Preoperative skin preparation is an integral part of the comprehensive strategy to reduce the incidence of SSI. Povidone-iodine (PVP-I) constitutes of iodine complex with a solubilizing agent that enables the release of free iodine in solution form. Iodine acts as an antiseptic as it destroys microbial proteins and DNA. Iodophor-containing products are extensively used on account of their broad-spectrum antimicrobial properties, efficacy, and safety on nearly all skin surfaces.¹

A study investigated the efficacy of PVP-I-based skin and nasal antiseptic using full-thickness tissue explant models and human subjects. Treatment of infected explants with the antiseptic led to >2.0 log10 CFU reduction in MRSA, irrespective of mupirocin sensitivity. The PVP-I-based antiseptic thus appeared to be a promising alternative for reducing the bioburden of anterior nares before surgery.²

A prospective, single-blinded, randomized study assessed the safety of PVP-I solution in spinal surgeries. Diluted PVP-I solution appeared to be safe in spinal surgeries, and did not influence wound healing, bone union and clinical outcome.³ Another prospective, single-blinded, randomized study explored the efficacy of diluted PVP-I irrigation of spinal surgical wounds in prevention of postoperative wound infection. No wound infection occurred in the group of patients whose surgical wounds were irrigated with diluted PVP-I before wound closure. One superficial infection (0.5%) and six deep infections (2.9%) occurred in the group that did not receive PVP-I irrigation.⁴

Fournel and colleagues⁵ performed a meta-analysis to determine the effect of intraoperative PVP-I application compared with no antiseptic solution on the rate of SSI. Twenty-four randomized controlled trials involving 5004 patients (2465 patients with PVP-I and 2539 patients without) were included in the analysis. The rate of SSI was 8% in the PVP-I group compared with 13.4% in the control group. The meta-analysis thus revealed that intraoperative PVP-I application significantly decreased the SSI rate.

SSI is the most frequently encountered HAI and represents a major cause of patient morbidity and mortality. The prevalence of SSIs is quite high globally, as well as in India. SSIs are associated with morbidity, increased expense and anxiety for patients and their caregivers. These are linked with greater mortality risk and longer postoperative hospitalization. The entire healthcare system is affected by SSIs. These are associated with increased resource use and higher direct medical costs and indirect costs.

Several key strategies have been proposed to prevent the development of SSIs. Some of the most commonly used and studied strategies include appropriate antimicrobial prophylaxis, avoiding surgical site hair removal, maintaining perioperative patient normothermia, and controlling perioperative blood glucose, mechanical bowel preparation, optimized tissue oxygenation, and use of a surgical safety checklist. Appropriate hand hygiene, preoperative bathing, use of gloves, screening for S. aureus and decolonization, antiseptic wound lavage, etc. are some additional measures that may help prevent SSIs.

Considering the fact that preoperative skin preparation plays a vital role in the prevention of SSIs, PVP-I solution is widely used for this purpose on account of the broad-spectrum antimicrobial properties, efficacy, and safety of iodophor-containing products. Intraoperative PVP-I application is known to significantly decrease the SSI rate. Wound irrigation with PVP-I is associated with 0% postoperative wound infection. PVP-I is therefore a promising agent with significant potential to reduce the rate of SSIs. 

1. Hemani ML, Lepor H. Skin Preparation for the Prevention of Surgical Site Infection: Which Agent Is Best? Rev Urol. 2009 Fall; 11(4): 190–195.
2. Anderson MJ, David ML, Scholz M, et al. Efficacy of Skin and Nasal Povidone-Iodine Preparation against Mupirocin-Resistant Methicillin-Resistant Staphylococcus aureus and S. aureus within the Anterior Nares. Antimicrob Agents Chemother. 2015 May; 59(5): 2765–2773.
3. Chang FY, Chang MC, Wang ST, et al. Can povidone-iodine solution be used safely in a spinal surgery? Eur Spine J 2006;15:1005–14.
4. Cheng MT, Chang MC, Wang ST, et al. Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery. Spine 2005;30:1689–93.
5. Fournel I, Tiv M, Soulias M, et al. Meta-analysis of intraoperative povidone-iodine application to prevent surgical-site infection. Br J Surg. 2010 Nov;97(11):1603-13.