellow coloured nanofiber mats of calculated average fiber diameters of 341 nm were obtained from electrospinning an optimized 80:20 (v/v) PCL: PEO composite solution, blended with an optimized quantity of pvpi acting as model medicine incorporated in the structure of the nanofiber mats. From the performance evaluation results, the electrospun composite nanofiber mats excelled in releasing over 50% of the loaded pvpi over prolonged drug release time of 210 min which compared well with 200 min we reported in our previous work. Additionally, the composite nanofiber mats proved to be hydrophilic, influenced by the incorporation of the hydrophilic pvpi and PEO within the composite mats. Furthermore, the nanofiber mats gradually dissolved in phosphate-buffered saline (PBS), that was employed as wound exudate mimic, just under 24 h qualifying them as wound exudates-dissolvable nanofiber bandages that could revolutionize the bandage history and make wound care management free from bandage changes as well as totally removing medicine wastage during bandage changing and improving medicine efficacy during wound dressing.&#x0D; Keywords: Chronic wounds, Wound exudates, Electrospinning, Polymer composite nanofibers, Electrospun nanofiber bandages, Innovative drug delivery bandages, Dissolvable nanostructured bandages

EFEKTIFITAS PREPARASI KULIT MENGGUNAKAN KLORHEXIDIN 7,5% SETRIMID 15%-POVIDON IODIN 10% DAN POVIDON IODIN 10%-ALKOHOL 70% TERHADAP INFEKSI LUKA OPERASI SEKSIO SESAREA DI RSUD DR. HARYOTO LUMAJANG

Surgical wound infections are the second most common cause of nosocomial infections and have high morbidity and mortality rates. The use of antiseptic skin preparations is effective in preventing surgical wound infections. There is still insufficient evidence to evaluate the type, concentration and method of use of antiseptic agents for skin preparation in cesarean section. The aim of the study was to determine the effectiveness of skin preparation using chlorhexidine 7.5%, cetrimide 15%-povidone iodine 10% and povidone iodine 10%-alcohol 70% against Wound Infections for Caesarean Section Operations in RSUD Dr. Haryoto Lumajang.&#x0D; The research design used is quantitative research with a quasi-experimental approach, post test only-control group design. The population in this study were patients who underwent cesarean section at RSUD Dr. Haryoto Lumajangl. The sample was selected by accidental sampling from 27 February 2023 to 25 March 2023, and 66 respondents were found who met the inclusion and exclusion criteria. The samples were divided into 2 groups: the test group (33 samples) received a combination skin preparation of 7.5% chlorhexidine, setrimide 15% - 10% povidone iodine and the control group (33 samples) received a skin preparation combination of 10% povidone iodine - 70% alcohol . Observation of the surgical wound was carried out on day 3 and day 10.&#x0D; The results of this study indicated that there was no incidence of surgical wound infection on the third day. Surgical wound infections on the 10th day in the 7.5% chlorhexidine skin preparation group, setrimide 15% - 10% povidone iodine by 2 respondents and in the 10% povidone iodine skin preparation group - alcohol by 4 respondents. But statistically it was not significantly different from the value of p = 0.395, meaning that Ho was accepted and Ha was rejected, so there was no significant difference between skin preparation using chlorhexidine 7.5% setrimide 15% - 10% povidone iodine and 10% povidone iodine - 70% alcohol on the Incidence of Wound Infection by Caesarean Section at RSUD Dr. Haryoto Lumajang.&#x0D; With the difference in the incidence of surgical wound infection, it can be considered and an alternative for Dr. Haryoto Lumajang to use skin preparation using 7.5% chlorhexidine, 15% setrimide-10% povidone iodine&#x0D; Keywords: Surgical wound infection, skin preparation, chlorhexidine, povidone iodine, alcohol, cesarean section.

Development of Thermoreversible In-situ gel containing copper ions to cure moderate skin burns

The primary goal of treating burns that are deep and widespread and where the dermis layer has been damaged. And the natural ability of spontaneous re-epithelialization has been severely compromised or eliminated, is wound closure. Burn victims experience mental suffering because of the scarring that arises from their functional and cosmetic damage. Iodine's primary purpose in wound treatment is as an antibacterial agent. For many decades, povidone iodine has been used and studied in wound healing. Copper oxide- based wound dressings accelerate wound healing through angiogenesis, regeneration, and antibacterial qualities. With its powerful antibacterial capabilities, copper is a vital mineral that is important for many physiological and metabolic processes, including angiogenesis, skin production, expression, and stability of extracellular skin proteins. These two characteristics work together to make copper a desirable mineral for enhancing skin wellbeing. As a result, when copper oxide is added to standard items, the result is an improved product. Several compositions for Gel made of poloxamer (p188) and poloxamer(p407). Poloxamer Gels (TPGEL) are excellent thermosensitive polymers for topical application because they exist as low-viscosity liquids at ambient temperature but as Gels at body temperature.

Review of Intra-Articular Use of Antibiotics and Antiseptic Irrigation and Their Systematic Association with Chondrolysis.

Intra-articular antibiotics have been proposed as a treatment for septic arthritis to allow for high local concentrations without subjecting a patient to the toxicity/side effects of systemic therapy. However, there is concern for chondrotoxicity with intra-articular use of these solutions in high concentrations. The purpose of this systematic review was to evaluate the intra-articular use of antibiotics and antiseptic solutions, and to determine their association with chondrolysis following in vitro or in vivo administration. A systematic review was conducted following PRISMA guidelines through PubMed, Clinical Key, OVID, and Google Scholar. Studies in English were included if they evaluated for chondrotoxicity following antibiotic exposure. The initial search resulted in 228 studies, with 36 studies meeting criteria. These 36 studies included manuscripts that studied 24 different agents. Overall, 7 of the 24 (29%) agents were non-chondrotoxic: minocycline, tetracycline, chloramphenicol, teicoplanin, pefloxacin, linezolid, polymyxin-bacitracin. Eight (33%) agents had inconsistent results: doxycycline, ceftriaxone, gentamicin, vancomycin, ciprofloxacin, ofloxacin, chlorhexidine, and povidone iodine. Chondrotoxicity was evident with 9 (38%) agents, all of which were also dose-dependent chondrotoxic based on reported estimated half maximal inhibitory concentrations (est. IC50): amikacin (est. IC50 = 0.31-2.74 mg/mL), neomycin (0.82), cefazolin (1.67-3.95), ceftazidime (3.16-3.59), ampicillin-sulbactam (8.64 - >25), penicillin (11.61), amoxicillin (14.01), imipenem (>25), and tobramycin (>25). Additionally, chondroprotective effects of doxycycline and minocycline were reported. This systematic review identified agents that may be used in the treatment of septic arthritis. Nine agents should be avoided due to their dose-dependent chondrotoxic effects. Further studies are needed to clarify the safety of these medications for human intra-articular use.

Comparison Between Chlorhexidine Gluconate and Povidone Iodine In Preventing Surgical Site Infection In Laparoscopic Cholecystectomy

Surgical site infection is one of the major postoperative complication resulting in an increase in both morbidity and mortality of the patient. Preoperative patients body surface preparation is one of the major factors in preventing surgical site infection. In this study we compared povidone iodine usually used disinfectant with chlorhexidine gluconate for surgical site infection&#x0D; MATERIALS &amp; METHODS&#x0D; It was a cross sectional study conducted at General Surgery ward Gulab Devi Hospital Lahore from January 2021 to December 2022. A total of 200 patients undergoing laparoscopic cholecystectomy were included in this study through purposive sampling and then divided into two groups using lottery methods. In Group A peroperative patients skin preparation was done with 10% povidone iodine while in Group B 4% chlorhexidine gluconate was used for skin preparation. Patients with empyema gall bladder, gall bladder or gut perforation and laparoscopic procedures converted to open were excluded from this study.&#x0D; RESULTS&#x0D; In this study mean age of 45.8 ± 10.3 years with range from 25 to 65 years. In Group A mean age was 45.7 ± 10.8 years while in group B it was 45.8 ± 9.8 years. In Group A 12% wound infection was documented while in Group B it was only 4% (P-value 0.03).&#x0D; CONCLUSION&#x0D; Many antiseptic solutions are used for patient skin preparation before surgery which includes chlorhexidine gluconate, povidone iodine and alcohol. Among these solutions povidone iodine solution is commonly used. In our study we compared povidone iodine with chlorhexidine gluconate solution which showed less surgical site infection which shows chlorhexidine gluconate solution can be safely replaced with povidone iodine solution for skin preparation.

Wound Healing Potentials of Methanolic Leaf Extract of &lt;i&gt;Piliostigma thonningii&lt;/i&gt; Schum

Philostigma thonningii (Schum.) is used in many parts of West Africa including Kebbi State, Nigeria for the management of wounds, chronic ulcers, gastric heart pain, and headache. It has been estimated that nearly 6 million people suffer from chronic wounds worldwide. This study aimed to investigate the wound healing activity of Philostigma thonningii leaves. The air-dried powdered leaves were extracted by maceration in methanol to obtain a crude methanolic extract (CME). The CME was screened phytochemically, then prepared into 2.5, 5 and 10% CME ointment by fusion before subjecting to wound healing assay using the wound excision model in Wister albino rats. The results showed a non-dependent dose healing effect owing to CME ointment since wound contraction at 2% and 5% CME treatment yielded higher percent contraction compared to that of 10% maximum dose administered. Comparatively, the treatment groups with CME showed better wound closure and re-epithelization of tissue repair and fibroblast in the granulation tissue formation than those in the untreated group of the negative control (in Group I, DW). However, the animals treated with 5% povidone iodine, PI (in Group II, Standard), showed a better wound contraction and arrangement of granulated tissue repair than those of both the CME treated group and the DW groups in the experiment. Consequently, there was no significant difference (p &gt; 0.05) observed between wounds treated with CME (2.5, 5 and 10) % of P. thonningii leaves, except the standard treatment group with 5% PI, which showed significantly (p&lt;0.05) wound healing activity. Conclusively, the observed wound healing activity of P. thonningii leaves may be attributed to a single or a synergistic effect of phytochemical constituents. The findings have also justified the traditional medicinal uses of P. thonningii leaves for the management of wounds.

Assessment regarding dental practitioners’ knowledge, attitude, and practices towards pre-procedural mouth rinse during COVID-19 pandemic – A cross-sectional study in Tamil Nadu

Objectives: Evolving strains of SARS-CoV-2 causing the COVID-19 disease has challenged the scientific world in limiting the disease and curbing the pandemic. Several factors such as increased salivary viral load in COVID-infected patients, procedures generating aerosols put the dental professionals at high risk of acquiring the disease. The present study aims to assess the knowledge, attitude and practices regarding the use of pre-procedural mouth rinse among the dental practitioners in Coimbatore. Material and Methods: A descriptive, cross-sectional study was conducted among dental practitioners in Coimbatore using a pre-validated questionnaire which comprised of sections interrogating knowledge, awareness, and practice of the use of pre-procedural mouth rinse in dental setup. One hundred and twenty-five dental practitioners in Coimbatore responded to the questionnaire. Results: Assessment of knowledge regarding the effectiveness of pre-procedural mouthwashes in reducing the bacterial and viral load was 97%. About 89% of dental practitioners were aware of the superior antimicrobial properties of Povidone Iodine in comparison with Chlorhexidine. Only 65% of dental practitioners used pre-procedural mouthwashes in practice. Conclusion: There is high inquisitiveness among dental practitioners in acquiring knowledge regarding preventive measures for SARS-CoV-2 alike the use of pre-procedural mouth rinses in reducing the viral load in COVID-19 infected patients. Although there is high awareness, there exists reluctance in implementing the knowledge acquired in real practice.

Antimicrobial Mouthwashes: An Overview of Mechanisms—What Do We Still Need to Know?

This narrative literature review is the first in a 6-section supplement on the role of mouthwashes in oral care. This introduction briefly summarises current knowledge on antimicrobial mechanisms, relating to some of the most common over-the-counter mouthwash products available worldwide: chlorhexidine, hydrogen peroxide, cetylpyridinium chloride, povidone iodine, and essential oils. The aim of this first article is to describe how mouthwashes "kill" pathogenic microbes when used adjunctively and thus provide a basis for their widespread use to manage key oral diseases, namely caries, gingivitis, and periodontal disease. This article therefore sets the scene for subsequent, more detailed exploration of mouthwashes regarding their clinical effectiveness, impact on the oral microbiome, and possible effects on systemic health as well as natural alternatives and future directions. Other than the clinical effectiveness (for certain agents) of mouthwashes, on many topics there remains insufficient evidence for systematic review or formulation of robust national guidelines. The supplement, therefore, compiled by an international task team, is aimed at general dental practitioners across the globe, as an easy-to-read guide for helping to advise patients on mouthwash use based on the current best available evidence.

Chronological changes in the rate of surgical field contamination in the shoulder joint

BackgroundIn shoulder surgery, low-virulence bacteria such as Cutibacterium acnes and coagulase-negative staphylococci can cause postoperative infection. However, the degree of sterility during surgery after disinfection is not known, and the efficacy of double skin preparation for such bacteria is unclear. This study aimed to evaluate chronological changes in the surgical field contamination rate in the shoulder joint and to compare single and double skin preparation. MethodsIn total, 126 shoulders in 121 patients undergoing shoulder surgery (64 men, 62 women; mean age 64 years) were enrolled. Patients were divided into two groups: single skin preparation, where the site was painted with 10% povidone iodine, and double skin preparation, where the site was treated with 1% chlorhexidine gluconate/83% isopropyl alcohol and painted 10% povidone iodine. Swab samples from the axillary and proximal areas in the surgical field were collected chronologically before starting surgery and at 30, 60, and 120 min after starting surgery (MAS). The contamination rate of each sample was compared and detected species were evaluated. ResultsThe contamination rate for the axillary area was 48.4%, 85.9%, 95.3%, and 97.1% in the single-preparation group and 32.3%, 72.6%, 87.1%, and 91.2% in the double-preparation group before starting surgery and 30, 60, and 120 MAS, respectively, and that the proximal area was 12.5%, 26.6%, 29.7%, and 35.3% in the single-preparation group and 16.1%, 19.4%, 27.4%, and 38.2% in the double-preparation group, respectively. Significant differences were not seen between the groups by area or time point. Most detected species were Cutibacterium acnes and coagulase-negative staphylococci. ConclusionsThe incidence of surgical field contamination in shoulder joint was high from immediately after starting surgery. In the axillary area, the contamination rates exceeded 70% from 30 MAS in both groups. Measures against infection should be instituted considering these findings when performing shoulder surgery.

Povidone Iodine Intrarectal Cleaning versus Formalin Needle Disinfection for Minimizing Transrectal Prostate Biopsy-related Infections

Background: A most feared complication of transrectal prostate biopsy is post-biopsy infection and/or sepsis. Safe intraprocedural measures that complement the antibiotic prophylaxis are intrarectal povidone iodine instillation or formalin needle disinfection after every core of the biopsy. Both are more effective at preventing post-biopsy infection than performing antibiotic prophylaxis alone. Objective: To assess the effectiveness of povidone-iodine intrarectal cleaning and formalin needle disinfection to prevent infection after prostate biopsy. Methodology: This study was conducted from July 2021 to June 2022 with 90 patients who underwent prostate biopsy at NIKDU. Patients were randomized into 2 equal groups, 45 in each group, by lottery. Two groups were Group-F: Standard biopsy, where the needle is disinfected with 10% formalin after each core, and Group-P: intrarectal luminal instillation of 10 ml 10% povidone-iodine for 10 min before the biopsy. Endpoint of the study was the development of signs and symptoms of infection within 7 days of prostate biopsy. Result: In terms of age, S. PSA &amp; prostate volume, there was no significant difference between the two group. Infective complications within 7 days of the prostate biopsy were observed in 14 patients (15.6%), 3.67 times more in Group-F patients (p=0.03), and a higher incidence of UTI (72.73%) was observed in Group-F (p=0.03) than Group- P patients. The incidence of septicemia, epididymal-orchitis, and acute prostatitis was not statistically significant between the two groups. E. coli was the predominant organism found on urine culture, followed by Klebsiella pneumoniae, Enterococcus faecalis, and proteus species. Conclusion: Along with prophylactic antibiotics, povidone iodine intrarectal cleaning is superior to formalin needle disinfection in preventing infective complications of prostate biopsy. Bangladesh J. Urol. 2022; 25(2): 80-83

Decolonization in Nursing Homes to Prevent Infection and Hospitalization

BackgroundNursing home residents are at high risk for infection, hospitalization, and colonization with multidrug-resistant organisms.MethodsWe performed a cluster-randomized trial of universal decolonization as compared with routine-care bathing in nursing homes. The trial included an 18-month baseline period and an 18-month intervention period. Decolonization entailed the use of chlorhexidine for all routine bathing and showering and administration of nasal povidone–iodine twice daily for the first 5 days after admission and then twice daily for 5 days every other week. The primary outcome was transfer to a hospital due to infection. The secondary outcome was transfer to a hospital for any reason. An intention-to-treat (as-assigned) difference-in-differences analysis was performed for each outcome with the use of generalized linear mixed models to compare the intervention period with the baseline period across trial groups.ResultsData were obtained from 28 nursing homes with a total of 28,956 residents. Among the transfers to a hospital in the routine-care group, 62.2% (the mean across facilities) were due to infection during the baseline period and 62.6% were due to infection during the intervention period (risk ratio, 1.00; 95% confidence interval [CI], 0.96 to 1.04). The corresponding values in the decolonization group were 62.9% and 52.2% (risk ratio, 0.83; 95% CI, 0.79 to 0.88), for a difference in risk ratio, as compared with routine care, of 16.6% (95% CI, 11.0 to 21.8; P<0.001). Among the discharges from the nursing home in the routine-care group, transfer to a hospital for any reason accounted for 36.6% during the baseline period and for 39.2% during the intervention period (risk ratio, 1.08; 95% CI, 1.04 to 1.12). The corresponding values in the decolonization group were 35.5% and 32.4% (risk ratio, 0.92; 95% CI, 0.88 to 0.96), for a difference in risk ratio, as compared with routine care, of 14.6% (95% CI, 9.7 to 19.2). The number needed to treat was 9.7 to prevent one infection-related hospitalization and 8.9 to prevent one hospitalization for any reason.ConclusionsIn nursing homes, universal decolonization with chlorhexidine and nasal iodophor led to a significantly lower risk of transfer to a hospital due to infection than routine care. (Funded by the Agency for Healthcare Research and Quality; Protect ClinicalTrials.gov number, NCT03118232.)

Povidone-iodine intra-abdominal irrigation versus no irrigation in pediatric perforated appendicitis: A secondary economic analysis of a Bayesian randomized controlled trial

BackgroundA pilot randomized controlled trial (RCT) conducted in children (2–17 ​y) with perforated appendicitis demonstrated an 89% probability of reduced intra-abdominal abscess (IAA) rate with povidone-iodine (PVI) irrigation, compared with no irrigation (NI). We hypothesized that PVI also reduced 30-day hospital costs. MethodsWe conducted a retrospective economic analysis of a pilot RCT. Hospital costs, inflated to 2019 U.S. dollars, were obtained for index admissions and 30-day emergency visits and readmissions. Cost differences between groups were assessed using frequentist and Bayesian generalized linear models. ResultsWe observed a 95% Bayesian probability that PVI reduced 30-day mean total hospital costs ($16,555 [PVI] versus $18,509 [NI]; Bayesian cost ratio: 0.90, 95% CrI, 0.78–1.03). The mean absolute difference per patient was $1,954 less with PVI (95% CI, -$4,288 to $379). ConclusionsPVI likely reduced the IAA rate and 30-day hospital costs, suggesting the intervention is both clinically superior and cost saving.

The Inflammatory and Cytological Effect of Repeated Povidone-Iodine Application in Patients Receiving Intravitreal Injections.

To investigate the effect of repeated povidone-iodine (PVI) application on the ocular surface parameters of patients who received intravitreal injections. In this prospective study, 52 eyes of 52 patients with age-related macular degeneration who underwent unilateral intravitreal injection at least three times in the last 1 year (intravitreal injection [IVI] group), 52 fellow eyes with no previous intravitreal injection (NIVI group), and 51 eyes of 51 healthy subjects (control) were included. Tear break-up time (TBUT), the Schirmer test, the Oxford staining score, the Ocular Surface Disease Index questionnaire, conjunctival impression cytology, and tear inflammatory cytokine levels (interleukin [IL]-1β and IL-6) were analyzed in all participants. The IVI group had lower TBUT and higher Oxford staining score than the NIVI and control groups ( P <0.05). No significant difference was found between the groups in the Schirmer test ( P =0.161). Conjunctival impression cytology analysis revealed that the IVI group had a significantly lower goblet cell count and significantly higher Nelson staging result than the NIVI and control groups ( P <0.05). As a result of tear cytokine analysis, although IVI and NIVI groups had higher IL-1β and IL-6 levels than the control group ( P <0.05), there was no difference between NIVI and IVI groups ( P ≥0.05). Repeated PVI application caused cytotoxic injury to the ocular surface, resulting in goblet cell loss and squamous metaplasia of epithelial cells. As a result, the stability of the tear film layer was found to be impaired and ocular surface-related symptoms developed in patients.

The Use of Iodophor-Impregnated Drapes in Patients With Iodine-Related Allergies: A Case Series and Review of the Literature.

The use of iodophor-impregnated adhesive drapes have become almost universally incorporated into standard practice of arthroplasty draping technique. Iodine-related allergies in patients planned for joint replacement present a challenge in terms of the best course of action to minimize complications and optimize outcomes. This is a retrospective case series of patients that received an iodophor-impregnated drape as part of draping for a total hip or knee arthroplasty at a single orthopaedic-specific hospital with documented iodine-related allergies. From 2015 to 2023, 9816 total hip arthroplasty and total knee arthroplasty cases were reviewed, and 135 were documented to have an iodine-related allergy for a prevalence of 1.38%. Intraoperative and postoperative records were reviewed to screen for an allergic reaction or wound healing issues that may have been related to an adverse reaction to the use of the iodophor-impregnated drape. Of the 135 patients, 43 had iodine listed as an allergy, 85 had shellfish, 20 had iodinated contrast media, and 3 had povidone iodine. Sixteen patients had a cluster of iodine-related allergies. There were no intraoperative reports of an allergic reaction to this drape. There were four superficial wound problems, none of which were documented to relate to an allergic dermatitis reaction, and none required further surgery. Patients reporting iodine-related allergies were present in 1.38% of patients undergoing hip or knee arthroplasty in our series. We encountered no allergic reactions or adverse outcomes that could be attributed to the use of iodiphor impregnated drapes in these patients.