Vaginal absorption of povidone-iodine

Preoperative vaginal cleansing with chlorhexidine and cetrimide solution for reduction of postoperative infectious morbidity at a tertiary care center in North India: A prospective cohort study

OBJECTIVE

To determine the effect of preoperative vaginal cleansing with chlorhexidine and cetrimide solution on postoperative infectious morbidity.

METHODS

This prospective cohort study was conducted over a period of 18 months in the Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Women undergoing cesarean section were alternately allotted to study and control groups. Women with chorioamnionitis, antepartum hemorrhage, rupture of membranes for more than 24 h, and fever in the preoperative period were excluded. The study group received preoperative vaginal cleansing with antiseptic solution (7.5% chlorhexidine w/v and 15% cetrimide w/v); the control group did not receive vaginal cleansing. Both groups were followed for the presence of any infectious morbidity until they were discharged from the hospital.

RESULTS

Age, body mass index (calculated as weight in kilograms divided by the square of height in meters), gestational age, and the parity of the women in the study and control groups were comparable (n = 760). The rate of endometritis was lower in the study group, but the difference was not statistically significant (P = 0.054). Post-cesarean febrile morbidity and wound sepsis were significantly lower in the study group (P = 0.017 and P = 0.02, respectively). On subgroup analysis, women in the study group with rupture of the membranes before cesarean delivery had lower wound sepsis and a reduced duration of hospital stay. Women in the study group with emergency cesarean delivery showed a significant reduction in wound sepsis, febrile morbidity, and length of hospital stay.

CONCLUSION

Preoperative vaginal cleansing with chlorhexidine and cetrimide solution before a cesarean section reduces postoperative infectious morbidity.

Urinary iodine excretion after using povidone iodine or chlorhexidine gluconate for topical disinfectant in patients undergoing thyroidectomy due to thyroid carcinoma: When to do radio active iodine therapy?

Background

Povidone Iodine (PI) is the most frequent antiseptic used as a topical disinfectant in surgery. It has been reported high transcutaneous iodine absorption due to topical PI usage, but there is a lack of data in periods of excess iodine depletion.

Materials and Methods

This is a cross-sectional study designed to assess serial urinary iodine concentration (UIC) after topical administration of PI to evaluate the transcutaneous iodine absorption and the proper iodine depletion time for safe administration of Radio Active Iodine (RAI) therapy as ablative or adjuvant therapy.

Results

Thirty-seven patients with papillary thyroid carcinoma undergoing total thyroidectomy were assigned to the PI group (n = 20) or chlorhexidine gluconate (CHG) group (n = 17). In the PI group, the UIC levels rose to a maximum of 2 times in the 4th week after administration and returned to pre-operative levels in the 8th week after. In the CHG group, there was a decrease in UIC levels due to a low iodine diet (LID) with a significant P-value of 0.001, <0.001, and 0.001 in the 2nd, 4th, and 8th weeks follow up respectively compared to the PI group. The urinary excretion of excess iodine lasts about 8 weeks after total thyroidectomy until iodine levels turn back to pre-operative values.

Conclusion

If the thyroidectomy was prepared with PI, RAI is better to be performed 6-8 weeks after surgery rather than the standard prescription of 4 weeks.

Povidone-Iodine-Induced Acute Kidney Injury in a 23-Year-Old Woman: The First Clinical Case Report From the Republic of Cyprus

Povidone-iodine (PI) is considered a generally safe broad-spectrum, antiseptic substance, which is widely used in healthcare services, mostly for burn patients, in wound treatment, surgical wound irrigation, as well as for a few gynecological indications. Although it is safe, its use on mucosa can cause toxicity due to iodine absorption and the high concentration in the serum. PI toxicity is absorption depended and has been associated with severe adverse events including acute kidney injury (AKI). To our knowledge, there are only three cases of PI-induced AKI after uterine instillation in the published literature. We report a case of severe PI-induced AKI that occurred in a 23-year-old female due to iodine systemic absorption immediately post uterine instillation, in terms of infertility evaluation.

The patient was admitted to the intensive care unit (ICU), supported with mechanical ventilation and treated with renal replacement therapy (RRT). Renal function and urine output improved and the patient was discharged from ICU.

Severe adverse events may be linked to internal use, therefore, PI on mucosa should be used with extreme caution. Clinicians should be aware of iodine intoxication and possible AKI.

Oral transmucosal absorption of iodine after intraoral preparation with povidone-iodine prior to oral surgeries: a randomized controlled study in 12 male patients

INTRODUCTION

Absorption of iodine through skin and an increased incidence of thyroid disorders due to iodophor exposure are reported. However, the risk of oral transmucosal absorption of povidone-iodine after intraoral preparation is not clear.

OBJECTIVE

To investigate the possibility of oral transmucosal absorption of povidone-iodine after intraoral preparation and its effect on thyroxine level in blood.

PATIENTS AND METHODS

A randomized controlled study was carried out in the department of oral and maxillofacial surgery. Twenty- to 40-year-old healthy male adults planning to receive oral surgery under general anesthesia were enrolled. The study group received povidone-iodine irrigation of oral cavity for 3 min as intraoral preparation before operation. The control group received chlorhexidine gluconate irrigation of oral cavity for 3 min as intraoral preparation before operation. Iodine levels in blood and urine, and thyroxine levels in blood were tested and compared, before and after operation.

RESULT(S)

In total, 24 patients were included and analyzed finally. We found that after intraoral preparation with povidone-iodine, serum iodine level increased significantly to 2-3 times the pre-operation level in 15-30 min, and the urinary iodine level increased to 5 times the pre-operation level on the first day after operation. Iodine levels in blood and urine decreased significantly on the third day after operation but still significantly greater than the pre-operation levels. However, thyroxine levels were not altered accordingly.

CONCLUSION(S)

Oral transmucosal absorption of iodine is observed when povidone-iodine is used for intraoral preparation in healthy male adults, though the free thyroxine in blood is not affected accordingly.

CLINICAL RELEVANCE

Povidone-iodine is commonly used as an antiseptic in oral surgery and dental clinics. Based on our findings that iodine levels in blood and urine may elevate significantly after intraoral preparation with povidone-iodine prior to oral surgeries, care must be taken for individuals when excess iodine intakes can endanger the safety of the patient.

REGISTRATION INFORMATION

Name of the trial registry: The Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ). Registration number: ChiCTR2100042028.

Comparison of topical honey and povidone iodine-based dressings for wound healing: a systematic review and meta-analysis

OBJECTIVES

In this review and meta-analysis, we analyse the evidence to compare the efficacy of honey and povidone iodine-based dressings on the outcome of wound healing.

METHOD

A systematic literature search was performed using PRISMA guidelines in academic databases including MEDLINE, Scopus, Embase and CENTRAL. A meta-analysis was carried out to assess the effect of honey and povidone iodine-based dressings on mean healing duration, mean hospital stay duration and visual analogue scale (VAS) score of pain.

RESULTS

From the search, 12 manuscripts with a total of 1236 participants (mean age: 40.7±11.7 years) were included. The honey-based dressings demonstrated a medium-to-large effect in reduction of mean healing duration (Hedge's g: -0.81), length of hospital stay (-3.1) and VAS score (-1.2) as compared with the povidone iodine-based dressings. We present evidence (level 1b) in favour of using honey for improvement of wound recovery as compared with povidone iodine.

CONCLUSION

This review and meta-analysis demonstrate beneficial effects of honey-based dressings over povidone iodine-based dressings for wound recovery.

Effect of povidone iodine on thyroid functions and urine iodine levels in caesarean operations

OBJECTIVE

In the present study, the effects of povidone iodine (PI) used during Caesarean operations on maternal thyroid hormones and urine iodine levels in the infant and the mother were investigated.

DESIGN

Twenty-seven patients were allocated to the PI group I (Gr I), and 28 to the non-PI group (Group II). Maternal preoperative and 24th-h postoperative free T3 (fT3), freeT4 (fT4), TSH, and urine iodine levels were determined, as well as infant urine iodine values.

RESULTS

In both groups, fT3 levels before and after the operation were found to be reduced (p < 0.01, p = 0.01, respectively). However, the decrease in fT3 was approximately 1.5-fold higher in Gr I than in Gr II. TSH levels increased significantly in Gr I (p = 0.005). The urine iodine levels of the mothers increased 25% in Gr I, but only 2% in Gr II.

CONCLUSIONS

The absorption of PI by the skin was found to lead to changes in fT3, TSH, and urine iodine excretion values in the mothers. The findings of this study of Caesarean operations, which have a short duration, might be a signal to be careful of thyroid hormone effects in operations lasting longer.

Pink-color sign in esophageal squamous neoplasia, and speculation regarding the underlying mechanism

AIM

To investigate the reasons for the occurrence of the pink-color sign of iodine-unstained lesions.

METHODS

In chromoendoscopy, the pink-color sign of iodine-unstained lesions is recognized as useful for the diagnosis of esophageal squamous cell carcinoma. Patients with superficial esophageal neoplasms treated by endoscopic resection were included in the study. Areas of mucosa with and without the pink-color sign were evaluated histologically. The following histologic features that were possibly associated with the pink-color sign were evaluated. The keratinous layer and basal cell layer were classified as present or absent. Cellular atypia was classified as high grade, moderate grade or low grade, based on nuclear irregularity, mitotic figures, loss of polarity, chromatin pattern and nuclear/cytoplasmic ratio. Vascular change was assessed based on dilatation, tortuosity, caliber change and variability in shape. Vessels with these four findings were classified as positive for vascular change. Endoscopic images of the lesions were captured immediately after iodine staining, 2-3 min after iodine staining and after complete fading of iodine staining. Quantitative analysis of color changes after iodine staining was also performed.

RESULTS

A total of 61 superficial esophageal neoplasms in 54 patients were included in the study. The lesions were located in the cervical esophagus in one case, the upper thoracic esophagus in 10 cases, the mid-thoracic esophagus in 33 cases, and the lower thoracic esophagus in 17 cases. The median diameter of the lesions was 20 mm (range: 2-74 mm). Of the 61 lesions, 28 were classified as pink-color sign positive and 33 as pink-color sign negative. The histologic diagnosis was high-grade intraepithelial neoplasia (HGIN) or cancer invading into the lamina propria in 26 of the 28 pink-color sign positive lesions. There was a significant association between pink-color sign positive epithelium and HGIN or invasive cancer (P = 0.0001). Univariate analyses found that absence of the keratinous layer and cellular atypia were significantly associated with the pink-color sign. After Bonferroni correction, there were no significant associations between the pink-color sign and presence of the basal membrane or vascular change. Multivariate analyses found that only absence of the keratinous layer was independently associated with the pink-color sign (OR = 58.8, 95%CI: 5.5-632). Quantitative analysis was performed on 10 superficial esophageal neoplasms with both pink-color sign positive and negative areas in 10 patients. Pink-color sign positive mucosa had a lower mean color value in the late phase (pinkish color) than in the early phase (yellowish color), and had similar mean color values in the late and final phases. These findings suggest that pink-color positive mucosa underwent color fading from the color of the iodine (yellow) to the color of the mucosa (pink) within 2-3 min after iodine staining. Pink-color sign negative mucosa had similar mean color values in the late and early phases (yellowish color), and had a lower mean color value in the final phase (pinkish color) than in the late phase. These findings suggest that pink-color sign negative mucosa did not undergo color fading during the 2-3 min after iodine staining, and underwent color fading only after spraying of sodium thiosulfate.

CONCLUSION

The pink-color sign was associated with absence of the keratinous layer. This sign may be caused by early fading of iodine staining.

Systemic iodine absorption associated with the use of preoperative ophthalmic antiseptics containing iodine

BACKGROUND

Polyvinylpyrrolidone-Iodine (PVP-I) is routinely used as preoperative antiseptic during ophthalmic surgery. Iodine absorption from iodine-containing antiseptics can lead to the development of thyroid disorders. Therefore, a quantitative measurement of iodine absorption from these antiseptics was performed in patients undergoing elective cataract surgery.

METHODS

This study enrolled 241 patients to evaluate systemic iodine absorption after exposure to conjunctival and/or periorbital 1.25% and 10% PVP-I compared to an iodine-free antiseptic.

RESULTS

All patients who received the 10% PVP-I regardless of the application site showed a 1.2-1.5-fold increase in urinary iodine excretion after 24 h (p = 0.01). In 17 out of 110 (15.5%) patients in whom 10% PVP-I was used, the critical threshold of urinary iodine excretion as defined by WHO (>300 µg/L) was exceeded. In contrast, no significant ioduria was observed with the use of 1.25% PVP-I except in patients after 48 h (p = 0.01) and with a concurrent conjunctival and periorbital application. The proportion of the excreted iodine in urine ranged from 0.24% to 1.77%. No correlation was found between the total applied concentration of iodine and the amount excreted in urine.

CONCLUSION

Based on our findings, we believe that the use of 10% PVP-I as preoperative ophthalmic antiseptic should undergo further clinical evaluation in regard to its impact on thyroid function. Conjunctival or periorbital application of 1.25% PVP-I does not result in significant ioduria.

Povidone iodine: features of critical systemic absorption

Povidone iodine (PI), a skin antiseptic, is sometimes used internally but this procedure exposes to potentially lethal iodine absorption. Indeed, a 41-year-old woman, with no relevant medical history, developed a transient hypotension, anuric renal failure, hemolysis, coagulopathy and uterine infarction after intra-uterine injection of PI as a dye to check the fallopian tube patency (hydrotubation). Iodemia peaked at 6929 μg/dL (normal range 3.4-8.0 μg/dL), and decreased over the 9 days of renal replacement therapy. Extreme caution should be exercised when PI is in contact with a mucosa, the early recognition of iodine toxicity being of utmost importance to rapidly prompt renal replacement therapy. The main purpose of this report is to highlight the clinical features of PI absorption, whatever the route of administration.

Microbicidal efficacy of povidone-iodine in a noncontact manner applied to a continuous ambulatory peritoneal dialysis connection system

In peritoneal dialysis (PD) the dialysate is introduced into the peritoneal cavity, and the peritoneal membrane is used as the dialysis membrane. In PD, patients exchange the dialysate by themselves through the connection tube attached to the indwelling catheter that is inserted into the peritoneal cavity. Microbes may enter the peritoneal cavity during dialysate exchange, and, therefore, peritonitis is a potential complication of PD. To prevent microbial contamination, the connection tube tip is generally sealed with a protection cap containing povidone-iodine (PVP-I) during the dwelling time. This cap is designed to make direct contact with the tube tip so that microbes attached during dialysate exchange are killed by the next dialysate exchange. However, if excess PVP-I flows into the peritoneal cavity and is absorbed into the body, the complications, including thyroid dysfunction, peritoneal inflammation, and fibrous thickening, can develop. Therefore, in this study, a new manual connection system (Zero System, JMS Co., Ltd., Hiroshima, Japan) for continuous ambulatory peritoneal dialysis was investigated to confirm that the PVP-I solution within the protection cap of the new system would not flow into the fluid passing through the tube. An experiment was also performed to confirm that the microbes on the connector tip become completely nonviable after attachment of the cap for 3 hours. The cap is fitted with a sponge containing a 10% PVP-I solution, the same as for the conventional cap system. However, the system is designed to achieve disinfection without contact, unlike with the conventional system, in which disinfection is achieved by direct contact of the PVP-I-containing sponge with the open end of the attached connector. The test results demonstrated that adequate disinfection with this system can be achieved by the next exchange, while avoiding entry of PVP-I into the peritoneal cavity from the cap. The results suggest that the use of this connection system can avoid adverse reactions arising from the absorption of PVP-I and prevent the onset of peritonitis caused by microbial invasion of the peritoneal cavity.

The transport of chemicals in semen

Three mechanisms have been proposed for exposure of the conceptus to chemicals in semen: access of chemicals to the maternal circulation after absorption from the vagina, direct chemical exposure of the conceptus following transport from the vagina to the uterine cavity, and delivery to the egg and subsequent conceptus of chemical bound to the sperm cell. We review published data for each of these three mechanisms. Human seminal fluid chemical concentrations are typically similar to or lower than blood concentrations, although some antimicrobial agents achieve higher concentrations in semen than in blood. Vaginal absorption of medications has been shown to occur, although the vehicles in which these medications are delivered to the vagina may maintain contact with the vaginal epithelium to a greater extent than does semen. Assuming total absorption of a seminal dose of a chemical with a high semen:blood concentration ratio, distribution within the recipient woman would result in a blood concentration at least three orders of magnitude lower than that in the man. Direct delivery of seminal chemicals into the uterine cavity of humans has not been shown to occur, although it may occur in species such as the rat in which seminal fluid has access to the uterine cavity. Chemicals in or on human sperm cells have been demonstrated with respect to tetracycline and cocaine in vitro and aluminum, lead, and cadmium in vivo. The in vitro cocaine study offers sufficiently quantitative data with which to predict that oocyte concentrations would be five orders of magnitude lower than blood concentrations associated with cocaine abuse, assuming a maximally cocaine-bound sperm were capable of fertilizing. Thus, even using liberal assumptions about transmission of chemicals in semen or sperm, predicted exposure levels of a pregnant woman or of the conceptus are three or more orders of magnitude lower than blood concentrations in the man whose semen is the putative vehicle for chemical transport.

Anaphylaxis to polyvinylpyrrolidone after vaginal application of povidone-iodine

A 59-year-old woman who had had several episodes of contact urticaria after hair treatment, developed anaphylaxis after vaginal application of povidone-iodine solution for disinfection. Prick tests showed wheal-and-flare responses to both povidone-iodine (0.1% aqueous) and polyvinylpyrrolidone (povidone, PVP) (0.001% aq.), but not to iodine or polyoxy-ethyrenenonylphenyl ether, both of which are also contained in povidone-iodine solution. We confirmed that basophils from her peripheral blood released considerable amounts of histamine on stimulation by PVPs. It appeared that both the shampoo and the permanent-wave solution contained polyvinylpyrrolidone N, N-dimethyl aminoethyl methacrylic acid copolymer diethyl sulphate solution and polyvinylpyrrolidone styrene-copolymer emulsion. Both these agents in the hair care products provoked an immediate skin response on prick testing. We speculate that sensitization to PVP had been established by these hair care products at a beauty parlor. She was recommended to avoid PVP-containing products and remained free from symptoms thereafter.

Iodine absorption after intraoperative bowel irrigation with povidone-iodine

PURPOSE

Povidone-iodine is a commonly used intrarectal tumoricidal agent in patients undergoing colorectal surgery. The aim of this study was to assess systemic absorption of total iodine and its effect on thyroid function after intrarectal application.

METHODS

Twenty patients with carcinoma of the rectum received intraoperative irrigation with either povidone-iodine (Group A; n = 10) or physiologic saline (Group B; n = 10). Ten patients with carcinoma of the sigmoid colon (group C) were treated the same as Group A. Electrolyte, total iodine, triiodothyronine, thyroxine, and thyroid-stimulating hormone values were measured in serum preoperatively and before intraoperative irrigation and immediately, ten minutes, 1 hour, 6 hours, 24 hours, and two weeks after irrigation.

RESULTS

No significant changes occurred in serum electrolytes. A significant uptake of the total iodine was demonstrated in each group. Total iodine levels examined immediately, ten minutes, and one hour after irrigation in Group C were significantly higher than those examined in Group B. Maximum values were obtained one hour after irrigation in Groups A and B and six hours after irrigation in Group C. No significant changes occurred in triiodothyronine, thyroxine, and thyroid-stimulating hormone levels among the three groups. The decrease in triiodothyronine levels after surgery was demonstrated in each group. We noted a decrease after surgery in thyroxine levels for Groups A and B and in thyroid-stimulating hormone levels for Group B. Those hormones were not affected by the administration of povidone-iodine.

CONCLUSION

High serum levels of iodine did not cause organ toxicity, suggesting that a single use of intraoperative bowel irrigation with povidone-iodine may be performed with practically negligible risk.

Tests of vaginal microbicides in the mouse genital herpes model

Microbicide candidates were selected that have demonstrated activity against sperm or sexually transmitted disease pathogens in vitro, and the efficacy of these agents for preventing vaginal transmission of genital herpes infection was evaluated in the progestin-treated mouse. Each agent was delivered to the vaginas of mice approximately 20 sec prior to delivering a highly infectious herpes simplex virus-2 inoculum. The following agents provided significant protection: anti-HSV monoclonal antibodies III-174 and HSV8, modified bovine beta-lactoglobulin (beta-69), carrageenan, concanavalin A, chlorhexidine, dextran sulfate (average molecular weight 8,000 and 500,000), fucoidan, neem, nonoxynol-9, polystyrene sulfonate, and povidone-iodine. Two agents, gramicidin and heparan sulfate, though highly effective in vitro, were not protective in vivo at the doses tested.

Effect on neonatal thyroid function of povidone-iodine used on mothers during perinatal period

OBJECTIVE

Our objective was to evaluate the effect on the neonatal thyroid function of povidone-iodine (PVP-I) used on mothers during the perinatal period.

METHODS

Eight consecutive-term pregnant women were randomly separated into 4 groups. Either PVP-1 or benzethonium chloride (BC) was used to disinfect both maternal skin during labor and vaginal lacerations after delivery in Group I and IV; and PVP-1 or BC was supplied to either skin or lacerations in Groups II and III. On day 5, we measured the iodide concentration in breast milk and random urine of neonates, and the levels of neonatal thyroid-stimulating hormone (TSH) and free thyroxine.

RESULTS

The TSH levels in Group I and the breast-milk iodide concentrations in Groups I and II were significantly higher than those in Group IV (p < 0.05). Dietary iodide intake from breast milk correlated significantly with urinary iodide concentrations (r = 0.52, p < 0.001). In our clinic, the recall rate at the time of screening for congenital hypothyroidism was significantly decreased by discontinuing the use of PVP-I (4.47% vs 0.74%, p < 0.001).

CONCLUSIONS

These findings suggest that the use of PVP-I on mothers is associated with transient neonatal hyperthyrotropinemia, in which breast milk might play an important role. Therefore, we recommend that the use of PVP-I be avoided during labor.

Topical iodine-containing antiseptics and neonatal hypothyroidism in very-low-birthweight infants

The thyroid function of very-low-birthweight (VLBW; below 1500 g) infants admitted to neonatal intensive-care units was studied at two hospitals; one routinely used topical iodinated antiseptic agents and the other used chlorhexidine-containing antiseptics. Serial monitoring of urinary iodine excretion and serum thyrotropin and thyroxine levels was undertaken from birth for the first 4 weeks of life. Urinary iodine excretion rose dramatically in the 54 iodine-exposed infants and was up to fifty times greater than in the 29 non-exposed infants. Within 14 days, 25% (9 of 36) of the infants exposed to iodine had serum thyrotropin levels above 20 mIU/l, compared with none of the control group. The mean serum thyroxine level in these 9 infants (44.1 nmol/l) was significantly lower than that in exposed infants with normal thyrotropin levels (83.1 nmol/l) and in the non-exposed control group (83.0 nmol/l); thyroxine levels fell before serum thyrotropin rose. These disturbances in thyroid function correlated positively with urinary iodine excretion and hence iodine absorption. Thyroid function had returned to normal by the time of discharge from hospital. It is concluded that iodine absorption, from topical iodine-containing antiseptics, may cause hypothyroidism during a critical period of neurological development in the newborn infant. The routine use of iodine antisepsis in VLBW infants should be avoided because of this effect.

Sterile technique and the prevention of wound infection in office surgery--Part II

Surgical infection and associated complications are minimized by a combination of appropriate sterile technique and careful surgical technique. This review covers the essential elements of infection control for the office-based surgical practice. Recommendations are made concerning operating room facilities, instrument sterilization, and tray set-up (Part I, J Dermatol Surg Oncol 14:1364-1371, 1988). Part II addresses surgical prepping, surgical technique, and prophylactic antibiotics.

The intravaginal absorption of male generated hormones and their possible effect on female behaviour

In this paper I hypothesize that a woman through her vagina absorbs sufficient quantities of the prostaglandins from her partner's semen, to affect her mood. The vagina appears to have an active transport mechanism which readily absorbs the hormones found in seminal plasma. The seminal secretions include estrogens, F.S.H., LH, testosterone, and at least 13 prostaglandins. Prostaglandins have a modulating effect on neurotransmitters. Evening Primrose Oil (E.P.O., Efamol) may improve depressed mood by facilitating the production of prostaglandins. I have described a depressed, child abusing mother who was possibly getting insufficient exogenous prostaglandins post-partum to maintain her pre-partum mood state because she was avoiding intercourse with her husband. When her mood improved on E.P.O., she began enjoying her husband and her child. If these observations and deductions are correct, regular amounts of seminal plasma may be important in maintaining a woman's affective health and E.P.O. may be useful in treating depressed abusing mothers.

Chemical and microbiologic characteristics and toxicity of povidone-iodine solutions

The chemical, microbiologic, and toxic characteristics of povidone-iodine solution, a commonly used antiseptic agent, are addressed in a collective review of relevant works published from 1956 to the present. Interactions of this agent with the thyroid gland and the kidneys and its toxicity at the cellular and systemic level are discussed.

Allergic contact dermatitis from povidone-iodine

A patient developed an erythematous papular, vesicular rash after application of povidone-iodine 10% solution used as a surgical antiseptic. Patch testing revealed positive responses to povidone iodine 10 and 5% in water; 25 controls were negative. Patch testing with iodine, 0.5% in ethanol gave negative results.

[Changes in iodine metabolism in patients with burns treated topically with PVP-iodine]

Under exposure treatment of 33 burn patients with povidone-iodine (polyvinylpyrrolidon-iodine) preparations (Betaisodona ointment and solution) massive absorption of the iodine by the body and temporary changes in the thyroid hormones (T3 and T4 lowered, TSH raised) were found. No other clinical or laboratory-chemical side effects were observed in the patients. TRH stimulation test was carried out on 18 patients 3-6 months after ceasing povidone-iodine application. The results showed normoreaction of the hypothalamus-pituitary regulation. Povidone-iodine topical treatment of the burn patients involves them in substantial exposure to iodine, but offers no additional risk to the patients.

Handwashing and skin. Physiologic and bacteriologic aspects

Handwashing practices are often based on tradition and belief. To develop sound rationale for handwashing practices, the physiologic and bacteriologic effects of handwashing must be examined. The purposes of this article are to review the three major microenvironments of the skin with their bacterial flora, to discuss physiologic and bacteriologic characteristics of the skin with particular reference to handwashing, and to describe current handwashing recommendations and practices.

Effects of drugs and chemicals on the fetus and newborn (2)

Physicians have become increasingly aware of the side effects of specific drugs. Obstetricians and family physicians should especially be cognizant of the implications of the administration of any drug, not only for the pregnant mother but also for the unborn child. In this second installment of our two-part article, we conclude our review of drugs, chemicals, and environmental pollutants that may affect the fetus or newborn.

Surgical antiseptics

The skin cannot be sterilized because approximately 20% of the resident flora are beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Four antiseptics which have been popular over the past two decades are discussed. Benzalkonium chloride is somewhat unstable on the skin and is too prone to contamination to be in general use. Hexachlorophene is not recommended due to narrow spectrum and risks secondary to percutaneous absorption. The iodophors are excellent antiseptics, but recent studies raise questions about effectiveness and contamination. Chlorhexidine is a very safe and effective antiseptic. Comparison studies with chlorhexidine, hexachlorophene, and iodophors show chlorhexidine to be the most effective agent. Chlorhexidine can be toxic to the middle ear and irritating to the eyes with direct contact. Caution should be used in these areas with chlorhexidine and other antiseptics.