No Risk of Surgical Site Infections From Residual Bacteria After Disinfection With Povidone-Iodine-Alcohol in 1014 Cases A Prospective Observational Study

Objective: We studied the impact of residual bacteria at the incision site after disinfection with polyvinylpyrrolidone (PVP or povidone)-iodine-alcohol and the correlation with postoperative surgical site infections (SSIs). Background: Chlorhexidine-based preparations are significantly more effective for catheter insertion care than povidone-iodine solutions to prevent catheter-associated infections, suggesting that the use of PVP-iodine should be reevaluated for disinfection of the surgical site. In the majority of European hospitals PVP-iodine-alcohol is still standard of care to prepare the preoperative site. Methods: We consecutively and prospectively enrolled 1005 patients from representative surgical disciplines. Skin cultures to determine skin microbial counts were taken after disinfection with PVP-iodine-alcohol, immediately before incision. Disinfection of the surgical site was performed using standardized procedure under supervision. Criteria for SSI were based on guidelines issued by the Centers for Disease Control including appropriate follow-up of 30 days and 1 year. Results: A total of 1014 skin cultures from surgical sites were analyzed from 1005 patients, of which 36 (3.6%) revealed significant colonization of the preoperative site, and 41 SSIs were detected, accounting for an SSI rate of 4.04%; residual bacteria before incision were completely unrelated to the incidence of SSI, even after adjustment for multiple potentially confounding variables. Conclusions: A low rate of SSIs of 4.04% was achieved when using PVP-iodine-alcohol for disinfection of the preoperative site. Remaining bacteria after standardized 3-step disinfection did not at all correlate with the development of an SSI. Our data provide clear evidence that PVP-iodine-alcohol is effective for preparation of the preoperative site.