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- See: Skin Prep:

- Discussion:
    - 3M™ DuraPrep™
    - iodophors need not be removed, since they are less likely to result in skin irration; 
    - iodophors are solutions in which iodine is chemically bound to polyvinylpyrrolidone or a comparable molecule;
    - they are water soluble, less irritating to skin and other tissues than tincture, and are non staining;
    - iodophores are also non-irritating to the eyes and mucous membranes;
    - they act by penetrating the bacterial cell wall, oxidation, and substitution of microbial cell contents with free iodine;
    - iodophores require about 2 min of contact time to allow release of free iodine;
    - iodine & iodophors have wide range of antibacterial actions against gram positive & neg bacteria, tubercle bacilli, fungi, &
             viruses, & some act against spores;
    - upon drying, the antimicrobial action of iodophores declines rapidly because of the unavailability of free iodine;
    - most widely used iodophore for surgical scrub is povidone iodine which contains 7.5 percent iodine, of which 1 percent is
             available as free iodine;

- Use of Iodophors on Surgical Tissues:
      - Rush Betadine Lavage Protocol:
              - preparation of solution:
                      - scrub nurse draws up 17.5cc of 10% povidone-iodine with a syringe and mixes it with 500cc of sterile normal saline;
                      - this results in a dilution of 0.35% povidone-iodine for use prior to wound closure;
                      - following implantation of the prosthetic components, the wound is soaked with 500cc of the dilute betadine solution for
                                three minutes, followed by pulsatile lavage with 1L of normal saline without antibiotics;
                      - prior to final closure, betadine is applied to the skin surrounding the incision;
             - references:
                      - Dilute betadine lavage a simple, less expensive way to reduce postoperative TKA infection
                      - Dilute Betadine Lavage Before Closure for the Prevention of Acute Postoperative Deep Periprosthetic Joint Infection
- Misc References for Topical Iodine:
             - Are Dropped Osteoarticular Bone Fragments Safely Reimplantable in Vivo
             - A Comparison of Five Treatment Protocols for Contaminated Bone Grafts in Reference to Sterility and Cell Viability
             - Bactericidal activity and toxicity of iodine-containing solutions in wounds.
             - Studies in management of the contaminated wound. 3. Assessment of the effectiveness of irrigation with antiseptic agents.
             - Studies in the management of the contaminated wound. V. An assessment of the effectiveness of pHisoHex and Betadine
             - Effect of povidone-iodine and saline soaking on bacterial counts in acute, traumatic, contaminated wounds.
             - A comparison of wound irrigation solutions used in the emergency department.
             - Reduced bacteria on transplantable allograft skin after preparation with chlorhexidine gluconate, povidone-iodine, and isopropanol.
             - A prospective trial of prophylactic povidone iodine in lacerations of the hand.
             - Comparison of silver sulfadiazine, povidone-iodine and physiologic saline in the treatment of chronic pressure ulcers.
             - Quality control in chronic wound management: the role of local povidone-iodine (Betadine) therapy 
             - Antiseptic efficacy of local disinfecting povidone-iodine (Betadine) therapy in chronic wounds of lymphedematous patients
             - Selection of an optimal antiseptic solution for intraoperative irrigation: an in vitro study.

- Cautions:
   - free iodine causes and increased risk for skin irritation, it should be removed after 2-3 min. 
   - tincture:
           - iodophors have virtually replaced tincture of iodine because they do not cause burning sensation when applied to raw tissue,
                      are water soluble, and are as effective as tincture for all practical purposes;
           - most effective tincture of iodine is 1 to 2 percent iodine and potassium iodine in 70 percent alcohol solution;
           - it should be removed with 70 alcohol after dying because it may cause chemical dermatitis;
    - always note that free iodine may increase serum levels in the patient;
    - references:
             - Visual Loss after Povidone–Iodine Pleurodesis
             - Povidone-iodine and tensile strength of wounds in rats.
             - Damage to tissue defenses by a topical anesthetic agent.
             - Disinfection of surgical wounds without inhibition of normal wound healing.
             - Cellular and bacterial toxicities of topical antimicrobials.
             - Topical antimicrobial toxicity.
             - Acute compartment syndrome caused by organically bound iodine solutions: a study of the toxic effects on synovial cells and fibroblasts.
                        Spar I, Lovett E, Krakauer K. Orthop Trans. 1981;5:430.
             - Patient Burned by Surgical Prep Awarded $5.5K in Damages


Reduction in amputation stump infection by antiseptic pre-operative preparation.

Evaluation of topical povidone-iodine ointment in experimental burn wound sepsis.    

Comparison of a one-step iodophor skin preparation versus traditional preparation in total joint surgery

In-vitro evaluation of povidone-iodine and chlorhexidine against methicillin-resistant Staphylococcus aureus.


Antiseptics, iodine, povidone iodine and traumatic wound cleansing

The efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection: an evidence-based review

 Antiseptics on Wounds: An Area of Controversy (PART ONE)