Povidone Iodine: Properties, Mechanisms of Action, and Role in Infection Control and Staphylococcus aureus Decolonization

Chlorhexidine for ocular antisepsis before intravitreal injection: A systematic review and meta-analysis

Povidone-iodine (PI) is the gold standard for pre-intravitreal injection ocular antisepsis. Chlorhexidine (CHX) is an emerging alternative with less ocular irritation. This meta-analysis aims to evaluate post-injection endophthalmitis rates with the use of CHX compared to PI. A systematic search of PubMed, Embase, and Scopus was performed for studies published between January 1, 2000 and February 21, 2024. Data on the number of injections and endophthalmitis cases were analyzed. A sample-size weighted mean difference (MD) meta-analysis was performed using RevMan 5.4.1, p < 0.05 was considered statistically significant. Five studies including 230,656 injections were pooled to determine an endophthalmitis rate of 0.0003 [95 % CI, 0.0001-0.0005] with preinjection CHX antisepsis. Three studies included an additional PI branch and thus were used for secondary meta-analysis comparing CHX against PI. The analysis consisted of 185,799 injections in the CHX group and 269,441 injections in the PI group. No significant difference in the weighted relative risk of endophthalmitis with CHX was found (RR = 1.27 [95 %CI 0.50-3.22], p = 0.62). A total of 24 and 31 cases of culture-positivity were recorded in the CHX and PI groups respectively but no significant difference in weighted means was found (RR = 1.42[95 %CI 0.96-2.12], p = 0.08). This meta-analysis disclosed that the rate of post-IVI endophthalmitis while using CHX antisepsis is approximately 1 in 3937 injections, compared to 1 in 3906 with PI. CHX was not associated with a significant difference in the rate of endophthalmitis or culture-positivity compared to PI.

A review of advancements in antiseptics for wound care in diabetic and non-diabetic patients

Wounds affect many people and require a considerable annual cost to manage. Wound infections significantly delay the healing process, particularly in individuals with diabetes mellitus, due to impaired immunity and microvascular complications. The use of antiseptics is considered a way to reduce this problem. The study aims to assess the different antiseptic categories frequently employed in wound management, focusing on identifying and understanding their unique features. A comprehensive review of PubMed, Scopus, and EMBASE databases identified key antiseptics, including isopropyl alcohol, chlorhexidine, polyhexanide, octenidine, povidone-iodine, hypochlorous acid, silver-based products, hydrogen peroxide, triclosan, and benzalkonium chloride. These antiseptics exhibit varying efficacies and cytotoxicity profiles, necessitating tailored usage to optimize healing while preventing antimicrobial resistance. The primary indication for antiseptics is the prevention of Surgical Site Infections (SSIs), as recommended by guidelines. For diabetic foot ulcers, the strongest evidence supports the use of hypochlorous acid. There are no universal recommendations for antiseptic use; their application depends on specific circumstances. This review highlights the need for evidence-based, condition-specific antiseptic strategies to address unique patient needs effectively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01607-7.

Effect of perioperative disinfection and isolation measures in infection control after gastrointestinal surgery: A retrospective analysis

BACKGROUND

The application of perioperative disinfection and isolation measures to patients undergoing gastrointestinal surgery with postoperative infection can provide a data reference for reducing the postoperative infection rate, improving postoperative biochemical markers, and enhancing postoperative recovery outcomes.

AIM

To explore the effectiveness of perioperative disinfection and isolation measures in controlling postoperative infection following gastrointestinal surgery. It also sought to compare infection rates and biochemical markers between the observation and control groups and evaluate the impact of disinfection and isolation measures on reducing postoperative complications.

METHODS

A retrospective analysis was conducted. Ninety-six patients who underwent gastrointestinal surgery between January 2022 and December 2023 were selected and divided into an observation group and a control group, with 48 cases in each. The observation group received disinfection and isolation measures during the perioperative period, whereas the control group received standard nursing care. The incidence of infection, white blood cell count, C-reactive protein levels, hemoglobin levels, and liver function markers (alanine aminotransferase, aspartate aminotransferase, creatinine, and blood urea nitrogen) were monitored postoperatively in both groups.

RESULTS

The postoperative infection rate in the observation group was significantly lower than that in the control group (P < 0.05). White blood cell and C-reactive protein levels decreased significantly after surgery in the observation group and were significantly lower than those in the control group (P < 0.05). Alanine aminotransferase, aspartate aminotransferase, creatinine, and blood urea nitrogen levels in the observation group were lower than those in the control group on postoperative days 1 and 3, showing a significant difference (P < 0.05).

CONCLUSION

Perioperative disinfection and isolation measures effectively reduce postoperative infection rates in gastrointestinal surgery patients and improve biochemical markers, thereby enhancing recovery outcomes. This study provides a valuable basis for postoperative infection control and has significant clinical applications.

Impact of Preoperative Povidone Nasal Swab on the Incidence of Surgical Site Infection: An Observational Study

OBJECTIVES

Surgical site infections (SSIs) are the most common hospital-acquired infections in the United States, of which methicillin-resistant Staphylococcus aureus (MRSA) accounts for 43%. Preoperative povidone-iodine nasal swab (PNS) is considered an effective and cost-saving treatment for Staphylococcus aureus decolonization. We aim to assess the impact of preoperative PNS on SSI incidence.

MATERIALS AND METHODS

This retrospective observational study utilized elective surgical cases between January 1, 2018 and May 31, 2023, at a single academic medical center. The cohort was divided into PNS and no PNS groups. The cohort was propensity-matched, and Pearson χ2/Kruskal-Wallis tests were performed to compare group differences. Multivariable logistic regression was utilized to compare events between cohorts before and after matching. An alpha of <0.05 was considered significant.

RESULTS

A total of 45,998 (22,999 per group) matched participants were evaluated. On multivariate regression, the non-PNS treatment group was associated with an increase in hospital overall SSI occurrence (OR: 1.48, P= 0.02) but not specifically in-hospital methicillin-sensitive Staphylococcus aureus SSI, MRSA-SSI, or any 30-day SSI (P> 0.05). Compared with PNS treatment and prophylactic antibiotics, in-hospital SSI was higher in the absence of PNS treatment (OR: 1.83, P< 0.001), antibiotic (OR: 2.63, P< 0.001), or both (OR: 2.06, P< 0.01). Compared with PNS treatment plus prophylactic antibiotic, in-hospital MRSA-SSI was only higher in the absence of antibiotic (OR: 2.92, P< 0.01) treatment.

CONCLUSIONS

Preoperative treatment with PNS may reduce overall in-hospital SSI but has no independent impact on MRSA SSI.

Povidone-Iodine and Hydrogen Peroxide Combination Improves the Anti-Biofilm Activity of the Individual Agents on Staphylococcus aureus

Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA), poses significant challenges in healthcare settings due to its ability to form biofilms on various surfaces. These biofilms enhance bacterial survival and increase resistance to conventional treatments, complicating infection control efforts. This study evaluated the efficacy of combined povidone-iodine (PVP-I) and hydrogen peroxide (H2O2) to disrupt pre-formed S. aureus biofilms. A series of assays-including crystal violet staining, colony-forming unit (CFU) enumeration, gene expression analysis, and confocal laser scanning microscopy-were performed to assess the effects of each treatment individually and in combination. The combined treatment resulted in significantly greater reductions in biofilm biomass and viable bacteria compared with either agent alone. Gene expression analysis revealed downregulation of key biofilm-associated genes (icaA, icaB, icaD, icaR, and clfA), suggesting interference with biofilm stability and maintenance. While formal synergy quantification was not conducted, the observed effects suggest a potentially synergistic or additive interaction between the two agents. These findings support the use of dual antiseptic strategies as a promising approach to biofilm eradication and highlight the potential clinical utility of dual antiseptic strategies. However, we underscore the need for further optimization and safety evaluation.

Spontaneous Cell Detachment from Temperature Gradients: Getting the Method Ready for Antimicrobial Drug Testing at Cell Culture Level

Spontaneous cell detachment describes an effect in which eukaryotic cells first sediment onto a heated chip and then detach from it spontaneously and collectively after a sharply defined dwell time td. This behavior is triggered by the temperature gradient between the chip and the colder supernatant liquid. Notably, td allows distinguishing between different yeast strains and cancer-cell lines. At the same time, it also varies in the presence of nutrients and cytotoxins, suggesting an added value of this method for pharmacological studies. In the present work, we study the role of fluid convection on the detachment of yeast cells experimentally and by simulations using a sample compartment with a variable aspect ratio. Hereby, we found that the absolute chip temperature, the strength of the temperature gradient and the number of cells inside the sample compartment all affect the dwell time td. To demonstrate the concept, we show that the spontaneous-detachment method can measure the impact of an antibiotic and an antiseptic drug on yeast cultures and corroborate this with reference assays.

Reducing rates of endophthalmitis from intravitreal injections - strategies and areas of controversy

PURPOSE OF REVIEW

Post-injection endophthalmitis (PIE) is the most concerning complication that accompanies intravitreal injections. This review discusses the recent literature in endophthalmitis prophylaxis including types of antisepsis, the use of topical antibiotics, methods of anesthesia, masking, and office-based versus operating room-based injections.

RECENT FINDINGS

Povidone iodine (PI) remains the gold standard for PIE prophylaxis. Chlorhexidine gluconate (CHG) is an alternative antiseptic agent utilized in other areas of medicine with similar broad spectrum antibacterial activity. Recent clinical trials have demonstrated that the rate of endophthalmitis is similar with CHG prophylaxis compared to PI prophylaxis while offering improved patient comfort at a similar cost. Routine use of topical antibiotics should be avoided as they do not appear to reduce endophthalmitis risk and may promote bacterial resistance. All methods of anesthesia appear to be acceptable. In-office injections are not associated with an increased rate of endophthalmitis compared to operating room injections.

SUMMARY

The rate of post-injection endophthalmitis is extremely low due to a myriad of measures employed by retina specialists. Topical antisepsis is the most important tool to combat post-injection endophthalmitis. CHG is emerging as an alternative to PI due to its efficacy and enhanced patient comfort.

In vitro efficacy of aqueous PVP-iodine solution below 5% as alternative to preoperative antisepsis in ophthalmology as the basis for an in vivo study

PURPOSE

Pre-operative antisepsis of the conjunctiva is indicated prior to intraocular surgery to prevent post-interventional endophthalmitis. In Germany, antisepsis with 5% povidone-iodine (PI) aqueous solution is explicitly required prior to intravitreal injections (IVI), and also generally recommended for intraocular surgery. However, this concentration often leads to a foreign body sensation and an unpleasant burning in combination with dry eye symptoms. Postoperative eye pain, persistent corneal epithelial defects, and a risk of keratitis are further side effects. Due to the repetitive nature of IVI, these symptoms are particularly present in IVI patients. A reduced concentration may be favorable to decrease patient discomfort. A 1.25% PI solution does not increase the iodine concentration in the aqueous humor and is also used for prophylaxis of ophthalmia neonatorum and for preoperative antisepsis; in both cases the renal iodine excretion stays in a physiological range thus thyroid diseases are no contraindication for its use. Thus, the efficacy of reduced concentrations of PI should be evaluated in vitro.

METHODS

PI with dilutions below 5% (0.625 - 2.5% serial 1:2 dilution) was tested in vitro in a quantitative suspension assay and in a quantitative carrier test without and with addition of matrices to identify their antimicrobial effect against Staphylococcus epidermidis, Pseudomonas aeruginosa, Cutibacterium acnes and Candida albicans.

RESULTS

No differences in the antimicrobial effect was seen due to reduced concentrations of PI in comparison to a 5% solution. However, a trend was seen regarding the required contact time of the antiseptic solution.

CONCLUSION

The in-vitro tests have shown adequate antisepsis of 1.25% PI prior to intraocular surgery. However, it is important to pay attention to a sufficient contact time of the antiseptic of about 1 min before ophthalmologic intervention. In order to give final recommendations, in vivo testing is needed to build a robust data foundation.

In-Vitro Determination of Minimum Inhibitory Concentration (MIC) and Contact Time of Povidone-Iodine against Staphylococcus aureus and Klebsiella aerogenes Using Micro Suspension Test, Colorimetric Resazurin Microplate Assay, and Dey Engley Neutralizer Assay

Background and Objective

The human nasal passages host major human pathogens. Recent research suggests that the microbial communities inhabiting the epithelial surfaces of the nasal passages play a key factor in maintaining a healthy microenvironment by affecting both resistance to pathogens and immunological responses. Colonization of the nasal cavity by different pathogens such as Staphylococcus aureus and Klebsiella aerogenes, is associated with a higher postoperative infection morbidity. Povidone-iodine (PVP-I) as an antiseptic has been proven to display high antibacterial, antiviral, and antifungal properties even at low concentrations, and was shown to be effective in the control of infections to limit their impact and spread. It can be used as a topical antiseptic for skin decontamination and wound management, as a nasal spray, or as a gargle. There are different methods in testing the efficacy of potential antimicrobial suspensions. This study aimed to determine the concentration of PVP-I that is most effective in nasal decolonization using microsuspension test and colorimetric minimum inhibitory concentration (MIC) determination assays, resazurin microtiter assay (REMA), and Dey-Engley (D/E) neutralizer assay. The findings of this study will contribute to knowledge regarding the intended use of PVP-I in microbial control, particularly in bacterial infections.

Methods

Several dilutions (2.0%, 1.0%, 0.5%, 0.25%, 0.1% and 0.09%) of commercially bought 10% (10 mg per 100 ml) povidone-iodine were prepared and tested against a standardized inoculum (1x105) of Staphylococcus aureus and Klebsiella aerogenes at different contact times (5 seconds, 10 seconds, 30 seconds, 1 minute, and 5 minutes). Microdilution suspension test was performed to determine the log reduction per variable, while REMA and D/E neutralizer assay were used to determine the MIC. A value of greater than or equal to 5 log reduction was considered effective for microdilution suspension test. Estimates of agreement statistics were used to interpret the results of the assay in which the overall percent agreement (OPA), positive percent agreement (PPA), negative percent agreement (NPA), and Cohen's kappa statistics were calculated.

Results

Povidone-iodine concentration of 0.25% exhibited ≥5 log reduction against K. aerogenes at the minimum contact time of 5 seconds. On the other hand, a slightly higher PVP-I concentration was required to achieve ≥5 log reduction for S. aureus at 0.5% concentration and a minimum contact time of 1 minute. There was an observed concordance of the results of REMA and D/E neutralizer as MIC colorimetric indicators, which yielded an overall test percent agreement of 90.30% (95% CI: 84.73-94.36), and a strong level of agreement (Κ = 0.8, p<0.0001). A lower overall percent agreement for both REMA and D/E neutralizer versus the microsuspension test was observed at 79.17% (Κ = 0.57, p<0.0001) and 78.18% (Κ = 0.55, p<0.0001), respectively.

Conclusion

Low povidone-iodine concentrations (i.e., 0.5% against S. aureus and 0.25% against K. aerogenes) were observed to have bactericidal activity of at least 5 log reduction as rapid as the minimum contact time of 5 seconds. Furthermore, D/E and REMA, as colorimetric indicators, had comparable performance (OPA = 90.30%; Κ = 0.8, p<0.0001) suggesting that both REMA and D/E neutralizer assay may detect the same range of minimum inhibitory concentration for the organisms and disinfectant tested in this study.

Intra-peritoneal Povidone-iodine Irrigation Decreases Abscesses in a Perforated Appendicitis Murine Model

BACKGROUND

Children with perforated appendicitis frequently form post-operative intra-abdominal abscesses (IAA). Intra-peritoneal irrigation for prevention remains controversial. Using a perforated appendicitis murine model, we sought to determine the effect of intra-peritoneal irrigation on post-operative IAA and adhesion formation.

METHODS

A survival operation was performed where cecal ligation and puncture was used to simulate perforated appendicitis. After 72 h, mice underwent a second operation where a distal cecectomy and intra-peritoneal irrigation was performed. Mice were assigned to a no irrigation group or one of four irrigation groups: normal saline, povidone-iodine (PVI), tacrolimus, or PVI followed by tacrolimus. At 2-weeks or 2-months after the second survival operation, mice were euthanized and IAAs were counted, measured, and cultured. Intra-peritoneal adhesion severity was graded on a 4-point scale. Statistical analysis compared IAA numbers and adhesion grade between the irrigation groups.

RESULTS

In the 2-week cohort, prevalence of IAA was 78 % (n = 129). Type of irrigation solution was associated with abscess development (p < 0.001). Pairwise comparisons demonstrated PVI alone decreased abscess count. PVI irrigation caused more severe adhesions while tacrolimus decreased adhesions and adhesion grade was dependent on irrigation solution (p < 0.001). In the 2-month cohort, similar responses were observed with decreased abscess numbers in the PVI group (p = 0.006) but increased adhesion burden (p = 0.002).

CONCLUSION

Povidone-iodine irrigation decreases intra-abdominal abscess formation, but increases adhesion formation.

LEVEL OF EVIDENCE: 1

Use of Supplemented Medical-Grade Honey to Treat Traumatic Skin Injuries in Geriatric Patients in a Home-Care Setting

Background Traumatic skin injuries (TSI) are more common to geriatric population due to reduced skin elasticity and increased gait instability. This is also associated with an altered wound-healing mechanism thus requires a cost-efficient and effective treatment. Therefore, the aim of the present study is to highlight the efficacy of medical-grade honey (MGH) supplemented with vitamins C and E for the conservative treatment of TSI in a home-care setting. Methodology The present multicenter retrospective case series study included 10 geriatric patients (four men and six women) who sustained TSI of various etiologies. The median age of the patients was 82.5 years (min-max: 65-90 years). Cardiovascular disease was the most frequent concomitant illness (50% of the patients). Previous treatments with povidone-iodine, alginate gel, or simple gauze for 5.5 days (median, min-max: 0-21 days) were ineffective. Treatment with a variety of supplemented MGH products, including ointment, wound gel, gauze, and foam, was commenced upon the initial patients' examination. Results By using MGH products, we achieved effective reduction of the inflammation, removal of the necrotic tissue, and formation of healthy granulation and epithelial tissue. MGH eliminated clinical signs of infection after 7.5 days (median, min-max: 5-35 days). Wounds were completely healed after 21 days (median, min-max: 14-56 days), without evidence of recurrence or complications, and with good functional and aesthetic outcomes. Conclusions Supplemented MGH-based products present high clinical efficacy for the treatment of TSI in older adults in a home-care setting, while demonstrating a safe and easy-to-use profile. Therefore, they can be proposed as an alternative or complementary therapeutic approach to conventional TSI therapies.

Dilute Povidone-Iodine Irrigation: The Science of Molecular Iodine (I2) Kinetics and Its Antimicrobial Activity

Dilute povidone-iodine (polyvinylpyrrolidone iodine [PVP-I]) irrigation in spine surgery and total joint arthroplasty has seen a rapid and substantial increase in its use during the past decade. Yet, most surgeons do not know the chemistry and biochemistry that explain its efficacy in preventing infections. PVP-I forms a complex with molecular iodine (I2), facilitating the delivery of I2 to the membrane of the infectious organism. Here, PVP-I establishes an equilibrium between complexed and noncomplexed (free) I2 in the aqueous solution. The I2 acts at numerous cellular targets of infecting organisms augmenting its role as a biocidal molecule. The paradoxical increase in the concentration of I2 that occurs with dilution of PVP-I is a result of equilibrium kinetics and is associated with an enhanced antimicrobial activity. Cytotoxicity studies have yielded conflicting results, but most endorse diluted concentrations as being less damaging to tissues. Clinical studies have verified notable reductions in surgical site infections with a 3-minute soak of 0.35% dilute povidone-iodine irrigation. Guidelines from the World Health Organization, Centers for Disease Control and Prevention, and International Consensus Meeting on Musculoskeletal Infection support the use of prophylactic incisional wound irrigation with aqueous PVP-I to reduce and prevent surgical site infections.

Spine surgical site infection outcome with preoperative application of a presaturated 10% povidone-iodine nasal decolonization product in a 32-bed surgical hospital

BACKGROUND

To pursue an irreducible minimum overall surgical site infection (SSI) rate, a 32-bed surgical hospital employed an outside consultant and performed sterile processing and surgery internal audits: No obvious improvements were identified. A 10-year review determined that 70% of SSI's were spine procedure patients. After a nasal decolonization product literature review, an intervention was implemented. The purpose of this study was to assess if the intervention impacted spine SSI rates.

METHODS

A 36-month implementation science study was conducted. The 18-month intervention was the immediate preoperative application of a manufactured presaturated 10% povidone-iodine nasal decolonization product in spine surgery patients, with monthly product application documentation surveillance feedback to the preoperative staff. Chi-square test was used to determine the difference in types of spine SSI surgery rates pre and post intervention.

RESULTS

Overall spine SSI decreased 35.7% (P = .04) with a 58.7% reduction in superficial incisional SSI (P = .02). The 16.1% decline in deep incisional SSI was not significant (P = .29).

CONCLUSIONS

Within this hospital, conducting 7,576 surgical spine procedures over 36 months, with the immediate preoperative application of a presaturated 10% povidone-iodine nasal decolonization product, the only intervention in SSI prevention protocol, produced a statistically significant decrease in spine patient SSI rate percent.

Comparison of the Efficacy of Povidone-Iodine with Mupirocin in Decolonizing Staphylococcus aureus from the Nasal Cavity of Healthcare Workers: A Single-Blinded Randomized Controlled Trial

BACKGROUND

Nasal colonization of Staphylococcus aureus increases the risk of nosocomial infections. Therefore, medications that can decolonize this pathogen can help prevent such infections.

OBJECTIVE

Our study aimed to compare the efficacy of povidone-iodine solution with intranasal mupirocin ointment in decolonizing S. aureus from the nasal cavity of healthcare workers.

METHODS

This single-blinded randomized controlled trial was conducted on healthcare workers carrying S. aureus nasally. After confirming nasal colonization through culture tests, participants were assigned to intervention groups A and B with an allocation ratio of 1:1. Group A received intranasal mupirocin ointment twice daily for five days, while group B received intranasal povidone-iodine solution twice daily for five days. After the decolonization period, samples were taken to compare the efficacy of both interventions in decolonizing S. aureus.

RESULTS

In this study, 54 healthcare workers with a mean age of 39.37±7.80 years were included, 42.6% and 57.4% of whom were male and female, respectively. They were randomly assigned to each of the intervention groups. After the intervention, individuals who received povidone-iodine had significantly more positive cultures than those who received mupirocin (37.0% vs. 11.1%, P = 0.026). Additionally, factors such as age, gender, wards, and employment duration may affect the efficacy of mupirocin and povidone-iodine in decolonizing S. aureus from the nasal cavity.

CONCLUSION

The study findings revealed that both mupirocin and povidone-iodine were effective in decolonizing S. aureus from nasal carriers. However, mupirocin was more effective compared with povidone-iodine.

CLINICAL TRIAL REGISTRATION NUMBER

IRCT 20170417033487 N2.

Reduction in Balloon Pump Size Reduces Axillary Intraaortic Balloon Pump Failure Risk

Axillary artery intra-aortic balloon pump (axIABP) placement has been implemented as a bridging solution before heart transplantation. This study evaluates complications associated with axIABP support and describes an approach to minimize adverse events. We previously described a percutaneous approach for axIABP placement. However, patients receiving axIABP between September 1, 2017, and September 26, 2019 (n = 32) demonstrated a high rate of balloon pump malfunction (8/32; 25%) and other complications (totaling 15/32; 47%). Sixty-four patients were sequentially treated under a revised protocol. Compared to the initial cohort, no significant differences in demographics were noted. A significant reduction in rate of balloon malfunction (8/32, 25% vs. 1/64, 2%; p < 0.001) and total complications (15/32, 47% vs. 10/64, 16%; p = 0.0025) during the period of support were noted after intervention. Subsequent analysis of total complications per device size (40 vs. ≤ 34 ml balloon) revealed significantly reduced complications in patients with smaller devices (40% vs. 13%, respectively; p = 0.0022). This study provides guidelines to limit complications in patients supported with axIABP, facilitating a protracted period of bridging support.

Chlorhexidine gluconate versus povidone-iodine for nasal bacteria decolonization before transsphenoidal surgery in patients with pituitary neuroendocrine tumors: a prospective, randomized, double-blind, noninferiority trial

BACKGROUND

This study aimed to compare the nasal decolonization efficacy and comfort between chlorhexidine gluconate (CHG) and povidone-iodine (PVP) to provide an evidence basis for clinical guidance.

METHODS

A prospective, randomized, single-blinded, noninferior clinical trial was conducted in 174 patients with pituitary neuroendocrine tumors (PitNETs) who were scheduled to undergo transsphenoidal surgery. The noninferiority margin was δ=-0.1. The primary outcome was the effective rate of disinfection. The secondary outcomes included postoperative inflammatory indicators, the intracranial infection rate, and the proportion of intracranial infection.

RESULTS

The effective clearance rate of postoperative nasal bacteria was nonsignificantly different between the CHG and PVP groups (88.64% vs. 82.56%; between-group difference 6.10%; 95% CI [-5.30 to 17.50]). There was no significant difference in the incidence of postoperative central nervous system infections or serum inflammation-related indications between the two groups, but sterilization tended to occur quicker and last longer in the CHG group. CHG seemed to have advantages in terms of comfort, including less nasal irritation, less pungency, and better intranasal coloration.

CONCLUSION

CHG and PVP have equal efficacy in nasal decolonization before transsphenoidal surgery, but CHG seems to have comfort-related advantages in terms of less nasal irritation, less pungency, and better intranasal coloration.

Effective Eradication of Mouse Norovirus and Helicobacter spp. in Laboratory Mice (Mus musculus) via Iodine Immersion and Cross-Fostering Technique

Eradication of pathogens from mouse colonies is crucial for scientific research reproducibility and animal welfare. The previously described techniques for eradicating pathogens by rederivation through embryo transfer or caesarian technique can be costly and technically challenging. The objective of our study was to assess the efficacy of iodine immersion combined with cross-fostering for eradicating murine norovirus (MNV) and Helicobacter spp. in laboratory mice. The iodine immersion technique was modified to prevent pathogen transmission and reduce the risk of cannibalism. The hypothesis of this study was that iodine immersion combined with cross-fostering of pups would be as effective at eliminating MNV as it is at clearing Helicobacter in laboratory mice. This study was performed on newborn litters of various mice strains housed in a room positive for both these pathogens. The pups were immersed in warmed, diluted iodine within 48 h of birth, and then cross-fostered to a Swiss Webster dam negative for MNV and Helicobacter. The presence of MNV and Helicobacter in donor dams, weanlings, and adult post-immersion animals was tested using fecal PCR. All 27 litters born to MNV- and Helicobacter-positive dams tested negative for both pathogens at weaning and at 8 wk postweaning. Follow-up PCR exhaust dust testing from the housing racks confirmed a negative status for MNV and Helicobacter over multiple quarterly pathogen screening tests conducted over an 18-mo period. This study is, to our knowledge, the first to demonstrate successful eradication of MNV through iodine immersion combined with cross-fostering, proving this method to be effective for eliminating MNV and Helicobacter spp. in affected colonies.

Effect of Bacterial Nanocellulose with Chemisorbed Antiseptics on Alveolar Bone Repair in Rats Undergoing Bisphosphonate Therapy

Objectives: This work investigated the effect of bacterial nanocellulose (BNC) alone or with chemisorbed chlorhexidine or povidone-iodine on post-tooth extraction repair in rats undergoing bisphosphonate therapy. Methods: Forty Wistar rats were treated with zoledronic acid, subjected to tooth extractions and allocated into groups according to the material inserted in the post-extraction socket: (1) BNC (n = 10); (2) BNC/Iodine (n = 10); (3) BNC/Chlorhex (n = 10); (4) Control (n = 10). Maxillae were dissected and macro- and microscopically analyzed. Results: Oral lesion frequency on macroscopic examination did not differ between the groups, whereas it was larger in the BNC/Iodine group compared to the BNC/Chlorhex and Control. BNC/Chlorhex had significantly more connective tissue than did BNC but did not differ from the BNC/Iodine and Control. Epithelium, vital bone, non-vital bone, tooth fragment and inflammatory infiltrate did not significantly differ between the groups. BNC/Iodine showed greater CD31 immunostaining compared to BNC and the Control. Myeloperoxidase staining did not differ between the groups, and scanning electron microscopy analysis showed similar characteristics in all groups. Conclusions: BNC with chemisorbed povidone-iodine is associated with increased vascularization in post-extraction wounds of rats undergoing bisphosphonate therapy, whereas BNC with chemisorbed chlorhexidine improves connective tissue formation. BNC works as an effective carrier for the antiseptics tested.

Synthesis, physicochemical properties and antimicrobial activity of a di-aminopropionic acid hydrogen tri-iodide coordination compound

OBJECTIVE

The objective of this study is to synthesize and comprehensively characterize a novel iodine-containing coordination compound, di-aminopropionic acid hydrogen tri-iodide. This involves determining its structural, physicochemical, and thermal properties, as well as evaluating its antimicrobial activity against a range of bacterial strains, including multidrug-resistant pathogens. The aim is to explore the potential of this compound as a candidate for developing new antibacterial agents to address the challenge of antibiotic resistance.

RESULTS

An original iodine-containing semiorganic coordination compound was synthesized and characterized. The physicochemical properties were studied via diffraction, FTIR spectroscopy and thermogravimetric/differential scanning calorimetry (TG/DSC). In vitro antimicrobial activity evaluation was performed using two-fold serial dilution method. The obtained results demonstrated efficiency against both gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii) bacteria including MDR strains that cause infectious disease. The results of the antibacterial evaluation revealed that the new iodine coordination compound - di-aminopropionic acid hydrogen tri-iodide possesses high bactericidal properties and exhibits better antimicrobial activity against both susceptible and multidrug-resistant strains than does Lugol solution and ampicillin sodium, which are used as reference drugs.

Povidone-iodine-induced scalp lesions in pediatric neurosurgery patients: a case series

PURPOSE

Povidone-iodine, or Betadine® (Atlantis Consumer Healthcare Inc., Bridgewater, NJ), is a commonly used agent for surgical site preparation. Although commonly used, it carries the risk of skin reactions, and multiple cases of intra-operative contact dermatitis and chemical burns have been reported. However, to our knowledge, there are currently no published cases of povidone-iodine-induced skin lesions in neurosurgical patients.

METHODS

A single-center retrospective chart review was performed to identify patients who developed scalp lesions secondary to chemical toxicity following neurosurgical procedures between October 1, 2021, and June 30, 2024.

RESULTS

Three patients were identified, ranging from 2.5 months to 14 years old. Two were positioned prone and the third in lateral decubitus. All patients' heads were supported by a horseshoe headrest covered with a gel pad and wrapped in a cotton roll. For two patients, Reston™ foam (3M©, St. Paul, MN) was added on the horseshoe. Surgical sites were prepped with isopropyl alcohol, Betadine®, and chlorohexidine. Two patients had their heads intermittently lifted throughout the procedure. Lesions were identified immediately after returning the patient to the supine position in the operating room and steadily improved over the course of one to five months with local wound care.

CONCLUSIONS

Careful preparation of the surgical site is an essential step in the prevention of surgical site infections. However, caution should be exercised during skin preparation to avoid pooling of povidone-iodine around dependent regions. Additional steps, such as scheduled head elevations and pressure dispersion, should be taken to mitigate factors contributing to these lesions.

Povidone iodine-infused pars plana vitrectomy for severe Arthrographis kalrae fungal endophthalmitis

Purpose

Arthrographis kalrae is an opportunistic fungus that can cause a severe and atypical endophthalmitis. In limited studies, low-dose povidone iodine has been shown to be effective in treating fulminant bacterial endophthalmitis. In this case report, we describe the successful treatment of recalcitrant Arthrographis kalrae keratitis-associated endophthalmitis with intraocular povidone iodine during pars plana vitrectomy.

Observations

A patient with Arthrographis kalrae keratitis-associated endophthalmitis had persistent disease despite aggressive medical management. The infection resolved following pars plana vitrectomy with infusion of dilute povidone iodine. No toxicity was noted postoperatively.

Conclusions and importance

Povidone iodine-infused pars plana vitrectomy offers promise as a treatment for infectious endophthalmitis that fails medical management. This is the first report demonstrating eradication of fungal endophthalmitis using povidone iodine-infused pars plana vitrectomy.

Efficacy of 1% Povidone-Iodine in the Treatment of Anterior Blepharitis-Randomized Single-Center Controlled Trial

Background: Anterior blepharitis (AB) is a chronic eyelid inflammation with no definitive cure. Objectives: To assess the safety and efficacy of a 1% povidone-iodine (PVI) ophthalmic solution lid scrub compared to formulated eyelid wipes in treating AB. Design: A prospective, randomized, controlled, observer-masked, paired-eye trial. Methods: Sixty-three AB patients were randomly assigned to a 30-day treatment in which one eye underwent a daily lid scrub with 1% PVI solution (1% PVI group), while the fellow eye was treated with formulated eyelid wipes (control group). Clinical outcomes, such as blepharitis signs, tear breakup time, and corneal staining, were evaluated at study enrollment and exit visits. Symptom assessments utilized the visual analog scale (VAS) per eye and the ocular surface disease index (OSDI) questionnaire. Results: Fifty-two patients (mean age 62.3 years, 53.8% females) completed the treatment, while seven patients were lost to follow-up, three were non-compliant, and one sustained an eye trauma. After 30 days, both the 1% PVI and control groups exhibited significant improvements in symptoms, blepharitis signs, and corneal staining (p < 0.05). The 1% PVI scrubs were equally effective as eyelid wipes in most outcomes (p = 0.480) and superior in alleviating eyelid erythema (p = 0.007). Only the 1% PVI group showed a positive correlation between OSDI and VAS score improvements (r (52) = 0.353, p = 0.01). No adverse events related to either treatment modality were reported. Conclusions: A 1% PVI solution is an effective, safe, and well-tolerated treatment option for AB and is superior to formulated eyelid wipes in several subjective and objective measures.

In Vitro and In Vivo Translational Insights into the Intraoperative Use of Antiseptics and Lavage Solutions Against Microorganisms Causing Orthopedic Infections

The growing antibiotic resistance of microorganisms causing postoperative infections following orthopedic surgeries underscores the urgent need for localized antiseptic and lavage delivery systems to enhance infection control. This study evaluates the in vitro effectiveness of antiseptic and lavage solutions-including polyhexanide, povidone-iodine, low-concentrated hypochlorite, Ringer's solution, and saline-against Staphylococcus epidermidis, Staphylococcus aureus MRSA, Cutibacterium acnes, Corynebacterium amycolatum, Pseudomonas aeruginosa, and Candida albicans. Using microplate models (Minimum Inhibitory Concentration, Minimum Biofilm Eradication Concentration, and Biofilm-Oriented Antiseptic Test assays), flow-based models (Bioflux system), and surfaces relevant to orthopedic implants (e.g., stainless steel disks/screws, Co-Cr-Mo, Ti-Al-Nb orthopedic alloys, and ultra-high-molecular-weight polyethylene), as well as a bio-nano-cellulose scaffold representing tissue, we assessed the solutions' activity. The cytotoxicity of the solutions was evaluated using osteoblast and keratinocyte cell lines, with additional in vivo insights gained through the Galleria mellonella larval model. The results show that polyhexanide-based solutions outperformed povidone-iodine in biofilm eradication in most tests applied, particularly on complex surfaces, whereas iodine demonstrated higher cytotoxicity in applied in vitro and in vivo tests. Low-concentration hypochlorite solutions exhibited minimal antibiofilm activity but also showed no cytotoxicity in cell line and G. mellonella larval models. These findings highlight the importance of careful antiseptic selection and rinsing protocols to balance infection control efficacy with tissue compatibility in orthopedic applications.

Treatment of aggressive posterior retinopathy of prematurity accompanied by nasolacrimal duct obstruction with purulent discharge: A case report

This case demonstrates that probing and 10% povidone-iodine irrigation of the nasolacrimal duct prior to intravitreal bevacizumab injection can safely reduce the risk of endophthalmitis in infants with aggressive posterior retinopathy of prematurity and nasolacrimal duct obstruction. This method provides a viable treatment alternative when laser therapy alone is insufficient.

Enhanced Recovery After Surgery Cardiac Society turnkey order set for surgical-site infection prevention: Proceedings from the American Association for Thoracic Surgery ERAS Conclave 2023

OBJECTIVES

Surgical-site infections (SSIs) after cardiac surgery increase morbidity and mortality, consume health care resources, impair recovery, and diminish patients' quality of life. Numerous guidelines and expert consensus documents have been published to address the prevention and management of SSIs. Our objective is to integrate these documents into an order set that will facilitate the adoption and implementation of evidence-based best practices for preventing and managing SSIs after cardiac surgery.

METHODS

Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set for SSI reduction. Orders derived from consistent class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the turnkey order set in bold type. Selected orders that were inconsistent class I or IIA, class IIB or otherwise supported by published evidence, were also included in italicized type.

RESULTS

Preventative care begins with the preoperative identification of both modifiable and nonmodifiable SSI risks by health care providers. Assessment tools can be used to assist in identifying patients at a high risk of SSI. Preoperative recommendations include screening for and treating Staphylococcus aureus nasal carriage. Intraoperatively, tailored prophylactic intravenous antibiotics and maintaining blood glucose levels below 180 mg/dL are essential elements. Postoperative care includes maintaining normothermia, glucose control and patient engagement.

CONCLUSIONS

Despite the well-documented advantages of a multidisciplinary care pathway for SSI in cardiac surgery, there are inconsistencies in its adoption and implementation. This article provides an order set that incorporates recommendations from existing guidelines to prevent SSI in the cardiac surgical population.

Enhanced bactericidal effects of povidone-iodine in the presence of silver ions

The rising prevalence of antibiotic-resistant infections worldwide necessitates the development of innovative antimicrobial systems for effective pathogen control. This study investigates the synergistic bactericidal effects of a combined system comprising povidone-iodine (PVP-I) and silver ions (Ag(I)). The PVP-I/Ag(I) system exhibited enhanced bactericidal activity against four key surrogate bacterial species: two Gram-negative bacteria, Escherichia coli (E. coli) and Pseudomonas aeruginosa (P. aeruginosa), and two Gram-positive bacteria, Staphylococcus aureus (S. aureus) and Bacillus subtilis (B. subtilis). Our experiments revealed that Ag(I) interacts with iodide ions (I-) to form silver iodide (AgI). This reaction promotes the formation of hypoiodous acid (HOI), a more potent bactericidal agent than other reactive iodine species (RIS), by shifting the equilibrium of RIS released from PVP-I. Under representative conditions ([PVP-I]0 = 1 mg/L, [Ag(I)]0 = 5 μM, pH = 7.3), the concentration of HOI in the PVP-I/Ag(I) system was 2.4-3.9 times higher than in the PVP-I system alone, aligning with theoretical predictions. The bactericidal efficacy of the PVP-I/Ag(I) system was influenced by pH variations, affecting HOI formation. This system represents a promising tool for rapid and effective microbial control, potentially enhancing public health outcomes.

Far-Ultraviolet C Disinfection Reduces Oxidative Damage to the Cornea Compared to Povidone-Iodine Disinfection

Far-ultraviolet C (far-UVC) light shows promise for pathogen control but its safety and efficacy for corneal disinfection remain unclear. In this study, safe far-UVC dosages were investigated for corneal disinfection and its germicidal performance and oxidative damage potential to 5% povidone-iodine (PVP-I) were compared. Rat corneas were exposed to varying 222 nm far-UVC doses (3-60 mJ/cm2) and assessed for ocular damage, apoptosis, and oxidative stress to determine the safe dose of far-UVC. Far-UVC at 30 mJ/cm2 induced corneal apoptosis and oxidative damage, but 15 mJ/cm2 caused no apoptosis or oxidative damage. At this optimized dose (9 mJ/cm2), far-UVC achieved 90.5% sterilization, exceeding 5% PVP-I (80.8%), with significantly less oxidative damage and cell death in the cornea. In conclusion, our study demonstrates that the use of 5% povidone-iodine (PVP-I) for disinfection results in significant oxidative damage to the corneal tissue. However, a safe dosage of far-UVC light exhibited a promising disinfection effect without causing oxidative damage to the corneal tissue. Far-UVC offers a promising alternative for corneal disinfection but requires careful dosage control (≤30 mJ/cm2) to avoid ocular surface harm.

Determining the Disinfectants Resistance Genes and the Susceptibility to Common Disinfectants of Extensively Drug-Resistant Carbapenem-Resistant Klebsiella pneumoniae Strains at a Tertiary Hospital in China

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has become a significant threat to global health. The application of chemical disinfectants is an effective infection control strategy to prevent the spread of CRKP in hospital environments. However, bacteria have shown reduced sensitivity to clinical disinfectants in recent years. Furthermore, bacteria can acquire antibiotic resistance due to the induction of disinfectants, posing a considerable challenge to hospital infection prevention and control. This study collected 68 CRKP strains from the Fifth Affiliated Hospital of Xinjiang Medical University in China from 2023 to 2024. These strains were isolated from the sputum, urine, and whole blood samples of patients diagnosed with CRKP infection. Antibiotic susceptibility tests were performed on CRKP strains. Concurrently, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of disinfectants (benzalkonium bromide, 1% iodophor disinfectant, alcohol, and chlorine-containing disinfectant) against the test isolates were determined by the broth microdilution method. The efflux pump genes (cepA, qacE, qacEΔ1, qacEΔ1-SUL1, oqxA, and oqxB) were detected using polymerase chain reaction. The results showed that 21 out of the 68 CRKP strains exhibited extensive drug resistance, whereas 47 were nonextensively drug-resistant. The MIC value for benzalkonium bromide disinfectants displayed statistically significant differences (p < 0.05) between extensively drug-resistant (XDR) and non-XDR strains. Additionally, the MBC values for benzalkonium bromide disinfectants and 1% iodophor disinfectants displayed statistically significant differences (p < 0.05) between XDR and non-XDR strains. The detection rates for the efflux pump genes were as follows: cepA 52.9%, qacE 39.7%, qacEΔ1 35.2%, qacEΔ1-SUL1 52.9%, oqxA 30.8%, and oqxB 32.3%. The detection rate of the qacEΔ1-SUL1 gene in XDR CRKP strains was significantly higher than in non-XDR CRKP strains (p < 0.05). This indicates a potential link between CRKP bacterial disinfectant efflux pump genes and CRKP bacterial resistance patterns. Ongoing monitoring of the declining sensitivity of XDR strains against disinfectants is essential for the effective control and prevention of superbug.

Lower Rates of Reoperation Following Partial or Complete Revision Arthroplasty Compared to Debridement, Antibiotics, and Implant Retention for Early Postoperative and Acute Hematogenous Periprosthetic Hip Infection

BACKGROUND

This study aimed to: 1) compare treatment outcomes between debridement, antibiotics, and implant retention (DAIR) and partial or complete revision arthroplasty (RA) for early postoperative and acute hematogenous total hip arthroplasty periprosthetic joint infection (PJI) and 2) identify factors associated with treatment outcome.

METHODS

The study consisted of a retrospective cohort of patients who underwent surgery for PJI between 2004 and 2021. There were 76 patients (74.5%) who underwent DAIR and 26 patients (25.5%) who underwent RA. Treatment success was defined as treatment eradication at a minimum of a 2-year follow up. Bivariate regression analysis was used to assess the effect of different factors on treatment outcomes. Kaplan-Meier survivorship was performed to compare survivorship between cohorts.

RESULTS

At a mean follow-up of 8.2 years (range, 2.2 to 16.4), significantly more DAIR failed treatment (DAIR, 50 [65.8%]; 10 [38.5%]; P = .015). The 8-year Kaplan-Meier survivorship was 35.1% [95% confidence interval (CI), 24.3 to 45.9] for patients treated with DAIR and 61.5% [95% CI, 42.9 to 80.1] for those treated with RA (log rank = 0.039). Bivariate regression analysis showed performing a RA was associated with a higher likelihood of treatment success (odds ratio 4.499, 95% CI 1.600 to 12.647, P = .004), whereas a higher body mass index was associated with treatment failure (odds ratio 0.934, 95% CI 0.878 to 0.994, P = .032).

CONCLUSIONS

To reduce the rate of recalcitrant infection following early postoperative or acute hematogenous total hip arthroplasty PJI, RA may be of benefit over DAIR. This is especially relevant in the early postoperative period, when components can be readily exchanged.

Phase II Trial of the Impact 0.5% Povidone-Iodine Nasal Spray (Nasodine®) on Shedding of SARS-CoV-2

OBJECTIVE

A Phase II trial was conducted to determine if nasal disinfection with a commercial Good Manufacturing Practice-manufactured 0.5% povidone-iodine nasal spray (Nasodine®) may be a useful adjunct in the management of COVID-19 by reducing viral shedding and prevention of transmission of SARS-CoV-2. The aim was to confirm the results from a human single-dose pilot study by assessing repeated and frequent doses on nasal shedding of SARS-CoV-2 from adult subjects with confirmed COVID-19.

METHODS

A multicenter, randomized, double-blinded, placebo-controlled Phase II clinical trial involving adults with early COVID-19 symptoms. Baseline nasal swabs were collected to quantify pretreatment SARS-CoV-2 nasal viral load, followed by Nasodine treatment eight times daily over 3 calendar days. Daily nasal swabs were collected post-dose to assess the impact of treatment on nasal viral load, measured by log10 TCID50 in quantitative culture.

RESULTS

Nasodine subjects exhibited significantly improved reduction in viral load (log10 TCID50) on Days 2-4 compared to placebo recipients (p = 0.028), rate of nasal clearance of viable virus (p = 0.032), and complete (100%) nasal and throat clearance of the virus by Day 5. No difference was seen in antigen shedding as measured by time transition from Rapid Antigen Test (RAT) positivity to RAT negativity.

CONCLUSION

A total of 20 doses of Nasodine® nasal spray administered over 2.5 days significantly reduced the titers of viable SARS-CoV-2 virus in the nasal passages of COVID-19 subjects. This is the first study demonstrating the efficacy of a tolerable intranasal formulation of povidone-iodine on viral shedding in COVID-19 subjects. Nasal disinfection may diminish viral transmission to others.

LEVEL OF EVIDENCE

2 Laryngoscope, 134:3947-3952, 2024.

New Insights Regarding the Use of Relevant Synthetic Compounds in Dentistry

Worldwide, synthetic compounds are used for both in-office and at-home dental care. They are a valuable resource for both prophylactic and curative treatments for various dental problems, such as tooth decay, periodontal diseases, and many more. They are typically preferred due to their broad range of actions and ability to produce targeted, rapid, and long-lasting effects. Using a 0.12% chlorhexidine mouthwash is capable of reducing the plaque index from 47.69% to 2.37% and the bleeding index from 32.93% to 6.28% after just 2 weeks. Mouthwash with 0.1% OCT is also highly effective, as it significantly lowered the median plaque index and salivary bacterial counts in 152 patients in 5 days compared to a control group (p < 0.0001), while also reducing the gingival index (p < 0.001). When povidone-iodine was used as an irrigant during the surgical removal of mandibular third molars in 105 patients, it resulted in notably lower pain scores after 2 days compared to a control group (4.57 ± 0.60 vs. 5.71 ± 0.45). Sodium hypochlorite is excellent for root canal disinfection, as irrigating with 1% NaOCl completely eliminated the bacteria from canals in 65% patients. A 0.05% CPC mouthwash proved effective for perioperative patient care, significantly decreasing gingival bleeding (p < 0.001) and suppressing Streptococcus levels even one week post-surgery. Lastly, a 6% H2O2 paint-on varnish and 6% H2O2 tray formulations successfully bleached the teeth of 40 patients, maintaining a noticeably whiter appearance up to the 6-month follow-up, with significant color differences from the baseline (p < 0.005). Synthetic compounds have a large research base, which also provides a greater awareness of their mechanism of action and potential adverse effects. For a better understanding of how they work, several methods and assays are performed. These are protocolary techniques through which a compound's efficacy and toxicity are established.

Effects of povidone-iodine wound irrigation on surgical site infection in gastroenterological surgery: A randomized controlled trial

BACKGROUND

The irrigation efficacy of a povidone-iodine solution to prevent surgical site infection is still controversial. We assessed the irrigation effect with a povidone-iodine solution on the incidence of surgical site infection after gastroenterological surgery.

METHODS

This study is a single-center, prospective, randomized, blinded-end point superiority trial for surgical wound irrigation. Patients undergoing gastroenterological surgery were randomly assigned in a 1:1 replacement ratio using computer-generated randomization. Patients were grouped according to their surgical wound treatment into the control group using the normal sterile saline and the povidone-iodine group using 10% povidone-iodine solution after the NS solution. The main finding was 30-day surgical site infections assessed in the full analysis set.

RESULTS

From November 2020 to December 2022, 697 of 894 patients were eligible for the study, among which 347 were in the povidone-iodine group and 350 in the control group. Thirty-day surgical site infections occurred in 100 (14%) patients-54 (16%) in the povidone-iodine group and 46 (13%) in the control group (odds ratio, 1.229; 95% CI, 0.800-1.889; P = .406). Superficial incisional surgical site infections occurred in 30 (9%) and 15 (4%) patients, respectively (odds ratio, 2.154; 95% CI, 1.134-4.090; P = .026). Only 3 patients (1%) in the control group developed adverse skin reactions.

CONCLUSION

This study examined the irrigation efficacy of povidone-iodine for surgical site infection prevention compared to control in gastroenterological surgery. Povidone-iodine wound irrigation has shown no additional beneficial effect on the occurrence of surgical site infections.

Staphylococcus aureus screening and preoperative decolonisation with Mupirocin and Chlorhexidine to reduce the risk of surgical site infections in orthopaedic surgery: a pre-post study

BACKGROUND

Nasal carriage of Staphylococcus aureus is a risk factor for surgical site infections (SSI) in orthopaedic surgery. The efficacy of decolonisation for S. aureus on reducing the risk of SSI is uncertain in this speciality. The objective was to evaluate the impact of a nasal screening strategy of S. aureus and targeted decolonisation on the risk of S. aureus SSI.

METHODS

A retrospective pre-post and here-elsewhere study was conducted between January 2014 and June 2020 in 2 adult orthopaedic surgical sites (North and South) of a French university hospital. Decolonisation with Mupirocin and Chlorhexidine was conducted in S. aureus carriers starting February 2017 in the South site (intervention group). Scheduled surgical procedures for hip, knee arthroplasties, and osteosyntheses were included and monitored for one year. The rates of S. aureus SSI in the intervention group were compared to a historical control group (South site) and a North control group. The risk factors for S. aureus SSI were analysed by logistic regression.

RESULTS

A total of 5,348 surgical procedures was included, 100 SSI of which 30 monomicrobial S. aureus SSI were identified. The preoperative screening result was available for 60% (1,382/2,305) of the intervention group patients. Among these screenings, 25.3% (349/1,382) were positive for S. aureus and the efficacy of the decolonisation was 91.6% (98/107). The rate of S. aureus SSI in the intervention group (0.3%, 7/2,305) was not significantly different from the historical control group (0.5%, 9/1926) but differed significantly from the North control group (1.3%, 14/1,117). After adjustment, the risk factors of S. aureus SSI occurrence were the body mass index (ORaper unit, 1.05; 95%CI, 1.0-1.1), the Charlson comorbidity index (ORaper point, 1.34; 95%CI, 1.0-1.8) and operative time (ORaper minute, 1.01; 95%CI, 1.00-1.02). Having benefited from S. aureus screening/decolonisation was a protective factor (ORa, 0.24; 95%CI, 0.08-0.73).

CONCLUSIONS

Despite the low number of SSI, nasal screening and targeted decolonisation of S. aureus were associated with a reduction in S. aureus SSI.

Non-antibiotic antimicrobial agents for chronic rhinosinusitis: a narrative review

OBJECTIVE

This narrative review explores alternative non-antibiotic antimicrobial agents for CRS management in adults.

METHODS

Alternative antimicrobial agents using EPOS 2020 guidelines as reference were selected, and articles dated from 2003 to 2022 in English, Portuguese, or Spanish using PubMed and EMBASE databases. The parameters analyzed included study design, evidence level, population characteristics, CRS characteristics, interventions, outcomes, sample size, randomization, blinding, and side effects. Reviews, unrelated contexts,in vitro experiments, and duplicates were excluded.

RESULTS

148 articles were screened; 19 articles were selected for analysis. Randomized controlled trials and cohort studies assessing non-antibiotic antimicrobial treatments for CRS were included. Xylitol demonstrated effectiveness in reducing CRS symptoms, particularly SNOT-22 scores, surpassing saline irrigation benefits. Manuka honey showed potential microbiological benefits in recalcitrant CRS, but symptomatic and endoscopic improvements remained inconclusive. Baby shampoo irrigation improved nasal mucociliary clearance and postoperative outcomes. Colloidal silver nasal irrigation showed limited efficacy in reducing CRS symptoms or endoscopic scores. Povidone-Iodine (PI) nasal irrigation yielded mixed results, with varying effects on culture negativity and SNOT-20 scores. Bacteriophage treatment exhibited promise in decreasing specific bacterial strains and cytokine levels.

CONCLUSION

Non-antibiotic antimicrobial therapies, including xylitol, manuka honey, baby shampoo, colloidal silver, PI, bacteriophages, lactoferrin, and carrageenan offer potential alternatives for CRS in adult patients. Xylitol, baby shampoo, and PI presented benefits in improving symptoms and nasal endoscopic scores, however, the number of studies is limited for conclusive recommendations and safety assessments. CRS management should adopt a comprehensive approach, particularly for non-infectious or immune-related cases, moving beyond antibiotics. Antibiotics should be reserved for confirmed bacterial infections. Overall, this review shows the importance of exploring non-antibiotic therapies to enhance the management of CRS.

Getting the drop on Staphylococcus aureus: Semiquantitative Staphylococcus aureus nasal colony reduction in orthopedic surgery reduces surgical site infection

BACKGROUND

Surgical site infection (SSI) is a frequent health care-associated infection. We aimed to reduce SSI risk after joint arthroplasty and spine surgery by reducing Staphylococcus aureus colonization burden with presurgery intranasal povidone-iodine (PVP-I) application in conjunction with skin antisepsis ("the intervention").

METHODS

Retrospective case-control study; postintervention cohort versus a historical cohort. Adults who underwent joint arthroplasty or spine surgery during February 2018 through October 2021 ("post-intervention cohort") included. In the analysis cases any patient who underwent surgery and developed SSI within 90 days postsurgery, controls had no SSI. Postintervention cohort data were compared with a similar retrospective 2016 to 2017 patient cohort that did not use intranasal PVP-I.

RESULTS

The postintervention cohort comprised 688 consecutive patients aged 65y/o, 48.8% male, 28 cases, and 660 controls. Relatively more cases than controls had diabetes mellitus (P = .019). There was a 39.6% eradication rate of S aureus nasal colonization post intranasal PVP-I (P < .0001). SSI rate was higher in patients positive versus those negative for S aureus on a 24-hour postsurgery nasal culture (P < .0001). The deep SSI rate per 100 operations postintervention versus the historical cohort decreased for all surgical procedures.

CONCLUSIONS

Semiquantitative S aureus nasal colony reduction using intranasal PVP-I is effective for decreasing SSI rate in joint arthroplasty and spine surgery. In patients with presurgery S aureus nasal colonization additional intranasal PVP-I postsurgery application should be considered.

Salivary iodide status as a measure of whole body iodine homoeostasis?

Iodine is a trace element required to produce the thyroid hormones, which are critical for development, growth and metabolism. To ensure appropriate population iodine nutrition, convenient and accurate methods of monitoring are necessary. Current methods for determining iodine status either involve a significant participant burden or are subject to considerable intra-individual variation. The continuous secretion of iodide in saliva potentially permits its use as a convenient, non-invasive assessment of status in populations. To assess its likely effectiveness, we reviewed studies analysing the association between salivary iodide concentration (SIC) and dietary iodine intake, urinary iodide concentration (UIC) and/or 24-h urinary iodide excretion (UIE). Eight studies conducted in different countries met the inclusion criteria, including data for 921 subjects: 702 healthy participants and 219 with health conditions. SIC correlated positively with UIC and/or UIE in four studies, with the strength of relationship ranging from r = 0·19 to r = 0·90 depending on sampling protocol, age, and if salivary values were corrected for protein concentration. Additionally, SIC positively correlated with dietary intake, being strongest when saliva was collected after dinner. SIC varied with external factors, including thyroid function, use of some medications, smoking and overall health status. Evidence provided here supports the use of SIC as a viable, low-burden method for determining iodine status in populations. However, small sample sizes and high variability indicates the need for more extensive analyses across age groups, ethnicities, disease states and dietary groups to clarify the relative accuracy and reliability in each case and standardise procedure.

Medical-Grade Honey Is a Versatile Wound Care Product for the Elderly

Introduction

Ageing of the global population has led to an increase in the demand for the treatment of wounds, especially considering the challenges of managing wounds in the elderly. Therefore, more effective treatment strategies need to be explored. In this article, we aimed to compare medical-grade honey (MGH) products with other wound care products and to provide guidelines on using MGH in wounds commonly found in the elderly.

Methods

Based on literature research and expert opinion, an overview of commonly used wound care products and their wound healing characteristics is provided. In addition, literature-based classification of wounds in the elderly and the recommendations for treatments are provided.

Results

Frequently used wound care products include povidone-iodine, enzymatic products, absorbing dressings, larvae, silver dressings, and MGH dressings. Supported by systematic reviews and meta-analyses, MGH dressings were identified as the most potent and all-round wound care product compared to the others. Next, we provided basic guidelines for managing the most common wounds in the elderly, both acute and chronic, and specified how and which MGH products can be used in these wounds.

Conclusion

MGH is a widely applicable, safe, easy-to-use, and cost-effective product to manage wounds in the elderly. In case of doubt, refer to a trained wound care specialist who can support the treatment of difficult-to-heal wounds.

Impact of Povidone Application to Nares in Addition to Chlorhexidine Bath in Critically Ill Patients on Nosocomial Bacteremia and Central Line Blood Stream Infection

Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial (MRSA) bacteremia in critically ill patients. A quality improvement study was completed with pre and post-design. The study period was from January 2018 until February 2020 and February 2021 and June 2021. The control period (from January 2018 to May 2019) consisted of CHG bathing alone, and in the intervention period, we added 10% PI to the nares of critically ill patients. Our primary outcome is rates of nosocomial MRSA bacteremia, and our secondary outcome is central line associated blood stream infection (CLABSI) and potential cost savings. There were no significant differences in rates of MRSA bacteremia in critically ill patients. Nosocomial MRSA bacteremia was significantly lower during the intervention period on medical/surgical areas (MSA). CLABSIs were significantly lower during the intervention period in critically ill patients. There were no Staphylococcus aureus CLABSIs in critical care area (CCA)during the intervention period. The intervention showed potential significant cost savings. The application of 10% povidone iodine twice a day in addition to CHG bathing resulted in a significant decrease in CLABSIs in critically ill patients and a reduction in nosocomial MRSA in the non-intervention areas. Further trials are needed to tease out individual patients who will benefit from the intervention.

Profiles of central nervous system surgical site infections in endoscopic transnasal surgery exposing the intradural space

OBJECTIVE

Despite its efficacy and minimal invasiveness, the clean-contaminated nature of endoscopic transnasal surgery (ETS) may be susceptible to central nervous system surgical site infections (CNS-SSIs), especially when involving intradural exposure. However, the profiles of ETS-associated CNS-SSIs are not fully elucidated.

METHODS

The institutional ETS cases performed between May 2017 and March 2023 were retrospectively analysed. The incidences of CNS-SSIs were calculated, and their risk factors examined.

RESULTS

The incidence of CNS-SSIs was 2.3% (7/305) in the entire cohort and 5.0% (7/140) in ETSs with intradural exposure. All the CNS-SSIs were meningitis and developed following ETS with intradural exposure. The incidences were 0%, 5.6% and 5.8% in ETSs with Esposito grade 1, 2 and 3 intraoperative cerebrospinal fluid leakage, respectively. Among the pre- and intra-operative factors, body mass index (unit odds ratio (OR), 0.62; 95% confidence interval (CI), 0.44-0.89; P<0.01), serum albumin (unit OR, 0.03; 95% CI, 0.0007-0.92; P=0.02), and American Society of Anesthesiologists physical status score (unit OR, 20.7; 95% CI, 1.65-259; P<0.01) were significantly associated with CNS-SSIs. Moreover, postoperative cerebrospinal fluid leakage was also significantly associated with CNS-SSIs (OR, 18.4; 95% CI, 3.55-95.0; P<0.01).

CONCLUSIONS

The incidence of ETS-associated CNS-SSIs is acceptably low. Intradural exposure was a prerequisite for CNS-SSIs. Malnutrition and poor comorbidity status should be recognized as important risks for CNS-SSIs in ETS.

METHOD OF POVIDONE-IODINE APPLICATION AND ENDOPHTHALMITIS RISK

PURPOSE

To evaluate the proportion of patients developing endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents according to the mode of povidone-iodine (PI) antisepsis.

METHODS

A retrospective review of the anti-vascular endothelial growth factor injections given in a 7-year period at a community-based retinal practice. Endophthalmitis was diagnosed to have occurred if an eye developed intraocular inflammation and was given antibiotics with or without supportive culture identification of an organism. As part of their habitual clinical practice, component physicians used 5% PI as two drops, one drop, or just a dot of PI administered with a cotton-tipped applicator to the site before injection.

RESULTS

There were 113,610 intravitreal injections administered and 23 cases were diagnosed with endophthalmitis over the 7-year period, for a rate of 1 case per 4,940 injections. The mode of PI antisepsis showed no significant relation to the rate of endophthalmitis ( P = 0.55, chi-square test). The proportion of endophthalmitis by physician demonstrated no significant difference ( P = 0.39, chi-square test).

CONCLUSION

The use of PI has been associated with decreased incidence of endophthalmitis, but the mode of application has not been standardized. The results of this study suggest that "more is not better" in PI antisepsis in endophthalmitis. Moreover, the toxicity of PI on the ocular surface is known to be dose-related.

In Vitro and Ex Vivo Investigation of the Antibacterial Effects of Methylene Blue against Methicillin-Resistant Staphylococcus aureus

Methylene blue (MB) is a water-soluble dye that has a number of medical applications. Methicillin-resistant Staphylococcus aureus (MRSA) was selected as a subject for research due to the numerous serious clinical diseases it might cause and because there is a significant global resistance challenge. Our main goal was to determine and analyze the antibacterial effects of MB against S. aureus both in vitro and ex vivo to enhance treatment options. A total of 104 MRSA isolates recovered from various clinical specimens were included in this study. Minimum inhibitory concentration (MIC) values of MB against MRSA isolates were determined by the agar dilution method. One randomly selected MRSA isolate and a methicillin-susceptible S. aureus strain (S. aureus ATCC 25923) were employed for further evaluation of the antibacterial effects of MB in in vitro and ex vivo time-kill assays. A disc diffusion method-based MB + antibiotic synergy assay was performed to analyze the subinhibitory effects of MB on ten isolates. MICs of MB against 104 MRSA isolates, detected by the agar dilution method, ranged between 16 and 64 µg/mL. MB concentrations of 4 and 16 µg/mL showed a bactericidal effect at 24 h in the ex vivo time-kill assays and in vitro time-kill assays, respectively. We observed a significant synergy between cefoxitin and methylene blue at a concentration of 1-2 μg/mL in two (20%) test isolates. Employing MB, which has well-defined pharmacokinetics, bioavailability, and safety profiles, for the treatment of MRSA infections and nasal decolonization could be a good strategy.

Comparison of preoperative prophylaxis with povidone-iodine (5%) and moxifloxacin (0.5%) versus povidone-iodine (5%) alone: a prospective study from India

PURPOSE

To compare the effect of povidone-iodine (PI) 5% and moxifloxacin 0.5% solutions versus PI 5% solution alone on the conjunctival bacterial flora.

METHODOLOGY

This is a comparative study in which the study population comprised adult patients scheduled for elective small incision cataract surgery. The eye to be operated (control eye) received topical moxifloxacin 0.5% drops 4 times, 1 day before surgery and 2 applications on the day of surgery. As placebo, the contralateral eye (study eye) received saline 0.90% drops as per the same schedule. Before surgery, on table, PI 5% was instilled in the conjunctival sac in both eyes. Conjunctival swabs were taken before initiation of therapy and 3 min after instillation of PI.

RESULTS

Of the 96 pairs of eyes included in the study, conjunctival cultures before prophylaxis were similar between the two groups (p = 0.31), with 54 samples (56%) of the study group and 49 (51%) of the control group showing growth. With positive cultures reducing to 7 (14%) in the study group and 8 (16%) in the control group, both the prophylaxis methods appeared equally efficacious (p = 0.79). Both the groups showed a significant reduction in positive cultures following prophylaxis (p < 0.0001).

CONCLUSIONS

PI 5% alone as preoperative prophylaxis was as effective as its combination therapy with moxifloxacin 0.5% in the reduction in conjunctival bacterial colonization.

Antiseptic, Hemostatic, and Wound Activity of Poly(vinylpyrrolidone)-Iodine Gel with Trimethyl Chitosan

Wound management practices have made significant advancements, yet the search for improved antiseptics persists. In our pursuit of solutions that not only prevent infections but also address broader aspects of wound care, we investigated the impact of integrating trimethyl chitosan (TMC) into a widely used poly(vinylpyrrolidone)-iodine gel (PVP-I gel). Our study assessed the antimicrobial efficacy of the PVP gel with TMC against Escherichia coli, Staphylococcus aureus, multidrug-resistant S. aureus MRSA, and Candida albicans. Additionally, we compared hemostatic effects using a liver puncture bleeding model and evaluated wound healing through histological sections from full-thickness dermal wounds in rats. The results indicate that incorporating TMC into the commercially available PVP-I gel did not compromise its antimicrobial activity. The incorporation of TMC into the PVP-I gel markedly improves its hemostatic activity. The regular application of the PVP-I gel with TMC resulted in an increased blood vessel count in the wound bed and facilitated the development of thicker fibrous tissue with a regenerated epidermal layer. These findings suggest that TMC contributes not only to antimicrobial activity but also to the intricate processes of tissue regeneration. In conclusion, incorporating TMC proves beneficial, making it a valuable additive to commercially available antiseptic agents.

Advances in Contact Lens Care Solutions: PVP-I Disinfectant and HAD Wetting Agents From Japan

ABSTRACT

Half of the individuals who wear contact lenses use reusable lenses that require proper care. Improper contact lens (CL) care and using inadequate disinfecting solutions can lead to lens contamination, CL-related microbial keratitis, and Acanthamoeba keratitis. Oxidative disinfecting solutions, such as hydrogen peroxide, show higher efficacy than multipurpose solutions. Povidone-iodine (PVP-I), an oxidative disinfectant used in ophthalmic surgery, has been proven to be safe and effective. The PVP-I system, a CL disinfecting solution developed in Japan, has demonstrated excellent antimicrobial and antiviral properties. Although CL discomfort does not have a risk of ocular disorders with poor visual prognosis, such as keratitis, CL discomfort can still lead to lens dropout and thus needs to be addressed. To mitigate CL discomfort, it is essential to use disinfecting solutions containing surfactants and wetting agents that improve wettability of the lens surface. A CL solution containing hyaluronic acid derivatives (HADs) as wetting agents that permanently adhere to the lens surface to improve wettability of the lens surface was developed in Japan. There is potential for HAD to be integrated into various solutions. This article reviews the efficacy of novel PVP-I-based disinfecting solution and HAD wetting agents.

An objective comparative study of non-surgical cleansing techniques and cleanser types in bacterial burden management

Cleansing is a vital component of effective wound hygiene and biofilm management, often accomplished through vigorous mechanical action or through soaking with moistened gauze. In the present study, a quantitative comparison of the effectiveness of different cleansing techniques and solutions in removing bacteria was conducted on 71 chronic wounds using bacterial fluorescence imaging as a real-time diagnostic for moderate to high bacterial loads. Vigorous gauze cleansing for 30 s proved most effective by reducing bacterial fluorescence by 33.99%, surpassing 10-min soaking in bacterial reduction (13.24%). Among different cleansers, no statistically significant differences in effectiveness were observed, but povidone-iodine showed the strongest trend towards bacterial reduction. Sub-analysis highlighted the superiority of antiseptic cleansers over saline and gentle soap (-33.30% vs. -1.80% bacterial reduction respectively). Five percent acetic acid was also shown to be more effective in removing specific bacterial strains (Pseudomonas aeruginosa). Findings from studies like this contribute to refining wound hygiene guidelines and clinical algorithms for bacterial and biofilm management.

Comparison of Different Betadine and Saline Combinations on Microorganisms: An Original Research

Introduction

Pathogenic bacteria in the oral cavity or a physiological microbiome imbalance can cause or maintain disease. Thus, this work examined a novel betadine-saline combination for antibacterial and antifungal activities.

Materials and Methods

This study was in vitro. Betadine, saline, and their mixtures were tested for Bacillus subtilis, Staphylococcus aureus (gram-positive), Pseudomonas aeruginosa, Escherichia coli, and Aspergillus niger (gram-negative). Pour plate and disc diffusion methods were used to test CFUs, DZI, and RZI for various agent combinations.

Results

For Lactobacillus acidophilus, Betadine 90% + saline 10% had the greatest DZI and RZI at 24 and 12 mm, respectively. For E. coli, Betadine 50% + saline 50% had the highest at 16 and 8 mm. Betadine 60% + saline 40% had 14 mm RZI and the highest antifungal activity.

Conclusion

The novel betadine-saline antibacterial and antifungal combination performed well. In vivo research should confirm the existing findings.

Evaluation of the Possible Influence of Povidone Iodine (PVI) Solution and Polyhexanide (PHMB) on Wound Healing in Corneal Epithelial Regeneration

This study investigates the possible toxic effects of the preoperative antiseptic substances povidone iodine (PVI) and polyhexanide (PHMB; Serasept® 2) on wound healing in ophthalmology. To assess this impact, human telomerase-immortalized corneal epithelial (hTCEpi) cells and human telomerase-immortalized conjunctival epithelial (hCjE) cells were exposed to 1% and 5% PVI or 0.04% PHMB for different periods to evaluate the cytotoxicity of these two antiseptics. Furthermore, the toxicity of these antiseptics was investigated in a human tissue-specific corneal epithelial construct and porcine eye culture model. The results reveal the high cytotoxicity of PVI and PHMB in the hTCEpi and hCjE in monolayer cell culture models, independent of the incubation time and concentration of these substances. However, after hTCEpi cell differentiation into a tissue-specific corneal epithelial construct, contact with these antiseptics for the relevant preoperative time did not alter cPARP1 or Ki67 expression. Furthermore, the wound-healing process in the porcine cornea was not significantly influenced after incubation with these antiseptics. In summary, corneal and conjunctival epithelial cell lines are very sensitive to PVI and PHMB, whereas no significant alterations were found in intact tissue-specific corneal epithelial constructs or porcine corneas. Therefore, we could not identify PVI and PHMB as reasons for postoperative eye irritation.

Evaluation of dermal toxicity and toxicokinetics of povidone‑iodine in Göttingen minipigs

BACKGROUND

Povidone‑iodine (PVP-I) is an effective and commonly used broad-spectrum antiseptic; limited information exists around its long-term safety and impact on endocrine disruption. We assessed the dermal toxicity and toxicokinetics following a once-daily application of 7.5% (w/v) and 10% (w/v) PVP-I in Göttingen Minipigs® for up to 39 weeks.

METHODS

An in vivo study was conducted in male (n = 27) and female (n = 27) minipigs. Animals were randomized into untreated control, 7.5% and 10% PVP-I, and matching vehicle treatment groups. Animals were assessed for general in-life measurements, including skin irritation and organ weights. Serum samples were analyzed for PVP, total iodine, triiodothyronine [T3], thyroxine [T4], thyroid stimulating hormone [TSH], and toxicokinetic parameters.

RESULTS

Neither 7.5% nor 10% PVP-I affected general in-life measurements. Increased mean thyroid gland absolute weights were noted with 7.5% and 10% PVP-I. Serum levels of PVP, T3, T4, and TSH in the 7.5% and 10% PVP-I treatment group animals were similar to those in vehicle treatment group animals. Mean total serum iodine concentration was 52- and 13-fold higher with 7.5% and 10% PVP-I, respectively, vs respective vehicle treatments. There was no dose-dependent increase in mean maximum serum concentration and area under the curve from 0 to 24 h for PVP, T3, T4, and TSH, nor accumulation of PVP, T3, T4, or TSH in the study.

CONCLUSION

Once-daily dermal application of 7.5% and 10% PVP-I for up to 39 weeks was safe and well tolerated in Göttingen Minipigs® and was not associated with skin irritation, thyroid dysfunction, or endocrine disruption. As the anatomy and physiology of the minipig skin closely resembles that of human skin, the findings of this study suggest that 7.5% and 10% PVP-I may be translated into antimicrobial benefits for humans without the risk of endocrine disruption.

Comparison of the Effectiveness of Four Different Irrigation Solutions on Postoperative Sequelae in Patients Undergoing Lower Third Molar Surgery: A Prospective Study

Introduction Oral and maxillofacial surgeons frequently perform the removal of impacted mandibular third molars. The success of this surgical intervention depends on meticulous surgical technique and the use of appropriate irrigants to minimize complications in the postoperative period.  Aim The aim of this study was to evaluate the efficacy of four different irrigation solutions (povidone-iodine, metronidazole, chlorhexidine gluconate (CHX), and normal saline) on postoperative sequelae like pain, trismus, swelling, and alveolar osteitis following surgical extraction of the impacted mandibular third molars. Materials and methods The current research was a randomized study carried out at Saveetha Dental College and Hospital in Chennai, India, from December 2022 to March 2023. The study population consisted of 112 participants who were referred to the Oral and Maxillofacial Surgery for the surgical removal of impacted mandibular third molars. The population was divided into four groups, with 28 in each group. They were categorized as A, B, C, and D based on the final irrigation solution used after surgical removal of the impacted teeth. In group A, patients received 0.5% povidone-iodine as the final irrigation solution; group B received 1% metronidazole; group C received 0.12% chlorhexidine gluconate (CHX); and group D received 0.9% normal saline. Patients were examined on the first and seventh postoperative days to assess pain, swelling, trismus, and alveolar osteitis. The results were analyzed with SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States) software for Windows (Microsoft Corporation, Redmond, Washington, United States). A p-value less than 0.05 was considered statistically significant.  Results Group B experienced significantly less pain than groups A, C, and D on the first and seventh postoperative days (p<0.05). The facial swelling was significantly less on the first and seventh postoperative day in group B compared to groups A, B, and D (p<0.05). There was no statistically significant variation observed in trismus (mouth opening) across the groups on both the first postoperative and seventh postoperative days. The presence of alveolar osteitis was seen in groups A, C, and D, but no instances were reported in group B. Conclusion It can be concluded that among the four irrigation solutions used in the lower third molar surgery, metronidazole irrigation solution yielded the best results in terms of less pain, swelling, and alveolar osteitis followed by chlorhexidine. There was no difference between povidone-iodine irrigation and normal saline irrigation on the postoperative sequelae. Postoperative trismus does not depend on the irrigation solution used in the third molar surgery.

Efficacy of a New Alcohol-Free Organic Acid-Based Hand Sanitizer against Foodborne Pathogens

In light of the global health crisis triggered by the COVID-19 pandemic, numerous experts have deemed the utilization of hand sanitizers imperative as a precautionary measure against the virus. Consequently, the demand for hand sanitizers has experienced a substantial surge. Since the beginning of 2020, the utilization of alcohol-free hand sanitizers has been increasingly favored due to the potential risks associated with alcohol poisoning, flammability, as well as the adverse effects on skin lipid dissolution, dehydration, and sebum reduction, which can lead to severe cases of eczema and norovirus infections. In this study, we developed an aqueous hand sanitizer that does not contain alcohol. The sanitizer consists of naturally occurring, food-grade organic acids, including lactic, citric, and azelaic acids. Additionally, food-grade ammonium sulfate and a small amount of povidone-iodine (PVPI) were included in the formulation to create a synergistic and potent antibacterial effect. The effectiveness of the hand sanitizer was evaluated against four common foodborne pathogens, namely Clostridium botulinum, Escherichia coli, Listeria monocytogenes, and Staphylococcus aureus, via in vitro testing. The organic acids exhibited a synergistic inhibitory function, resulting in a 3-log reduction in CFU/mL. Furthermore, the presence of povidone-iodine and ammonium sulfate enhanced their antibacterial effect, leading to a 4-log reduction in CFU/mL. The hand sanitizer solution remained stable even after 60 days of storage. During this period, the detection of additional triiodide (I3-) ions occurred, which have the ability to release broad-spectrum molecular iodine upon penetrating the cell walls. This alcohol-free hand sanitizer may offer extended protection and is anticipated to be gentle on the skin. This is attributed to the presence of citric and lactic acids, which possess cosmetic properties that soften and smoothen the skin, along with antioxidant properties.