Povidone-iodine Group Research Articles

Effect of hypochloric acid on Escherichia coli biofilm and the clinical efficacy of hypochloric acid for wounds with Escherichia coli infection

Effect of hypochloric acid on Escherichia coli biofilm and the clinical efficacy of hypochloric acid for wounds with Escherichia coli infection

Impact of Povidone-iodine Versus Chlorhexidine for Periurethral Cleaning Before Catheterization on Pyuria and Bacteriuria Among Emergency Department Patients

Background: We aimed to determine the effect of periurethral cleaning before catheterization using chlorhexidine and povidone-iodine on bacteriuria and pyuria. Methods: This study was a single-blind clinical trial on a sample selected by convenience sampling. Demographic and clinical questionnaires were completed, and patients were randomly divided into two groups) 36 patients each of povidone-iodine and chlorhexidine using Minimization Software based on confounding variables including age, consciousness level, triage level, nutritional status, and underlying disease. The periurethral areas were cleaned with the given antiseptics and catheterized using standard and sterile procedures. Then, specimens were taken for urinalysis and urine culture immediately, 72 hours, and five days after catheterization. Then, bacteriuria rate, pyuria rate, and the number of microorganisms were determined through examinations. Data analysis was conducted using SPSS version 19. Results: There was no statistically significant difference in the bacteriuria rate between the two groups immediately (P = 0.76), 72 hours (P = 0.22), and five days (P = 0.50) after catheterization. The positive pyuria rate was not significantly different between the two groups immediately after catheterization. However, it was significantly higher in the povidone-iodine group 72 hours (P = 0.03) and five days (P = 0.004) after catheterization. The Mann-Whitney test compared the mean number of microorganisms between the two groups at different times. This test showed no significant difference in the number of microorganisms immediately (P = 0.93), 72 hours (P = 0.43), and five days (P = 0.61) after catheterization. Conclusions: Due to the lower side effects of chlorhexidine than povidone-iodine, it is suggested that similar studies be performed in other hospital wards with more stable patients to obtain more statistically significant results.

Comparison of Skin Antisepsis between Povidone-Iodine and Olanexidine Gluconate in Hepato-Biliary-Pancreatic Surgery

Introduction: Surgical site infections (SSIs) are major postoperative complications following hepato-biliary-pancreatic surgery. Globally, to reduce SSIs, especially superficial SSIs (S-SSIs), 4-5% chlorhexidine gluconate (CHG) is used for preoperative skin antisepsis. However, in Japan, since only a CHG concentration of less than 1% is permitted, Povidone-iodine (PVI) is commonly used. Recently, Olanexidine Gluconate (OLG) was developed as an alternative for CHG. We compared the cost and efficacy of preoperative skin cleansing with OLG compared to PVI in preventing S-SSI. Methods: We investigated patients who underwent laparotomy for hepatectomy or pancreatectomy between January 2019 and July 2021 at the Department of Hepato-Biliary-Pancreatic Surgery, Ehime University, excluding emergency surgery cases. PVI was used in all cases from January 2019 to December 2020 (PVI-group), while OLG was used in all cases from January 2021. We surveyed the presence of S-SSI based on CDC guidelines. We also evaluated patient demographic data, anthropometric parameters and perioperative data. Result: The PVI and OLG groups included 144 and 35 patients, respectively. The incidence of S-SSI was 3.5% (5 patients) in the PVI group and 2.9% (1 patient) in the OLG group, indicating no statistically significant difference. Three patients in the PVI group had adverse events, with none in the OLG group. Further, the cost of PVI was significantly lower than that of OLG. Conclusion: OLG did not show significant reduction of S-SSIs, although our study is limited by the small sample size. Therefore, antisepsis with PVI is useful considering its current widespread use and medical costs in Japan.

Current overview for chemical disinfection of dental impressions and models based on its criteria of usage: A microbiological study.

The aims of this study were to compare the efficacy of two proven chemical disinfectants, glutaraldehyde and povidone iodine on dental impression and models by determining the reduction in the microbial load, and to compare changes in the physical properties of the models after adding the disinfectants. Irreversible hydrocolloid upper impressions of 90 patients were made and divided into 3 groups of 30 samples each; Group A--Control group; Impressions were run under clean tap water before pouring the model. Group B--2% Glutaraldehyde sprayed on the impression and left in situ for 10 min before pouring the model. Group C -10 ml of (5%) povidone iodine incorporated into the gypsum before pouring the model. Models from all three groups were subjected to microbiological assessment at three different time intervals, T0--24 h, T1--1 month and T2--3 months of storage by comparing the colony forming units (CFUs) of bacteria and fungi. The compressive strength of 5 models from each group was also analyzed in Newton's/mm2. 2% Glutaraldehyde proved more effective than povidone iodine after 24 h of storage (T1), however at the end of 1 month (T1) and 3 months (T2) the Povidone group showed the maximum disinfection. Both the disinfectants caused a reduction in the compressive strength of the model with the povidone iodine group showing the maximum reduction. Although povidone iodine was the most effective disinfectant after 3 months, it showed a significant reduction in the compressive strength and caused discoloration of the model. 2% Glutaraldehyde proved to be the choice of disinfectant with minimal adverse effects.

Comparative Study of Two Different Disinfectant Solutions Used for Pin Site Care in Patients with Ilizarov Ring Fixation

The Ilizarov ring fixation system is used to treat fracture, osteomyelitis, and bone lengthening. Wires and pins are used in order to fix the Ilizarov frame to the affected bone. In patients with Ilizarov ring fixators, pin site infections (PSI) are the most prevalent problem seen by orthopaedic surgeons. Pin sites are prone to infection because the skin barrier is lost or broken, disrupting the body's natural defense against bacterial infection.
 This was a cross sectional study and 30 patients divided in 2 equal groups, each contained 15 patients were taken under study. The present study included patients treated with Ilizarov external fixators post-injury and followed-up at Orthopedic OPD by history, clinical examination and radiological evidence. 235 pin sites were examined -in all the 30 patients. Demographic information, socioeconomic status, and health status were asked and recorded in the patient identification forms. It was found that, Only 19 of the 125 pins cleaned with chlorhexidine showed evidence of infection, but 32 of the 110 pins cleaned with povidone iodine solution showed infection (p value 0.05This was found to be statistically significant. In the participating groups, the location of infection was not important. The povidone iodine group had the first-degree infections, followed by second- and third-degree infections. According to the Checketts otterburn classification scale, the chlorhexidine group did not report any third-degree infections.

A Randomized Controlled Trial Comparing Chlorhexidine in Water and Povidone Iodine for Surgical Site Preparation in Abdominal Surgery

Background: Surgical site infection (SSI) is the common complication after abdominal surgery. Proper use of antiseptic can decrease SSI. According to previous studies, chlorhexidine in alcohol is superior to povidone iodine when using as skin preparation before abdominal surgery. Due to alcohol is flammable substance, there are many reports shown usage of chlorhexidine in alcohol for skin preparation can cause skin burn. Our study will compare whether chlorhexidine in water superior to povidone iodine as effective antiseptic agent for skin preparation before abdominal surgery. Objective: The aim of the present study is to compare SSI rate between using chlorhexidine in water and povidone iodine in patient undergoing abdominal surgery. Materials and Methods: Patients undergoing abdominal surgery by single surgeon (WS) between 1 July 2017 to 30 June 2018 in Ramathibodi Hospital were randomized to use skin preparation with chlorhexidine in water or povidone iodine. The inclusion criteria were elective clean-contaminated abdominal surgery, patient’s age between 18 to 75 years, and patients who signed consent form. Exclusion criteria were history of allergic to antiseptic agents, previous skin infection at surgical site, refused to participate in study and cannot follow-up. The primary outcome was SSI rate within 30 days after surgery. Results: A total of 87 subjects (38 in the chlorhexidine in water group and 49 in the povidone iodine group) were enrolled. There are 19 males (50%) and 19 females (50%) in chlorhexidine in water group while there are 19 males (38.8%) and 30 females (61.2%) in povidone iodine group. The overall rate of SSI was 10.5% in chlorhexidine in water group and 16.3% in povidone iodine group (p-value=0.463). Conclusion: Preoperative skin preparation with chlorhexidine in water tend to had lower SSI rate compared to povidone iodine, even without statistically significant. Future study with larger sample size may reveal any difference. Keywords: Surgical site infection; Povidone iodine; Chlorhexidine in water

Effectiveness and safety of povidone iodine for prolonged lung air-leak after lung surgery.

Pulmonary surgery is often associated with postoperative prolonged parenchymal air-leak. The purpose of this study was to determine efficacy and safety of povidone iodine as treatment of prolonged parenchymal air-leak following all-types of lung surgery. This prospective trial was conducted from June 2019 to December 2020, and designed under PanAfrican Clinical Trials Registry requirements. Patients having prolonged parenchymal air-leak were randomly allocated to povidone iodine protocol (Group A) or surveillance without povidone iodine (Group B). We collected the number of povidone iodine injections required before bubbling stopped, total drainage period, tolerance after injection, complications and side-effects. Comparative study was performed to evaluate povidone iodine efficacy. Following randomization, Group A included 19 patients, and Group B 21. Both groups were comparable. The mean drainage period was 9.21 days in Group A (6-14 days) and 15.62 days in Group B (7-31 days) (p = 0.001). The mean hospitalization period was 11.05 days in Group A (7-16 days) and 18.9 days in Group B (9-38 days) (p < 0.0001). The mean follow-up period was 6.8 months (3-18 months). No deaths were noted in either groups. Four side-effects were reported in Group A (21%) and four serious complications were noticed in Group B (19%). No recurrences were reported in Group A versus one recurrence of homolateral pneumothorax in Group B (4.76%). Povidone iodine is an effective and safe solution for pleurodesis. It is associated with a low complication rate that remains acceptable, and could be proposed as treatment of prolonged parenchymal air-leak after lung resections.

Utilidad de los enjuagues con povidona yodada y peróxido de hidrógeno en pacientes con COVID-19

IntroductionPovidone-iodine and hydrogen peroxide could be effective in against SARS-CoV-2. MethodsA “non-interventional trial” in 88 patients (43±17 yrs, 55% men) with SARS-CoV-2 in nasopharyngeal swabs (RT-PCR). 31 received mouth rinses/gargling with povidone-iodine (every 8h, two consecutive days), 17 with mouth rinses/gargling of hydrogen peroxide, and 40 controls. PCR were repeated at 3, 11 and 17 days. ResultsAfter intervention the viral load (Log10copies/ml) remained similar in povidone-iodine (4.3±2.7copies/ml), hydrogen peroxide (4.6±2.9copies/ml; p=0.40) and controls (4.4±3.0copies/ml). The percentage of patients with a negative result in the second PCR was 27% in povidone-iodine group, 23% in hydrogen peroxide and 32% in controls; in the third PCR, 62%, 54% and 58% respectively; and in the fourth PCR, 81%, 75% and 81%. ConclusionOur results do not support the clinical usefulness of mouth rinses/gargling with povidone-iodine or hydrogen peroxide in patients with COVID-19.

Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery

Preoperative skin preparation is an effective method to prevent surgical site infections (SSI). Alcoholic chlorhexidine (CHG) and povidone iodine (PV-I) are the most widely used antiseptic agents. This meta-analysis aims to determine their efficacy in reducing natural bacterial skin flora in clean orthopedic surgery. A systematic search was conducted through current literature up to June 2021 to identify clinical randomized trials that compared the efficacy of alcoholic chlorhexidine and povidone iodine in reducing bacterial skin colonization after preoperative skin preparation. A meta-analysis was conducted. Of 235 screened articles, 8 randomized controlled trials were included. The results of the meta-analysis demonstrate a significantly lower positive culture rate in the chlorhexidine group than in the povidone iodine group (RR = 0.53, 95% Cl: 0.32–0.88). The present data show the superiority of chlorhexidine in reducing the normal bacterial flora compared to povidone iodine in clean orthopedic surgery.

English

BACKGROUND Diabetic patients have reduced ability to metabolize glucose resulting in elevated blood sugar levels which further burdens the wound healing process. This leads to non-healing chronic ulcers. The sufferers of chronic diabetic foot ulcers are increasing globally due to lack of preventive and control measures. Sucralfate has been demonstrated in molecular studies to enhance the granulation tissue proliferation and thus promoting ulcer healing in the skin. Various clinical studies have also showed the efficacy of sucralfate in complete healing of the wound and in reducing the size of the wound. The purpose of this study was to compare the efficacy of topical sucralfate with that of povidone iodine dressing, in the healing of diabetic ulcers. METHODS This is a randomized comparative study. Among 100 patients, 50 patients received treatment in the form of povidone iodine dressings and 50 took treatment with sucralfate dressing. The patient underwent a detailed clinical examination. Relevant investigations were also done. The initial wound area was recorded after thorough debridement by measuring length x width. Both the groups underwent dressings once daily. The patients were followed up daily for a period of 3 weeks in both the groups. RESULTS In this study, the mean ± SD area of reduction of the ulcer was observed to be higher in sucralfate group 54.17 ± 10.08 than the povidone iodine group 16.07 ± 4.19. There was a statistically significant difference between the groups for the mean of area reduction (P &lt; 0.0001, significant). CONCLUSIONS The ulcers in subjects treated with sucralfate dressing (S group) contracted more than the ulcers in the patients treated with povidone iodine (P group) (54.17 % Vs 16.07 %; P = &lt; 0.0001, significant) which points out that sucralfate dressing is an effective modality in helping the reduction of wound area in patients with diabetic foot ulcers. KEYWORDS Diabetic, Sucralfate, Area of Reduction

The Role of Chlorhexidine in the Prevention of Pin Tract Infection as Compared to Povidone-Iodine in Patients Managed by Ilizarov Circular Fixator

Objective: To compare the efficacy of Chlorhexidine in the prevention of pin tract infection as compared to Povidone-iodine antiseptic. Study Design: Prospective, single blinded randomized trial. Study Setting and Duration: Liaquat University of Health Science (LUMHS), Jamshoro between July 2018 to November 2020. Methodology: All patients who underwent Ilizarov external fixation as per indications were eligible for the study. Individuals with a previous history of osteomyelitis were excluded from the study. Pin sites were cleansed with normal saline using clean applicators. In the group chlorhexidine, the antiseptic was applied on the pin skin interphases (1% chlorhexidine). Similarly, 10% povidone iodine was applied to patients in group C. The control group was cleansed with normal saline. Pin sites were either dressed daily or weekly. The primary outcome was the rate of pin site infection days. Results: Chlorhexidine group had significantly lesser pin-site infections as compared to the povidone-iodine group with a frequency of 13 (39.39%) and 19 (63.33%), p=0.04, respectively. The mean pin tract infection rate days ± SD were significantly lower in the chlorhexidine group as compared to the povidone-iodine group (1.35 ± 2.26 vs 3.54 ± 4.30, p=0.041). Similarly, the mean duration to onset of pin site infection was also significantly higher in the chlorhexidine group compared to povidone-iodine and control groups. Conclusion: Patients who used Chlorhexidine as the cleansing agent had significantly fewer pin-site infections as compared to the povidone-iodine group. Keywords: Chlorhexidine, Ilizarov fixator, fracture, Povidone-iodine

17 Postoperative infectious morbidity after hysterectomy: A propensity-matched analysis comparing vaginal preparation with povidone iodine versus chlorhexidine

To compare rates of infectious morbidity and hospital utilization with preoperative vaginal preparation using povidone iodine (PI) or chlorhexidine (CHX) prior to hysterectomy. This was a retrospective analysis of women who underwent hysterectomy for gynecologic indications at 70 hospitals in a statewide surgical collaborative between January 2017 and December 2019. The primary outcome was post-operative infectious morbidity which included urinary tract infection and surgical site infection (SSI) involving superficial, deep, or organ space tissues within 30 days of surgery. To adjust for confounding, propensity score matching, 1:1 without replacement and with a caliper of 0.005 was performed to create cohorts that had vaginal preparation with either PI or CHX and did not differ in observable characteristics. We compared rates of infectious morbidity as well as hospital utilization (reoperation, readmission, and ED visits) in the matched cohorts. In the statewide collaborative, there were 18,184 patients who received PI and 3,018 who received CHX. After propensity score matching of 2935 pairs, the PI and CHX groups did not differ in demographics, comorbidities, choice of preoperative antibiotics, benign vs malignant surgical indication, and surgical approach (Table 1). PI was associated with a lower rate of infectious morbidity when compared to the CHX group (3.0% vs 4.3%, P = 0.008; Figure 1). There were significantly lower rates of urinary tract infection (1.1% vs 1.7%, P = 0.034) and emergency department visits (7.9% vs 9.7%, P = 0.013) in the PI group when compared with CHX. There were non-significant trends of lower rates of SSI (2.0% vs 2.7%, P = 0.071) and reoperation (1.6% vs 2.1%, P = 0.174) in the PI group when compared with CHX. This propensity score-matched analysis provides evidence that povidone iodine is preferable to chlorhexidine for vaginal preparation prior to hysterectomy due to lower rates of infectious morbidity and fewer emergency department visits. However, the absolute differences in infectious morbidity rates were relatively small, and in the event of an iodine allergy, chlorhexidine appears to be a reasonable alternative.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Success of Masking 5% Povidone-Iodine Treatment: The Reducing Adenoviral Patient Infected Days Study.

The effectiveness of masking is rarely evaluated or reported in single- or double-masked clinical trials. Knowledge of treatment assignment by participants and clinicians can bias the assessment of treatment efficacy. This study aimed to evaluate the effectiveness of masking in a double-masked trial of 5% povidone-iodine for the treatment of adenoviral conjunctivitis. The Reducing Adenoviral Patient Infected Days study is a double-masked, randomized trial comparing a one-time, in-office administration of 5% povidone-iodine with artificial tears for the treatment of adenoviral conjunctivitis. Masking was assessed by asking participants and masked clinicians at designated time points if they believed the treatment administered was povidone-iodine or artificial tears, or if they were unsure. Adequacy of masking was quantified using a modified Bang Blinding Index. Immediately after treatment, 34% of participants who received povidone-iodine and 69% of those who received artificial tears guessed incorrectly or were unsure of their treatment (modified Bang Indices of 0.31 and -0.38, respectively). On day 4, 38% of the povidone-iodine participants and 52% of the artificial tear participants guessed incorrectly or were unsure of their treatment (modified Bang Indices of 0.24 and -0.05, respectively), indicating adequate and ideal masking. On days 1, 4, 7, 14, and 21, masked clinicians guessed incorrectly or were unsure of treatment in 53%, 50%, 40%, 39%, and 42% among povidone-iodine participants compared with 44%, 35%, 38%, 35%, and 39% among artificial tears participants, respectively. The modified Bang Indices for clinician masking in the povidone-iodine group ranged from -0.05 to 0.25 and from 0.13 to 0.29 in the artificial tears group. Masking of participants and clinicians was adequate. Successful masking increases confidence that subjective measurements are not biased. We recommend quantitative assessment and reporting the effectiveness of masking in ophthalmic clinical trials.

Prevention of Surgical Site Infection in Lumbar Instrumented Fusion Using a Sterile Povidone-Iodine Solution

Surgical site infection (SSI) is a well-documented complication in patients who undergo posterior spine instrumentation with most studies reporting an incidence of 1%-12%. Some studies have documented that a diluted sterile povidone-iodine (PVI) solution can be safely used in posterior spinal fusion surgeries as an antiseptic; in this study, we analyzed its effectiveness in reducing SSI. This retrospective study consisted of consecutive patients who underwent elective posterior lumbar instrumentation performed by a single surgeon from 2016 to 2019. In the first 134 patients, wounds were irrigated before arthrodesis and closure with 1 L of 0.9% normal saline solution; in the subsequent 144 patients, wound irrigation was with a solution of 35 mL of sterile 10% PVI. Both groups were analyzed to determine if wound irrigation with sterile PVI solution decreased SSIs. There were 9 (6.7%) SSIs in the 0.9% normal saline solution group versus 1 (0.7%) SSI in the PVI group (P= 0.008). PVI solution had a relative risk for SSI of 0.093 (P= 0.008) and an adjusted odds ratio of 0.113 (P= 0.05). Increased body mass index and posterolateral spine fusion with laminectomy were significant risk factors for SSI (P= 0.04 and P= 0.030, respectively). Wound irrigation with PVI solution significantly reduced SSI in elective posterior lumbar instrumentation cases. Subgroup analysis provided significant results to recommend use of PVI solution for SSI prevention, particularly in overweight and obese patients. We also recommend its use in patients with risk factors for SSI, such as longer operative time and unintended durotomy.

In vivo evaluation of the virucidal efficacy of chlorhexidine and povidone-iodine mouthwashes against salivary SARS-CoV-2. A randomized-controlled clinical trial

ObjectivesThe oral cavity is potentially high-risk transmitter of COVID-19. Antimicrobial mouthrinses are used in many clinical preprocedural situations for decreasing the risk of cross-contamination in the dental setting. It is important to investigate the efficacy of mouthwash solutions against salivary SARS-CoV-2 in order to reduce the exposure of the dental team during dental procedures. AimsThe aim of this in vivo study was to evaluate the efficacy of 2 preprocedural mouthrinses in the reduction of salivary SARS-CoV-2 viral load and to compare the results of the mouthwashes to a control group. Materials and MethodsIn this randomized-controlled clinical trial, studied group comprised laboratory-confirmed COVID-19 positive patients through nasopharyngeal swabs. Participants were divided into 3 groups. For 30 s, the control group mouthrinsed with distilled water, the Chlorhexidine group mouthrinsed with 0.2% Chlorhexidine and the Povidone-iodine group gargled with 1% Povidone-iodine. Saliva samples were collected before and 5 min after mouthwash. SARS-CoV-2 rRT-PCR was then performed for each sample. Evaluation of the efficacy was based on difference in cycle threshold (Ct) value. The analysis of data was carried out using GraphPad Prism version 5 for Windows. Kristal wullis and Paired t-test were used. A probability value of less than 0.05 was regarded as statistically significant. ResultsSixty-one compliant participants (36 female and 25 male) with a mean age 45.3 ± 16.7 years-old were enrolled. A significant difference was noted between the delta Ct of distilled water wash and each of the 2 solutions Chlorhexidine 0.2% (P = .0024) and 1% Povidone-iodine (P = .012). No significant difference was found between the delta Ct of patients using Chlorhexidine 0.2% and 1% Povidone-iodine solutions (P = .24). A significant mean Ct value difference (P < .0001) between the paired samples in Chlorhexidine group (n = 27) and also in Povidone-iodine group (n = 25) (P < .0001) was found. In contrast, no significant difference (P = .566) existed before and after the experiment in the control group (n = 9). ConclusionChlorhexidine 0.2% and 1% Povidone-iodine oral solutions are effective preprocedural mouthwashes against salivary SARS-CoV-2 in dental treatments. Their use as a preventive strategy to reduce the spread of COVID-19 during dental practice should be considered.

Conjunctival flora growth in intravitreal injection settings

Purpose: To study the conjunctival flora in patients undergoing repeated intravitreal injections. Methods: Prospective observational study. Patients undergoing intravitreal injections were randomized into two groups: 1) preparation with povidone-iodine 5% alone, or 2) preparation with povidone-iodine 5% with Maxitrol eye drops. Our standard injection technique included topical anesthesia, a solid bladed lid speculum, and commercially prepared topical povidone-iodine 5% applied for 2 minutes. Cultures were obtained from the conjunctival cul-de-sac on routine office visits prior to any preparation and immediately after injection. Results: A total of 110 Eyes of 86 patients were enrolled in the study. Fifty-five were irrigated with povidone-iodine 5% only, and 55 were irrigated with a combination of povidone-iodine 5% and Maxitrol drops. Compared with the povidone-iodine only group, the Maxitrol and povidone-iodine group did not lead to a statistically significant reduction in patients with positive cultures after injection, (p=0.19). The most common organism cultured was coagulase-negative staphylococcus; however, Enterococcus, Pseudomonas, Staphylococcus aureus, and Bacillus were also cultured. Thirtyseven percent of organisms were resistant to 4th generation quinolones. No cases of endophthalmitis were recognized. Of the positive cultures, 33% were resistant to over 4 antibiotics tested. Conclusion: In this routine clinical setting, conjunctival antisepsis was difficult to achieve despite the use of topical povidone-iodine with or without Maxitrol. No infectious complications were recognized.

Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: randomized control trial in Singapore.

PurposeOne of the key approaches to minimize the risk of COVID-19 transmission would be to reduce the titres of SARS-CoV-2 in the saliva of infected COVID-19 patients. This is particularly important in high-risk procedures like dental treatment. The present randomized control trial evaluated the efficacy of three commercial mouth-rinse viz. povidone–iodine (PI), chlorhexidine gluconate (CHX) and cetylpyridinium chloride (CPC), in reducing the salivary SARS-CoV-2 viral load in COVID-19 patients compared with water.MethodsA total of 36 SARS-CoV-2-positive patients were recruited, of which 16 patients were randomly assigned to four groups—PI group (n = 4), CHX group (n = 6), CPC group (n = 4) and water as control group (n = 2). Saliva samples were collected from all patients at baseline and at 5 min, 3 h and 6 h post-application of mouth-rinses/water. The samples were subjected to SARS-CoV-2 RT-PCR analysis.ResultsComparison of salivary Ct values of patients within each group of PI, CHX, CPC and water at 5 min, 3 h and 6 h time points did not show any significant differences. However, when the Ct value fold change of each of the mouth-rinse group patients were compared with the fold change of water group patients at the respective time points, a significant increase was observed in the CPC group patients at 5 min and 6 h and in the PI group patients at 6 h.ConclusionThe effect of decreasing salivary load with CPC and PI mouth-rinsing was observed to be sustained at 6 h time point. Within the limitation of the current study, as number of the samples analyzed, the use of CPC and PI formulated that commercial mouth-rinses may be useful as a pre-procedural rinse to help reduce the transmission of COVID-19.ISRCTN (ISRCTN95933274), 09/09/20, retrospectively registered

Toxicity of Povidone-iodine to the ocular surface of rabbits

BackgroundWe evaluated the toxicity of 5% (w/v) povidone-iodine (PI) applied to the ocular surface of rabbits.MethodsTwenty-three white rabbits were divided into four groups; these were a control group and three study groups in which the ocular surface was exposed to PI for different times. In control group, one drop of phosphate-buffered saline (PBS) was applied once for 10 min. In study groups, one drop of 5% (w/v) PI was topically applied once for 1 min, 3 min, and 10 min, and then the animals were observed for 7 days. The Schirmer test, Rose Bengal staining, corneal fluorescein staining and conjunctival impression cytology were performed on day 0, 3, and 7. After 7 days, the rabbits were sacrificed and conjunctiva and cornea were collected and evaluated by light and electron microscope. Immunofluorescence staining was also performed to detect mucin 5 subtype AC (MUC5AC).ResultsThe decrease in goblet cell density, reductions in MUC5AC level and histopathological and ultrastructural changes of conjunctiva and cornea were more prominent in the 5% (w/v) PI groups than the control group (p < 0.05). Moreover, these changes were more prominent when PI was applied for 3 and 10 min rather than 1 min (both p values < 0.05).Conclusions5% (w/v) povidone-iodine caused damages to the ocular surface in a time-dependent manner. Therefore, we should be aware of that excessive PI exposure during ophthalmic procedures could be a pathogenic factor of dry eye syndrome after surgery.

Does Skin Preparation Influence Surgical Site Infection in Laparotomy Wounds: Comparative Evaluation of Preoperative Skin Preparation With 4% Chlorhexidine With 5% Povidone Iodine in Laparotomy Wounds: A Prospective Trial

Introduction: Surgical site infection is a dangerous condition causing a heavy burden on the patient and social health system. Surgical site infections are among the most common hospital acquired infections comprising 14 to 16% of inpatient infections. There are various factors predisposing the infections and many of them are patient related or disease related. The use of pre-operative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. There are several kinds of antiseptics available for preoperative skin preparation; however povidone iodine and spirit are commonly used in clinical practice. Materials and Methods: This study compared the incidence of surgical site infections within 7 days of postoperative period in laparotomy wounds prepared using 4% Chlorhexidine and those prepared with 5% Povidone iodine for pre-laparotomy skin preparation. Results: This study compared 128, 4% Chlorhexidine prepared patients and 109, 5% Povidone iodine prepared patients undergoing various elective n = 114 and emergency procedures n = 123. The overall SSI rates in 7 days in the whole group were 13.44 %. The SSI rates on the 4% Chlorhexidine group were 10.16% and 5% povidone iodine group were 17.27% and it was statically significant with a p value of p = 0.00413 showing significant reduction in the 4% Chlorhexidine group. The study also compared the SSI rates in elective and emergency procedures in both groups with significant difference in emergency procedures. More variables are also compared between the groups and results were analyzed. Conclusion: This study shows the use of Chlorhexidine 4% reduces the morbidity of one of the most common wound related complication in laparotomy patients in all categories of laparotomy wounds.

Inhibitory effect of topical antibiotics/antiseptics administration on bacterial growth in the open wound of the jawbone surgery: Randomized controlled, preliminary study

Background/purposeTThe bone cavities after extirpation of cysts or tumor of the jawbone requires the insertion of gauze containing various antibiotics/antiseptics to minimize the risk of pain, bleeding, and surgical site infection (SSI). However, there have been few reports on the efficacy of topical administration of antibiotics/antiseptics to an open wound of the jawbone. To compare the inhibitory effects of topical povidone-iodine gel and tetracycline ointment on the jawbone wound bacterial growth after extirpation of cyst or tumor. Materials and methodsThis is a preliminary, randomized controlled, open-labeled trial. Eighteen patients were randomly assigned into two groups. In povidone-iodine (PI) group, gauze mixed with povidone-iodine gel was inserted into the bone cavity wound, and in tetracycline (TC) group gauze mixed with tetracycline ointment was inserted after extirpation of cyst or tumor of the jaw bone. In both groups, gauze was removed 48 h after surgery, and examined by bacterial culture and real-time polymerase chain reaction (PCR) using primers detecting total bacteria and MRSA. ResultsThe topical application of tetracycline ointment was superior to that of povidone-iodine gel concerning inhibitory effects of total bacteria and methicillin-resistant Staphylococcus aureus (MRSA). ConclusionThis preliminary study suggests that the insertion of gauze mixed with tetracycline ointment is recommended for bone wounds after extirpation of cyst or tumor of the oral cavity.