Povidone-iodine administration in the prevention of infections of the surgical interference area
A.N. Barsukov1, O.I. Agafonov2, D.V. Afanasiev1
1 Smolensk State Medical University
2 1409 Naval Clinical Hospital, Chernyahovsk
Preoperative treatment of the surgical site with antiseptics is one of the key factors for the prevention of infections in the surgical interference area. One of the most frequently used drugs for this purpose is povidone-iodine, which is effective against bacteria, viruses, fungi, spores, and protozoa. The effectiveness of perioperative prevention with solutions of povidone-iodine was confirmed during surgical interventions on the abdominal organs, mammary gland, total articular replacement, cardiac surgery, neurosurgery, and gynecological operations.
With the similar efficacy of chlorhexidine and povidone-iodine in the treatment of the surgical site, the latter has the advantage due to its visibility on the skin. This allows to control the completeness of the antiseptic cover of skin in the area of surgical intervention, as well as to reduce the amount of the drug applied to the body surface, and thereby reduce the risk of adverse effects as a result of local exposure to the agent and its possible systemic absorption.
Solutions of povidone-iodine have a pronounced bactericidal effect on microorganisms in the absence of resistance. A low incidence of adverse effects accompanies povidone-iodine (Betadine® solution) administration.
Thus, povidone-iodine can be widely used for the prevention of infections in the surgical interference area in the perioperative period.
Key words: infections of the surgical interference area, surgery, preoperative treatment, prevention, povidone-iodine, Betadine®.
For citation: Barsukov A.N., Agafonov O.I., Afanasiev D.V. Povidone-iodine administration in the prevention of infections of the surgical interference area // RMJ. Medical Review. 2018. № 12. P. –11.
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7. Kanagalingam J., Feliciano R., Hah J.H. et al. Practical use of povidone-iodine antiseptic in the maintenance of oral health and in the prevention and treatment of common oropharyngeal infections // Int. J. Clin. Pract. 2015. Vol. 69(11). P.1247–1256.
8. Beukelman C.J., van den Berg A.J., Hoekstra M.J. et al. Anti-inflammatory properties of a liposomal hydrogel with povidone-iodine (Repithel) for wound healing in vitro // Burns. 2008. Vol. 34(6). P.845–855.
9. Al-Kaisy A.A., Salih Sahib A. Role of the antioxidant effect of vitamin E with vitamin C and topical povidone-iodine ointment in the treatment of burns // Ann. Burns Fire Disasters. 2005. Vol. 1 (1). P.19–30.
10. Yasuda T., Yoshimura Y., Takada H. et al. Comparison of bactericidal effects of commonly used antiseptics against pathogens causing nosocomial infections. Part 2 // Dermatology. 1997. Vol. 195 (Suppl. 2). P.19–28.
11. Kunisada T., Yamada K., Oda S., Hara O. Investigation on the efficacy of povidone-iodine against antiseptic-resistant species // Dermatology. 1997. Vol. 195 (Suppl. 2). P.14–18.
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13. Leaper D.J., Durani P. Topical antimicrobial therapy of chronic wounds healing by secondary intention using iodine products // Int. Wound J. 2008. Vol. 5 (2). P.361–368.
14. Yasuda T., Yoshimura S., Katsuno Y. et al. Comparison of bactericidal activities of various disinfectants against methicillin-sensitive Staphylococcus aureus and methicillin-resistant Staphylococcus aureus // Postgrad. Med. J. 1993. Vol. 69 (Suppl 3). P.S66–S69.
15. Lanjri S., Uwingabiye J., Frikh M. et al. In vitro evaluation of the susceptibility of Acinetobacter baumannii isolates to antiseptics and disinfectants: comparison between clinical and environmental isolates // Antimicrob. Resist. Infect. Control. 2017. Vol. 6. P.36.
16. Chuanchuen R., Beinlich K., Hoang T.T. et al. Cross-resistance between triclosan and antibiotics in Pseudomonas aeruginosa is mediated by multidrug efflux pumps: exposure of asusceptible mutant strain to triclosan selects nfxB mutants overexpressing MexCD-OprJ // Antimicrob. Agents Chemother. 2001. Vol. 45(2). P.428–432.
17. Houang E.T., Gilmore O.J., Reid C., Shaw E.J. Absence of bacterial resistance to povidone iodine // J. Clin. Pathol. 1976. Vol. 29(8). P.752–755.
18. Percival S.L., Finnegan S., Donelli G. et al. Antiseptics for treating infected wounds: efficacy on biofilms and effect of pH // Crit. Rev. Microbiol. 2016. Vol. 42(2). P.293–309.
19. Oduwole K.O., Glynn A.A., Molony D.C. et al. Anti-biofilm activity of sub-inhibitory povidoneiodine concentrations against Staphylococcus epidermidis and Staphylococcus aureus // J. Orthop. Res. 2010. Vol. 28(9). P.1252–1256.
20. Hoekstra M.J., Westgate S.J., Mueller S. Povidone-iodine ointment demonstrates in vitro efficacy against biofilm formation // Int. Wound J. 2017. Vol. 14(1). P.172–179.
21. Van Meurs S.J., Gawlitta D., Heemstra K.A. et al. Selection of an optimal antiseptic solution for intraoperative irrigation: an in vitro study // J. Bone Joint Surg. Am. 2014. Vol. 96(4). P.285–291.
22. Schmidt J., Zyba V., Jung K. et al. Cytotoxic effects of octenidine mouth rinse on human fibroblasts and epithelial cells — an in vitro study // Drug Chem. Toxicol. 2016. Vol. 39(3). P.322–330.
23. Sheth V.M., Weitzul S. Postoperative topical antimicrobial use // Dermatitis. 2008. Vol. 19(4). P.181–189.
24. Park M.R., Kim D.S., Kim J., Ahn K. Anaphylaxis to topically applied sodium fusidate // Allergy Asthma Immunol. Res. 2013. Vol. 5(2). P.110–112.
25. Bubenhofer M., Fricker M., Weber-Mani U., Helbling A. Chlorhexidine: a retrospective observational study of a potentially life-threatening molecule // J. Investig. Allergol. Clin. Immunol. 2015. Vol. 25(2). P.152–154.
26. Lachapelle J.M. A comparison of the irritant and allergenic properties of antiseptics // Eur. J. Dermatol. 2014. Vol. 24(1). P.3–9.
27. Mariappan R., Manninen P., Massicotte E.M., Bhatia A. Circulatory collapse after topical application of vancomycin powder during spine surgery // J. Neurosurg. Spine. 2013. Vol. 19(3). P.381–383.
28. Carvalho S., Marcelino J., Cabral Duarte F. et al. Is “Iodine Allergy” a contraindication to iodinated contrast media? The spread of a myth // Allergy. 2016. Vol. 71 (Suppl. 102). P.415–416.
29. Maiwald M. Skin preparation for prevention of surgical site infection after Cesarean delivery: a randomized controlled trial // Obstet. Gynecol. 2017. Vol. 129(4). P.750–751.
30. Dumville J.C., McFarlane E., Edwards P. et al. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery // Cochrane Database Syst. Reviews. 2015. Vol. 4. Art. No.: CD003949. 64 p. DOI: 10.1002/14651858.CD003949.pub4
31. Hakkarainen T.W., Dellinger E.P., Evans H.L. et al. Comparative effectiveness of skin antiseptic agents in reducing surgical site infections: a report from the Washington State Surgical Care and Outcomes Assessment Program Collaborative // J. Am. Coll. Surg. 2014. Vol. 218(3). P.336–344.
32. Лапина И.А. Применение различных концентраций раствора Бетадина (повидон-йод) в гинекологической практике // РМЖ. Медицинское обозрение. 2014. №4. С.298–301 [Lapina I.А. Primenenie razlichnykh kontsentratsij rastvora Betadina (povidon-jod) v ginekologicheskoj praktike // RMZh. Meditsinskoe obozrenie. 2014. №4. S.298–301 (in Russian)].
33. Elshamy E., Ali Y.Z.A., Khalafallah M., Soliman A. Chlorhexidine-alcohol versus povidone-iodine for skin preparation before elective cesarean section: a prospective observational study // J. Matern. Fetal Neonatal Med. 2018. DOI: 10.1080/14767058.2018.1489533
34. Tolcher M.C., Whitham M.D., El-Nashar S.A., Clark S.L. Chlorhexidine-Alcohol Compared with Povidone-Iodine Preoperative Skin Antisepsis for Cesarean Delivery: A Systematic Review and Meta-Analysis // Am. J. Perinatol. 2018. DOI: 10.1055/s-0038-1669907
35. Каторкин С.Е., Быстров С.А., Безбородов А.И. и др. Применение раствора повидон-йода при операциях на прямой кишке // РМЖ. Медицинское обозрение. 2018. №2 (2). С.52–55 [Katorkin S.E., Bystrov S.А., Bezborodov А.I. i dr. Primenenie rastvora povidon-joda pri operatsiyakh na pryamoj kishke // RMZh. Meditsinskoe obozrenie. 2018. № 2(2). S.52–55 (in Russian)].
36. Ghobrial G.M., Wang M.Y., Green B.A. et al. Preoperative skin antisepsis with chlorhexidine gluconate versus povidone-iodine: a prospective analysis of 6959 consecutive spinal surgery patients // J. Neurosurg. Spine. 2018. Vol. 28(2). P.209–214.
37. Yoshii T., Hirai T., Yamada T. et al. A Prospective Comparative Study in Skin Antiseptic Solutions for Posterior Spine Surgeries: Chlorhexidine-Gluconate Ethanol Versus Povidone-Iodine // Clin. Spine Surg. 2018. Vol. 31(7). P.E353–E356.
38. Craven C.L., Thompson S.D., Toma A.K., Watkins L.D. Superficial and Deep Skin Preparation with Povidone-Iodine for Ventriculoperitoneal Shunt Surgery: A Technical Note // J. Korean Neurosurg. Soc. 2018. DOI: 10.3340/jkns.2017.0282
39. Raja S.G., Rochon M., Mullins C. et al. Impact of choice of skin preparation solution in cardiac surgery on rate of surgical site infection: a propensity score matched analysis // J. Infect. Prev. 2018. Vol. 19(1). P.16–21.
40. Sindelar W.F., Brower S.T., Merkel A.B., Takesue E.I. Randomised trial of intraperitoneal irrigation with low molecular weight povidone-iodine solution to reduce intra-abdominal infectious complications // J. Hosp. Infect. 1985. Vol. 6 (Suppl. 1). P.103–114.
41. Cheng M.T., Chang M.C., Wang S.T. et al. Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery // Spine (Phila Pa 1976). 2005. Vol. 30(15). P.1689–1693.
42. Brown N.M., Cipriano C.A., Moric M. et al. Dilute betadine lavage before closure for the prevention of acute postoperative deep periprosthetic joint infection // J. Arthroplasty. 2012. Vol. 27(1). P.27–30.
43. Frisch N.B., Kadri O.M., Tenbrunsel T. et al. Intraoperative chlorhexidine irrigation to prevent infection in total hip and knee arthroplasty // Arthroplast. Today. 2017. Vol. 3(4). P.294–297.
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