Feasibility and acceptability of intranasal povidone iodine decolonization among orthopedic trauma surgery patients
Background: Nasal decolonization significantly decreases the incidence of Staphylococcus aureus surgical-site infections (SSIs). Patient adherence with self-administration of a decolonization ointment (ie, mupirocin) is low, especially among patients having urgent surgery. Povidone-iodine decoloniza...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2022-07-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X22001772/type/journal_article |
| _version_ | 1811157204349222912 |
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| author | Marin Schweizer Loreen Herwaldt Linda Boyken Jean Pottinger Rachel Quinn Daniel Diekema Fiona Armstrong Pavlik Melissa Ward Poorani Sekar Michael Willey |
| author_facet | Marin Schweizer Loreen Herwaldt Linda Boyken Jean Pottinger Rachel Quinn Daniel Diekema Fiona Armstrong Pavlik Melissa Ward Poorani Sekar Michael Willey |
| author_sort | Marin Schweizer |
| collection | DOAJ |
| description | Background: Nasal decolonization significantly decreases the incidence of Staphylococcus aureus surgical-site infections (SSIs). Patient adherence with self-administration of a decolonization ointment (ie, mupirocin) is low, especially among patients having urgent surgery. Povidone-iodine decolonization may overcome patient adherence challenges because povidone-iodine needs to be applied only on the day of surgery. We assessed the effectiveness and acceptability of povidone-iodine decolonization given on the day of surgery among patients having orthopedic trauma surgery. Methods: Adult patients who underwent operative fixation of traumatic lower extremity fractures were consented to receive 10% intranasal povidone-iodine solution. Povidone-iodine was applied ~1 hour before surgical incision and was reapplied the evening after surgery. Patients were tested for S. aureus nasal colonization before surgery, the evening after surgery (before povidone-iodine reapplication), and the day after surgery. Swabs were inoculated into Dey-Engley neutralizer and processed in a vortexer. A series of dilutions were performed and plated on mannitol salt agar plates. S. aureus cultures were quantitatively assessed to determine the reduction in S. aureus after povidone-iodine use. Reductions in S. aureus nasal growth were evaluated using the Skillings-Mack test. SSIs manifesting within 30 and 90 days of surgery were identified using NHSN definitions. A survey was administered the morning after surgery to determine the acceptability of intranasal povidone-iodine. Results: In total, 51 patients participated in this pilot study between February 2020 and June 2021. Nasal samples from 12 participants (23.5%) grew S. aureus. The S. aureus concentration decreased significantly across the time points (P = .03) (Fig. 1). No SSIs were identified within 30 days of surgery. One SSI occurred within 90 days of surgery; this patient did not carry S. aureus, and cultures from the infected site were negative. Also, 31% of patients reported at least 1 mild side effect while using povidone-iodine: dripping (n = 7), itching (n = 6), dryness (n = 4), stinging (n = 4), staining (n = 3), unpleasant taste (n = 3), runny nose (n = 2), burning (n = 1), sneezing (n = 1), sore throat (n = 1), tickling (n = 1), and/or cough (n = 1). Also, 86% of patients stated that povidone-iodine felt neutral, pleasant, or very pleasant, and only 14% stated that it felt unpleasant or very unpleasant. Discussion: In this pilot study, 2 applications of nasal povidone-iodine on the day of surgery were acceptable for patients, and this protocol significantly reduced S. aureus concentration in nares of patients. Future large clinical trials should evaluate whether this 2-application regimen of povidone-iodine significantly decreases rates of SSI among orthopedic trauma surgery patients. |
| first_indexed | 2024-04-10T05:03:11Z |
| format | Article |
| id | doaj.art-02cea40a315b4f319a590732ed96de0a |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-04-10T05:03:11Z |
| publishDate | 2022-07-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-02cea40a315b4f319a590732ed96de0a2023-03-09T12:28:11ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2022-07-012s62s6310.1017/ash.2022.177Feasibility and acceptability of intranasal povidone iodine decolonization among orthopedic trauma surgery patientsMarin SchweizerLoreen HerwaldtLinda BoykenJean PottingerRachel QuinnDaniel DiekemaFiona Armstrong PavlikMelissa WardPoorani SekarMichael WilleyBackground: Nasal decolonization significantly decreases the incidence of Staphylococcus aureus surgical-site infections (SSIs). Patient adherence with self-administration of a decolonization ointment (ie, mupirocin) is low, especially among patients having urgent surgery. Povidone-iodine decolonization may overcome patient adherence challenges because povidone-iodine needs to be applied only on the day of surgery. We assessed the effectiveness and acceptability of povidone-iodine decolonization given on the day of surgery among patients having orthopedic trauma surgery. Methods: Adult patients who underwent operative fixation of traumatic lower extremity fractures were consented to receive 10% intranasal povidone-iodine solution. Povidone-iodine was applied ~1 hour before surgical incision and was reapplied the evening after surgery. Patients were tested for S. aureus nasal colonization before surgery, the evening after surgery (before povidone-iodine reapplication), and the day after surgery. Swabs were inoculated into Dey-Engley neutralizer and processed in a vortexer. A series of dilutions were performed and plated on mannitol salt agar plates. S. aureus cultures were quantitatively assessed to determine the reduction in S. aureus after povidone-iodine use. Reductions in S. aureus nasal growth were evaluated using the Skillings-Mack test. SSIs manifesting within 30 and 90 days of surgery were identified using NHSN definitions. A survey was administered the morning after surgery to determine the acceptability of intranasal povidone-iodine. Results: In total, 51 patients participated in this pilot study between February 2020 and June 2021. Nasal samples from 12 participants (23.5%) grew S. aureus. The S. aureus concentration decreased significantly across the time points (P = .03) (Fig. 1). No SSIs were identified within 30 days of surgery. One SSI occurred within 90 days of surgery; this patient did not carry S. aureus, and cultures from the infected site were negative. Also, 31% of patients reported at least 1 mild side effect while using povidone-iodine: dripping (n = 7), itching (n = 6), dryness (n = 4), stinging (n = 4), staining (n = 3), unpleasant taste (n = 3), runny nose (n = 2), burning (n = 1), sneezing (n = 1), sore throat (n = 1), tickling (n = 1), and/or cough (n = 1). Also, 86% of patients stated that povidone-iodine felt neutral, pleasant, or very pleasant, and only 14% stated that it felt unpleasant or very unpleasant. Discussion: In this pilot study, 2 applications of nasal povidone-iodine on the day of surgery were acceptable for patients, and this protocol significantly reduced S. aureus concentration in nares of patients. Future large clinical trials should evaluate whether this 2-application regimen of povidone-iodine significantly decreases rates of SSI among orthopedic trauma surgery patients.https://www.cambridge.org/core/product/identifier/S2732494X22001772/type/journal_article |
| spellingShingle | Marin Schweizer Loreen Herwaldt Linda Boyken Jean Pottinger Rachel Quinn Daniel Diekema Fiona Armstrong Pavlik Melissa Ward Poorani Sekar Michael Willey Feasibility and acceptability of intranasal povidone iodine decolonization among orthopedic trauma surgery patients Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Feasibility and acceptability of intranasal povidone iodine decolonization among orthopedic trauma surgery patients |
| title_full | Feasibility and acceptability of intranasal povidone iodine decolonization among orthopedic trauma surgery patients |
| title_fullStr | Feasibility and acceptability of intranasal povidone iodine decolonization among orthopedic trauma surgery patients |
| title_full_unstemmed | Feasibility and acceptability of intranasal povidone iodine decolonization among orthopedic trauma surgery patients |
| title_short | Feasibility and acceptability of intranasal povidone iodine decolonization among orthopedic trauma surgery patients |
| title_sort | feasibility and acceptability of intranasal povidone iodine decolonization among orthopedic trauma surgery patients |
| url | https://www.cambridge.org/core/product/identifier/S2732494X22001772/type/journal_article |
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