Comparison of disinfection effect between benzalkonium chloride and povidone iodine in nasotracheal intubation: a randomized trial

Abstract

Background Nasotracheal intubation can potentially result in microbial contamination from the upper respiratory tract to the lower respiratory tracts. However, an ideal nasotracheal disinfection method is yet to be determined. Therefore, we compared the disinfection effects between benzalkonium chloride and povidone iodine in nasotracheal intubation. Methods Overall, this study enrolled 53 patients aged 20–70 years who were classified into classes 1 and 2 as per American Society of Anesthesiologists-physical status and were scheduled to undergo general anesthesia with NTI. Patients who did not give consent ( n = 2) and who has an allergy for BZK or PVI were excluded from the study. The patients were randomly divided into two groups on the basis of the disinfection method: BZK ( n = 26, one patient was discontinued intervention) and PVI ( n = 25). 50 patients were assessed finally. The subjects’ nasal cavities were swabbed both before (A) and after disinfection (B), and the internal surface of the endotracheal tube was swabbed after extubation (C). The swabs were cultured on Brain heart infusion agar and Mannitol salt agar. The number of bacteria per swab was determined and the rates of change in bacterial count (B/A, C/B) were calculated. The growth inhibitory activity of the disinfectants on Staphylococcus aureus were also investigated in vitro. Results Although the initial disinfection effects (B/A) were inferior for benzalkonium chloride compared with those for povidone iodine, the effects were sustained for benzalkonium chloride (C/B). In the in vitro growth inhibitory assay against S. aureus , benzalkonium chloride showed higher inhibitory activity than povidone iodine. Conclusion Although both disinfectants were inactivated or diffused/diluted over time, benzalkonium chloride maintained the threshold concentration and displayed antimicrobial effects longer than povidone iodine; therefore, benzalkonium chloride appeared to show a better sustained effect. Benzalkonium chloride can be used for creating a hygienic nasotracheal intubation environment with sustained sterilizing effects. Trial registration UMIN-CTR (Registration No. UMIN000029645 ). Registered 21 Oct 2017.

Cardiovascular Catheterization Using a New Antiseptic Agent Olanexidine Gluconate

“…Thus, benzalkonium chloride is considered to have an antiseptic effect that is more prolonged than that of PI. 10) Octenidine dihydrochloride 0.1% has the strongest antimicrobial activity against Staphylococcus aureus biofilms grown on vascular grafts; its antiseptic effect is superior to that of chlorhexidine combined with either PI or octenidine dihydrochloride. 11) Furthermore, preoperative hand washing is important in the prevention of surgical site infection.…”

Comparative in vitro evaluation of the antimicrobial activities of povidone-iodine and other commercially available antiseptics against clinically relevant pathogens

“…Finally, as this study evaluated in vitro data only it is not possible to draw conclusions regarding clinical efficacy. Published trials and simulation studies have, however, demonstrated that PVP-I results in >99% reduction in bacterial or viral load after 30 seconds contact time in a number of settings (e.g., prevention of surgical site infections, antisepsis before nasotracheal intubation, mouth antisepsis for prevention of respiratory infections) [ 41 ], [ 66 ], [ 67 ], [ 68 ]. Therefore, the in vitro data presented in this study provides further support for the efficacy of PVP-I against a wide range of clinically relevant pathogens.…”

Comparison of hemostatic effect and safety between epinephrine and tramazoline during nasotracheal intubation: a double-blind randomized trial

“…Until the effects of the neuromuscular blocking agent became apparent, mask ventilation was applied in all patients using 100% oxygen with propofol and remifentanil. While mask ventilation was being performed, the patients’ nasal mucosa and inferior nasal passages were adequately disinfected with benzalkonium [ 10 ] spray (ZALKONIN® SOLUTION 0.025, Kenei Phamaceutical Co., Ltd., Osaka). During disinfection, swabbing was not done to avoid nasal bleeding.…”

“…Although this method is very useful in operations wherein the operative field and airway are congruent, some complications associated with NTI include nasal bleeding [ 1 , 2 ], bacteremia [ 3 ], retropharyngeal perforation [ 4 ], and partial or complete obstruction of the tube [ 5 , 6 ] has been reported. Several effective preventive measures against nasal bleeding, retropharyngeal perforation, and bacteremia have been reported [ 7 – 10 ]. Previous studies [ 11 – 13 ] have compared vasoconstriction effect of epinephrine (E) and xylometazoline during NTI; however, xylometazoline is not available in authors’ country.…”