Surgical site antiseptic preparations for otolaryngology - Head and neck surgery: A current review

OBJECTIVE

To review current literature and guidelines on antiseptic surgical site preparations for preventing surgical site infections with consideration of contraindications specific to head and neck surgery.

DATA SOURCES

PubMed/MEDLINE, clinicaltrials.gov, accessdata.fda.gov, Manufacturer websites.

REVIEW METHODS

A scoping review on the literature and clinical studies comparing the efficacy of different surgical site preparations. Studies were included if they were a randomized controlled trial (RCT) comparing at least two commonly used and available antiseptic preparations. Additionally, a compilation of warnings and contraindications from manufacturer labels and articles are included. Due to the lack of randomized controlled trials concerning antiseptic preparation use in head and neck surgery specifically, an additional search was executed for articles not limited to randomized controlled trials that compared different antiseptic preparation used in surgeries concerning the head and neck.

RESULTS

Of 56,983 resulting abstracts and 3798 of them being screened, 25 RCTs were included. These RCTs included a variety of surgeries including gastrointestinal, obstetric, gynecologic, orthopedic, and vascular procedures. When searching for abstracts concerning head and neck surgeries, 9 studies were found and included.

CONCLUSIONS

To reduce surgical site infections and avoid application in situations with contraindications, practicing surgeons need to be familiar with the existing literature regarding different surgical preparations and what warnings manufacturers have listed on the products. Optimal surgical site preparation for head and neck surgery is challenging as proximity to oxygen contraindicates newer alcohol-based options that are potentially flammable. We summarize evidence-based surgical site preparation for head and neck surgery.

Quaternary ammonium N,N,N-trimethyl chitosan derivative and povidone‑iodine complex as a potent antiseptic with enhanced wound healing property

The importance of developing more potent antimicrobials and robust infection prevention practices has been highlighted recently with the increase in reports of emerging bacterial resistance mechanisms and the development of antibiotic-resistant microbes. In this study, a quaternary ammonium chitosan derivative, N,N,N-trimethyl chitosan chloride (TMC) with inherent bactericidal property was synthesized and complexed with povidone‑iodine (PVP-I) to create a potentially more potent antiseptic solution that could also significantly enhance the wound healing process. TMC, a positively charged, water-soluble derivative of chitosan, formed stable solutions with PVP-I at 5% w/v TMC concentration (TMC5/PVP-I). TMC5/PVP-I was significantly effective against multidrug-resistant bacteria S. aureus compared with PVP-I alone. TMC/PVP-I solutions also showed fungicidal property against C. albicans, with no cytotoxic effects when tested against human fibroblast cells cultured in vitro. Wound healing assessment in vivo revealed early collagen formation and re-epithelialization for TMC5/PVP-I treated wounds in rats relative to control and PVP-I only. Formulation of TMC/PVP-I solutions presented in the study can be easily adapted in the existing production of commercial PVP-I creating a new product with more potent bactericidal and enhanced wound healing properties for optimal wound care.

A novel bimetallic (Fe/Bi)-povidone-iodine micro-flowers composite for photocatalytic and antibacterial applications

The present work describes the synthesis of polyvinylpyrrolidone (PVP) assisted Fe-BiOI based Fe/Bi-povidone‑iodine (Fe/Bi-P-I) micro-flowers based composite and its photocatalytic and antibacterial applications. The Fe/Bi-P-I micro-flowers-based composite material was synthesized using a simple co-precipitation method. The prepared Fe/Bi-P-I micro-flowers-based composite materials were characterized using various characterization techniques and tested against photocatalytic degradation of rhodamine B (RhB) dye and antibacterial analysis. The PVP or povidone‑iodine provides more exposure of reactive sites and oxygen vacancies, which leads to a high separation rate of photoinduced charge carriers, and migration, thereby 100% of photodegradation efficiency at 1 mg/L initial concentration of RhB dye towards the synthesized P-Fe-BiOI based micro-flowers composite. Interestingly, Povidone-Iodine in Fe/Bi-P-I micro-flowers-based composite might be advantageous for antimicrobial activity against both gram-negative (E. coli), and gram-positive (S. aureus) bacterial strains. Therefore, the prepared Fe/Bi-P-I micro-flowers-based composite improved both photocatalytic degradation of organic pollutants as well as high antimicrobial activity. The method of synthesizing the Bi/Fe-P-I micro flower composite in the present study is novel, facile, and economically viable.