Comparison of the Antimicrobial Efficacy of Povidone-Iodine, Povidone-Iodine-Ethanol and Chlorhexidine Gluconate-Ethanol Surgical Scrubs

Abstract

Background: Scrubbing of the hands and forearms with a brush and antiseptic agents has been the standard for surgical practice. However, it has been increasingly recognized that brush scrubbing may provoke side effects and that an alcohol-based hand antiseptic used in conjunction with a scrub agent enhances the effectiveness. In this study, two types of alcohol-based agents were used after a povidone-iodine (PVP-I) scrub and compared for their effectiveness. Materials and Methods: The study was conducted as a crossover trial with 20 volunteers. After hand rubbing with PVP-I, either PVP-I-ethanol rubbing or chlorhexidine gluconate-ethanol (CHG-ethanol) rubbing was used for surgical hand cleansing. Samples were collected by the modified glove juice method to count bacteria on hands. Results: In both groups, the bacterial count was significantly reduced after handwashing (p < 0.001), and the reduction was still significant after 2 h (p < 0.001 for PVP-I-ethanol and p < 0.002 for CHG-ethanol). The log₁₀ reduction factor (RF) in the PVP-I-ethanol group was significantly higher than that in the CHG-ethanol group immediately after handwashing (p < 0.001) but significantly lowered after 2 h (p < 0.01) to the level similar to that of CHG-ethanol. Although RF was lower in the CHG-ethanol group immediately after and 2 h after handwashing compared to the PVP-I-ethanol group, it did not decrease with time. Conclusion: Brushless surgical scrubbing with PVP-I-ethanol or CHG-ethanol in conjunction with PVP-I showed antiseptic effects immediately after and 2 h after handwashing. RF immediately after handwashing was significantly higher with PVP-I-ethanol compared to CHG-ethanol, but it was similar in both groups after 2 h. These results suggest that when used in combination with a PVP-I scrub, an alcohol-based hand antiseptic containing the same active agent (PVP-I in this study) has a powerful antiseptic effect; however, when it contains different antiseptic agents (i.e. CHG in this study), it should be selected carefully based on its antiseptic property.

Virucidal efficacy of povidone-iodine-containing disinfectants

“…However, because of the better microbicidal results of the alcohol‐based PVP‐I formulation compared with the aqueous‐based PVP‐I formulation in this study, it is recommended to test Betaseptic Mundipharma ® vs chlorhexidine‐alcohol for preventing surgical‐site infections under clinical conditions. Furthermore, Betaseptic Mundipharma ® might be considered for hand and/or skin disinfection in preventing transmission of viruses such as noroviruses and for the preoperative brushless surgical scrubbing because of its excellent virucidal efficacy (Nishimura 2006; Lages et al. 2008).…”

Role of Antiseptics in the Prevention of Surgical Site Infections

“…50 Therefore, it should not be relied on for this purpose in normal clinical settings because of its rapid evaporation. 21,51 The utility of alcohol lies in its combination with more persistent antiseptic agents such as iodophors or CHG. 19 Alcohol provides fast acting antisepsis, but its lack of continued antimicrobial effect with drying precludes its stand-alone use.…”

“…Blood and other organic compounds do not affect the antimicrobial action of alcohol. 21,51 Alcohol also has a role in developing countries where alternative antiseptics may not be available. 21,51 The utility of alcohol lies in its combination with more persistent antiseptic agents such as iodophors or CHG.…”

“…2 The bactericidal effect of PVP-I is determined by the concentration of free iodine; a 10% PVP-I formula contains 1% available iodine. 2,13,51,56 These are nonirritating to the eyes and mucous membranes, provide visibility to areas covered, and do not readily remove surgical markings. 2,13,51,56 These are nonirritating to the eyes and mucous membranes, provide visibility to areas covered, and do not readily remove surgical markings.…”

“…51 Current available options include DuraPrep (3M Health Care, St. Paul, MN) and Prevail-FX (Cardinal Health, Dublin, OH). The alcohol allows for rapid acting antisepsis of the product, and the combination of alcohol with PVP-I increases the free iodine concentration higher than with PVP-I alone.…”