Evaluation of the role of povidone‑iodine in the prevention of surgical site infections

Stan J Monstrey; Kris Govaers; Patrice Lejuste; Didier Lepelletier; Paulo Ribeiro de Oliveira

doi:10.1016/j.sopen.2023.03.005

Evaluation of the role of povidone‑iodine in the prevention of surgical site infections

Surg Open Sci. 2023 Mar 16:13:9-17. doi: 10.1016/j.sopen.2023.03.005. eCollection 2023 Jun.

Authors

Stan J Monstrey¹, Kris Govaers², Patrice Lejuste³, Didier Lepelletier⁴, Paulo Ribeiro de Oliveira⁵

Affiliations

¹ Burn Care Center, Plastic Surgery Department, University Hospital Ghent, Ghent, Belgium.
² Division of Orthopaedic Surgery, az Sint-Blasius, Dendermonde, Belgium.
³ Department of Oral and Maxillofacial Surgery, Grand Hôpital de Charleroi, Charleroi, Belgium.
⁴ Hospital Hygiene Department, Nantes University Hospital, Nantes, France.
⁵ Department of Orthopaedic Surgery, São João University Hospital, Porto, Portugal.

Abstract

Background: The occurrence of surgical site infections (SSIs) is associated with increased risk of mortality, development of other infections, and the need for reintervention, posing a significant health burden. The aim of this review was to examine the current data and guidelines around the use of antiseptic povidone‑iodine (PVP-I) for the prevention of SSIs at each stage of surgical intervention.

Methods: A literature search for selected key words was performed using PubMed. Additional papers were identified based on author expertise.

Results: Scientific evidence demonstrates that PVP-I can be used at every stage of surgical intervention: preoperative, intraoperative, and postoperative. PVP-I is one of the most widely used antiseptics on healthy skin and mucous membranes for preoperative surgical site preparation and is associated with a low SSI rate. For intraoperative irrigation, aqueous PVP-I is the recommended agent and has been demonstrated to decrease SSIs in a range of surgical settings, and for postoperative wound healing, there is a growing body of evidence to support the use of PVP-I.

Conclusions: There is a need for more stringent study designs in clinical trials to enable meaningful comparisons between antiseptic agents, particularly for preoperative skin preparation. The use of a single agent (PVP-I) at each stage of surgical intervention could potentially provide advantages, including economic benefits, over agents that can only be used at discrete stages of the surgical procedure.

Key message: Evidence supports the use of PVP-I at all stages of surgical intervention, from preoperative measures (including skin preparation, preoperative washing, and nasal decolonization) to intraoperative irrigation, through to postoperative wound management. However, there is a need for more stringent study designs in clinical trials to enable meaningful comparisons between antiseptic agents, particularly for preoperative skin preparation.

Keywords: Antiseptic; Decolonization; Povidone‑iodine; Surgical site infection; Wound healing.

Publication types

Review