CLINICAL SCENARIO: An 82-year-old female with no apparent ocular problems, except fora brunescent cataract, underwent phacoemulsification with intraocular-lens (IOL) implantation. Postoperative medication consisted solely of antibiotic-steroid eye drops. One day after uneventful surgery, the patient developed severe pain, poor vision, and redness in the operated eye. Visual acuity was counting fingers at 1 meter. The eye had ciliary injection, grade 4 flare and cells, a small hypopyon, fibrin extending from the corneal wound, and a mildly edematous cornea. Intraocular pressure (IOP) was 24 mm Hg. Exudates behind the IOL were noted, but visualization was poor. Anterior-chamber and vitreous taps revealed gram-positive cocci. Could the ophthalmologist have prevented this complication? CLINICAL QUESTION: Among patients undergoing cataract extraction, what is the most effective regimen that can reduce the risk of endophthalmitis? SEARCH METHOD: A Medline search was performed using the keywords "endophthalmitis," "cataract," and "prevention." The search was limited to randomized controlled trials (RCT). No studies were found that compared endophthalmitis rates using different perioperative prophylactic measures. Most studies reported used substitute outcome measures such as periocular bacterial load, intraocular penetration of antibiotics, and anterior-chamber contamination. After reviewing the abstracts, only one RCT was considered relevant to the clinical question CITATION: Soto AM, Mendivil MP. The effect of topical povidone-iodine, intraocular vancomycin, or both on aqueous humor cultures at the time of cataract surgery. Ophthalmol 2001; 131:293-300. (Author)
PHACOEMULSIFICATION, VANCOMYCIN, POVIDONE-IODINE

Objectives: To determine the microbiologic flora after surgical skin preparation of the incision site using either chlorhexidine or povidone iodine antiseptic solution prior to cesarean section among obstetric patients. Materials and Methods: This is a cross-sectional study of ninety-two (92) obstetric patients who were admitted for cesarean section. They underwent fishbowl lottery, wherein participants drew from a bag of folded stubs written chlorhexidine or povidone iodine, to determine their distribution to either group. Forty six (46) participants were distributed in each group. Skin cultures were obtained by the researchers from the incision site after surgical skin preparation using chlorhexidine or povidone iodine. Results: Total of 92 participants enrolled in this study, 46 participants in chlorhexidine group and another 46 participants in povidone iodine group. There was no statistically significant difference between the 2 groups in terms of clinicodemographic characteristics. Out of the 92 participants, only one participant, under the povidone iodine group, showed a growth of 100,000 colony-forming units of Enterobacter cloacae and has no statistical significance in the growth of microbiologic flora after effective surgical skin preparation with either chlorhexidine or povidone iodine. Conclusions This study showed that chlorhexidine and povidone iodine are both effective in eliminating microbiologic flora after surgical skin preparation prior to cesarean section. Povidone iodine is still a sound choice of antiseptic especially in low resource setting. Due to the descriptive nature of this paper, only assumptions that chlorhexidine and povidone iodine are comparable antiseptic solutions can be deduced from this study.
Cesarean Section ; Povidone-Iodine

No abstract available.
Humans ; Peritoneal Dialysis* ; Povidone-Iodine*

OBJECTIVE: It is important to sterilize oral cavity with antibacterial agent before surgery for preventing infection. The object of this study was to compare the effect on reduction of salivary bacterial counts according to applied time when povidone-iodine (PVI) and chlorhexidine gluconate (CHX), most broadly used materials in dentistry, were applied intraorally before the surgery. METHODS: Sixty subjects were divided into 6 groups. PVI and CHX were applied in each group for 1, 2 and 3 minutes, respectively. Then salivary microbacteria taken before and after applying the materials were cultured using 5% sheep blood agar plate. RESULTS: There was significant difference in reduction of microbacteria in both PVI and CHX and the effect did not show differences depending on time. When applied for a minute, PVI showed somewhat higher reduction rate than CHX, but in the other groups, there was no difference in reduction rate. CONCLUSION: We found that there was no significant difference in sterilization ability of PVI and CHX in all groups in this study. Therefore, both agents would get sufficient effect when applied for a minute.
Agar ; Bacterial Load ; Chlorhexidine ; Dentistry ; Mouth ; Povidone-Iodine ; Sheep ; Sterilization

OBJECTIVE: It is important to sterilize oral cavity with antibacterial agent before surgery for preventing infection. The object of this study was to compare the effect on reduction of salivary bacterial counts according to applied time when povidone-iodine (PVI) and chlorhexidine gluconate (CHX), most broadly used materials in dentistry, were applied intraorally before the surgery. METHODS: Sixty subjects were divided into 6 groups. PVI and CHX were applied in each group for 1, 2 and 3 minutes, respectively. Then salivary microbacteria taken before and after applying the materials were cultured using 5% sheep blood agar plate. RESULTS: There was significant difference in reduction of microbacteria in both PVI and CHX and the effect did not show differences depending on time. When applied for a minute, PVI showed somewhat higher reduction rate than CHX, but in the other groups, there was no difference in reduction rate. CONCLUSION: We found that there was no significant difference in sterilization ability of PVI and CHX in all groups in this study. Therefore, both agents would get sufficient effect when applied for a minute.
Agar ; Bacterial Load ; Chlorhexidine ; Dentistry ; Mouth ; Povidone-Iodine ; Sheep ; Sterilization

No abstract available.
Animals ; Bandages* ; Methods* ; Polyurethanes* ; Povidone-Iodine* ; Rats* ; Wounds and Injuries*

No abstract available.
Animals ; Ear, Middle* ; Guinea Pigs* ; Guinea* ; Povidone-Iodine*

Povidone-iodine (PVP-I) is a widely used antiseptic for the skin and mucous membrane. It is known that povidone-iodine rarely induce contact sensitization. Recently, we have experienced 2 cases of povidone-iodine contact dermatitis. Standard patch test with PUP-I, PVP and, iodine were performed.
Dermatitis, Allergic Contact* ; Dermatitis, Contact ; Iodine ; Mucous Membrane ; Patch Tests ; Povidone-Iodine* ; Skin

Systemic antibiotic therapy is widely used for prophylaxis in major head and neck surgery, but the efficacy of topical oral antibiotic therapy has not been fully investigated. Therefore we planned to study the efficacy of topical clindamycin gargle on oral flora. Thirty-six healthy adults(20 males, 16 females) were included in the study, and we tried with three oral-washing agents; 0.9% normal saline, 10% povidone iodine, and 75mg clindamycin in 52ml tap water. Samples of saliva were cultured for aerobic and anaerobic bacteria immediately before, immediately after, and at 1- and 4-hour intervals after, washing the mouth with a solution of either control(normal saline or povidone iodine) or clindamycin. Quantitative analysis demonstrated significant reduction of oral flora level after use of the topical antibiotic at the 1-, 4-, and 8- hour interval. It is postulated that topical clindamycin, by reducing concentrations of oral flora, may also reduce the incidence of regional infection following major upper aerodigestive tract surgery.
Anti-Bacterial Agents ; Bacteria, Anaerobic ; Clindamycin* ; Head ; Humans ; Incidence ; Male ; Mouth ; Neck ; Povidone ; Povidone-Iodine ; Saliva ; Water

STUDY DESIGN: A prospective, randomized, controlled study. PURPOSE: The objective of this study was to evaluate the effectiveness of two techniques of skin preparation with povidone-iodine. OVERVIEW OF LITERATURE: Preoperative skin preparation is important for preventing surgical site infection by reducing the bacteria in the surgical area. Povidone-iodine is a commonly used agent for preoperative skin preparation, and further decrease in surgical site infections can be expected by understanding how to apply it more effectively. METHODS: Eighty-nine spine surgery patients were randomly allocated to two groups. In group A, povidone-iodine was applied to the surgical site just before starting the operation; in group B, povidone-iodine was applied several minutes prior to starting the operation and was allowed to dry. We collected samples from the wound edge before suturing, and we compared the rates of positive culture between the two groups. RESULTS: The rate of positive culture was 30.2% (13 out of 43 patients) in group A, and 6.5% (3 out of 46 patients) in group B. This indicates that there was a significant difference in postoperative infection rates between group A and group B. CONCLUSIONS: Because bacteria on the skin appeared significantly reduced by allowing povidone-iodine to dry for several minutes prior to surgery, we recommend this approach to reduce the incidence of postoperative infections.
Bacteria ; Humans ; Incidence ; Povidone-Iodine* ; Prospective Studies* ; Skin* ; Spine* ; Wounds and Injuries