It appears, from what I have found that iodine based products are
used as a cleaning solution, preoperatively. (I have typically seen
iodine used as a scrub before surgery and not used post-op on all
wounds). If a patient is a diabetic, or immunocompromised, a surgeon
is more likely to use an antiseptic topical solution/ointment. In
situations where iodine is used post op, it is used as a cleaning
solution ? a topical ointment may be applied afterwards, as iodine is
inactivated by wound serous fluid. Iodophors may be used when a wound
has become infected, to clean and help debride a wound. It depends on
the type of wound/surgery and surgeon?s choice however as to what
anti-microbials are used, if at all, immediately following surgery.
Some surgeons prefer no topicals, to prevent resistance.
Some patients have an iodine allergy or sensitivity, and according to
at least one source, absorbed iodine caused metabolic acidosis, renal
failure and death.
?Benefits from the use of topical antimicrobial products can be split
into two classifications:
? Interruption of infection in invasive situations due to the
transfer of resident bacteria into wounds, incisions, injection sites
or damaged skin.
? Interruption of disease transmission in non-invasive situations to
others and oneself due to the acquisition of transient bacteria and
their transfer to a point of entry into the host, and to oneself due
to skin infections from one?s own resident skin flora.
?Interruption of infection in invasive situations due to the transfer
of resident bacteria into wounds, incisions, injection sites or
Studies examining clinical endpoints that support the benefits of
using topical antimicrobial products in invasive procedures are
?Surgery ? Clinical studies have shown the benefit of using topical
antimicrobial products to control the resident flora on surgeons?
hands and at the site of incision in many different types of surgery
including: intrathoracic procedures (Hughes et al. 1966; Klovekorn et
al. 1985), gynecological surgery (Beaton undated), neurological
procedures (Jackson 1972), intraperitonial procedures (Gruer et al.
1984; Brown et al. 1984), vascular surgery (Grinbaum et al. 1995;
Denton 1991), and general or elective surgery (Georgiade et al.)?
?Furthermore, it is important to remember that topical antimicrobial
products are used as part of an overall hygiene regimen and should not
serve as the only means of infection control.?
?Though antisepsis as a method of prevention of post-operative wound
sepsis has been in use for nearly a century, no agreement exists as to
the best method for the preparation of the patients' skin and the
surgeons' hands. A large amount of research done in the recent years
has thrown doubt on many of the traditional concepts. It has been
shown that the mere application of an antiseptic on the operation site
will cause a 99% reduction in the colony counts of organisms on the
skin and that this reduction persists for two hours or more.
Dineen has shown that a five minute scrub is as effective as a ten
minute one in effectively reducing the number of microorganisms on the
hands. However, in a recent survey of 113 hospitals in the United
Kingdom it is seen that the time for antiseptic application varied
from between less than one minute to more than ten minutes. It is
difficult to opine as to the optimal contact time needed to get a
relatively germ free operation site. The position is complicated by
the fact that 20% or more cutaneous organisms reside in the deeper
layers of the skin and are beyond the reach of antiseptics applied to
the surface. It has also been shown that even after effective
decontamination of the skin surface, regrowth of organisms occurs from
the deeper layers of the skin and that the numbers of skin organisms
approached the control levels with passage of time. More
disturbingly, the action of vigorous scrubbing may in fact release
these organisms onto the surface, thus negating the very concept of
?The postoperative period usually does not contribute greatly to the
risk of surgical wound infections. Nevertheless, wounds can become
contaminated and later become infected if they are touched by
contaminated hands or objects after the operation, especially if the
wound is left open or if a drain is used. Until wound edges are sealed
and the wound is healing (about 24 hours after the operation for most
wounds), wounds are covered with sterile dressings to reduce the risk
of such contamination. A transparent, semipermeable membrane dressing
has been developed for use on wounds because the dressing does not
need to be removed for the wound to be observed; the effect of use of
this dressing on wound infection rates is unknown.?
1. Parenteral antimicrobial prophylaxis is recommended for operations
that 1) are associated with a high risk of infection or 2) are not
frequently associated with infection but, if infection occurs, are
associated with severe or life-threatening consequences, for example,
cardiovascular and orthopedic operations involving implantable
devices. Category I?
?The most common cause of wound sepsis is Staphylococcus aureus
(Cooper and Lawrence 1996b) and Beta-haemolytic streptococci
(Lancefield group A). Treatment of these infections is empirical,
partly because the bacteriology of ulcers with extensive surrounding
cellulitis is similar to that of chronic non-infected ulcers (Grey
Lawrence (1993a) reports that Group A streptococcus is so pathogenic
it almost inevitably leads to infection. Potentially pathogenic
bacteria commonly found in wounds are mostly aerobic (Cooper and
Lawrence 1996b). This is supported by Lawrence (1993a) who recorded
the percentage incidence of bacteria in 58 venous ulcers. A review of
leg ulcer bacteriology concluded that although streptococcal invasion
was unlikely to initiate ulceration, it resulted in ulcer
deterioration or delayed healing (Hayes 1997).
?A significant reduction in the incidence of coagulase negative
staphylococci related peritonitis was achieved by treating patient
skin with a CHG detergent followed by 70% ethanol or the use of
povidone?iodine with or without a subsequent alcohol rinse?
?A significant decrease in the number of post-operative infections
among patients with groin incisions was affected by using repeated
shower-baths with 4% CHG prior to standard surgical preparations
(Brandberg et al. 1981).
With repeated use (3-8 times), the number of infections decreased from
17.5% to 8% in the group using Hibiscrub versus the control group
(local washing only).?
?Mechanism of action. Povidone iodine acts by destroying microbial protein and DNA.
Spectrum of antimicrobial activity. This drug has excellent in vitro
antimicrobial activity but is inactivated by wound exudate.
Clinical use. Povidone iodine has not been proved useful as a topical
antimicrobial treatment for burn patients.?
?A commonly used antimicrobial agent is povidone-iodine (Betadine®), a
complex of iodine, the bactericidal component, with
polyvinylpyrrolidone (povidone), a synthetic polymer.1 The most common
commercial form is a 10% solution in water yielding 1% available
iodine.1 Povidone-iodine is available as a surgical scrub or skin
cleanser with a detergent base (0.75% available iodine) or in other
?The safety of a wound care treatment may be determined by whether the
treatment retards the progress of the wound through the stages of
healing (inflammatory, proliferative/reepithelializing, and
remodeling). The efficacy of a wound care treatment (eg,
povidone-iodine) can be judged in vitro by its ability to kill
microorganisms and in vivo by whether it decreases the rate or
severity of wound infection. The task of evaluating the choice of
povidone-iodine solution for treatment of wounds, especially the
chronic wounds most often seen in physical therapy practice, is made
complex by two factors.?
?Wounds may be irrigated or soaked once or repeatedly with
povidone-iodine solution. Povidone-iodine solution also can be applied
for longer periods as part of the dressing. There are no studies
comparing the effects of these methods. Povidone-iodine solution also
may be used at full strength (10%) or diluted to any desired
concentration prior to use. Research results should be interpreted
based on the specifics of the application used.
Recent positions taken by two federal agencies?the Food and Drug
Administration (FDA) and the Agency for Health Care Policy and
Research (AHCPR)?have implications for the use of povidone-iodine
solution in wound treatment. The FDA has approved povidone-iodine for
use in nonprescription first-aid antiseptic products.2 Use of the term
"first aid" implies that povidone-iodine can be used for short-term
treatment (approximately 1 week) and on relatively superficial and
acute wounds. In assessing the evidence regarding use of
povidone-iodine, the FDA report states:
Controlled studies on wound healing were conducted in animals and
humans and involved various types of dermal wounds.... Both
superficial and deeper wounds were studied with a contralateral
control.... Results showed that there were no statistically
significant differences in mean healing times between any of the
treatment groups and their controls. In addition, microscopic analysis
showed no differences in wound healing in the groups studied. These
pathological and histological studies did not indicate any deleterious
effect of povidone-iodine on wound healing. However, there was also no
evidence demonstrating that povidone-iodine might aid wound healing.2
The FDA has issued no position statement on povidone-iodine use for
prolonged periods or in treating chronic wounds.
?Rodeheaver et al23 inoculated experimental wounds in guinea pigs with
102 to 107 organisms of S aureus. Ten minutes later, the wounds were
irrigated with either povidone-iodine solution (10%) or normal saline.
Four days after treatment, the authors found no difference between the
two groups in the number of viable bacteria present in the wounds or
in the number of wounds with visible purulent exudate. When the same
experiment was conducted using povidone-iodine surgical scrub, the
wounds treated with povidone-iodine had higher rates of infection than
those treated with saline. Wounds contaminated with 103 organisms
showed 60% infection when treated with povidone-iodine versus 0% with
saline. Inoculation with 104 organisms produced 90% infection when
treated with povidone-iodine versus 0% with saline. With 105
organisms, wounds treated with povidone-iodine were 100% infected
versus 15% for saline controls.?
Please read the entire article, as I?m unable to post more than this
due to copyright restrictions.
?Iodophors penetrate the cell wall with oxidation of the contents and
free iodine substitution. There is a fast reaction time and
intermediate persistence. Iodophors rapidly neutralize in the presence
of organic matter. It has excellent activity against Gram-positive
organisms and good activity against Gram-negative and TB organisms,
fungi and viruses. It is a skin irritant and can be absorbed through
the skin. Iodophors contain both iodine and a carrier. This
combination provides a reservoir for the iodine. This reservoir
determines the iodine available while the amount of iodine in solution
indicates the free iodine. The activity of iodophors is dependent on
the concentration of this free iodine.25 The FDA TFM has tentatively
classified iodophors in 5 to 10 percent concentration as Category I, a
safe and effective agent.26?
?These experiments provide evidence that 1% povidone-iodine, 3%
hydrogen peroxide, 0.5% sodium hypochlorite, and 0.25% acetic acid are
unsuitable for use in wound care. This sequence of experiments could
be used to identify bactericidal, noncytotoxic agents prior to their
?Povidone iodine is available commercially in several formulations
(solution, cream, ointment, dry spray or dressings). There is
extensive in vitro evidence of the efficacy of PVP-I as a cidal agent,
from varying methodology , ,, . In one study it was
shown that PVP-I lethally damaged >99% cells within 10 seconds of
exposure, and as little as 2.36 ×105 atoms of iodine were required to
kill one bacterial cell. Activity at low concentration is affected
by the presence of organic matter, but not all in vitro tests
incorporate this factor into their design.
Clinically, PVP-I has application not only in the management of
wounds, but as a skin antiseptic prior to surgery, and in the
disinfection of inert surfaces . Whereas its efficacy as a skin
disinfectant is undisputed, numerous publications describe the use of
iodine in cleansing wounds, and as a topical agent to prevent or treat
localised wound infections, but controversy surrounds its safety and
efficacy. Since 1994 PVP-I has been approved by the US Food and
Drugs Administration for the 'first aid' treatment of small, acute
wounds, but it was not recommended for use with pressure ulcers by the
US Department of Health & Human Services.?
Page 3 of this article contains a chart comparing the benefits of
iodine 3%, chlorhexidine, iodophor, and other antiseptics.
?Both chlorhexidine gluconate and iodophors have broad spectra of
antimicrobial activity. In some comparisons of the two antiseptics,
chlorhexidine gluconate achieved greater reduction in skin microflora
than did povidone-iodine and also had greater residual activity after
a single application.
Further, chlorhexidine gluconate is not inactivated by blood or serum
Proteins. Iodophors may be inactivated by
blood or serum proteins, but exert a bacteriostatic effect as long as
they are present on the skin.
a. Protect an incision closed primarily with a sterile dressing for
24-48 hours postoperatively. Also ensure that the dressing remains dry
and that it is not removed bathing.\315\ \316\ Category IA
b. No recommendation on whether or not to cover an incision closed
primarily beyond 48 hours, nor on the appropriate time to shower/bathe
with an uncovered incision. Unresolved Issue
c. Wash hands with an antiseptic agent before and after dressing
changes, or any contact with the surgical site. Category IA
d. For incisions left open postoperatively, no recommendation for
dressing changes using a sterile technique vs. clean technique.
e. Educate the patient and family using a coordinated team approach
on how to perform proper incision care, identify signs and symptoms of
infection, and where to report any signs and symptoms of infection.
?Antibacterial ointments including bacitracin, Polysporin, and
Bactroban are routinely used for wound care after dermatologic surgery
to reduce infections and to provide a moist healing environment.
However, some patients develop allergic contact dermatitis.?
?Comment: White petrolatum appears to be a safe and much less costly
alternative to bacitracin ointment. There seems to be no significant
increase in wound infections with petrolatum, and the risk of allergic
contact dermatitis is eliminated. Bacitracin selects for Gram-negative
organisms, which can cause infections that may require more expensive
antibiotics to treat than S. aureus infections.
The use of antibacterial ointments is so universal that many more
studies like this one will be needed to convince dermatologists to
switch to petrolatum for routine postoperative wound care.?
Topical antibiotic ointments such as Bacitacin and Polysporin are very
often used in minor wounds.
In dermatological surgery:?Cleanse the wound or suture line twice
daily with soap and water. Use a cotton-tipped swab (Q-tip) to remove
any dried blood or crust. Pat dry gently. Apply a thin layer of
Bacitracin or Polysporin ointment over the wound and cover with a new
Telfa pad (non-stick dressing) or bandage. Avoid using ointments
containing neomycin (Neosporin) because they may cause redness or
itching in some people. The first day the wound may be tender and
bleed slightly or seep a small amount of clear fluid.
Two days after surgery you may shower and allow the wound to get wet,
but do not let the forceful stream of the shower hit the wound
directly. Always remove a wet bandage promptly and replace with a dry
bandage applied over a layer of antibiotic ointment.?
?Currently, a number of topical agents are available to assist in
microbial control of the burn wound, including silver sulfadiazine,
mefenide acetate, 0.5% silver nitrate, bacitracin/polymyxin B,
mupirocin, and Mycostatin. No single agent is totally effective and
each has advantages and disadvantages. Almost all agents will affect
wound healing and increase metabolic rate.
Silver sulfadiazine (e.g. Silvadene or SSD) is the most commonly used
topical antimicrobial agent in burns.
Mafenide acetate 11.2% cream (e.g. Sulfamylon) is one of the oldest
effective topical antimicrobial agents.?
?Topical antimicrobial agents usually have a non-specific mode of
action and therefore the opportunity for unwanted patient effects
exist, but there is a lesser chance of the development of resistance
in microbial species. The development of antiseptic resistance,
however, has already been noted with chlorhexidine, and it has been
linked to antibiotic resistance . Misuse and abuse of antiseptics
must, therefore, be avoided, and additional antimicrobial therapies
will always be needed. Tea tree oil has already been assessed for in
vitro and in vivo activity, and antimicrobial peptides
isolated from amphibian skin offer promise in treating
?There are topical agents that are less harmful to epidermal cells in
culture and can be successfully used immediately prior to surgery?
1. Amphotercin B
4. Gentamicin sulfate
5. Neomycin sulfate
6. Nystatin (Mycostatin®)
7. Polymyxin B sulfate
8. Tobramycin sulfate
9. Vancomycin hydrochloride
10. Polymyxin B sulfate & bacitracin zinc (Polysporin?, Bibiotic)
11. Polymyxin B sulfate, bacitracin zinc & neomycin sulfate (Triple Anitbiotic)
?Prep the wound surface with a scrub that is not detrimental to Epicel??(povidone
iodine, poloxamer 188, or acetic acid) then thoroughly rinse with sterile normal
saline.? In this situation, provodine iodine is used before applying
Epicel autograft, along with a triple antibiotic ointment.
?Goldman utilizes an anti-aerobic agent and an anti-anaerobic agent as
well, to best eliminate gram-positive, gram-negative and anaerobic
?Even if topical antibiotics are included in the therapy, they will be
Bacitracin or Neosporin, which are both offered over the counter.
"Review of the literature feels that all it does is set the patient up
for MRSA because you're treating a broad spectrum of bugs that are
sitting on the wound," Gill says. "But unless they're there in
sufficient quantities to actually cause infection, you're just giving
antibiotics for no good reason. The other thing is, patients
oftentimes develop an allergy to long-term use with Neosporin or
Bacitracin because of the vehicle they're mixed in--(like) petroleum
?Petroleum-based antimicrobial ointments such as bacitracin and/or
polymyxin B are clear on application, painless, and allow for easy
wound observation. These agents are commonly used for treatment of
facial burns, graft sites, healing donor sites, and small
partial-thickness burns. Povidone iodine ointment has a broad
antimicrobial activity, including bacteria, fungi, and some viral
forms. Mupirocin (e.g. Bactroban) has improved activity against gram
positive bacteria, especially methillin resistant Staph. aureus (MRSA)
and selected enteric bacteria. Gentamicin ointment will select for
resistant organisms and diminish effectiveness of its parenteral form,
but may be useful in selected cases.?
Most clinical use of bacitracin is in the prophylaxis of Gram-positive
bacteria infection in open areas. The addition of neomycin and
polymyxin B expands the antimicrobial action to Gram-negative
A physiological pH. A freshly prepared 0.1% NaOCl solution
decontaminates skin colonized with S. aureus, C. albicans, and P.
aeruginosa within 10, 20, and 30 min, respectively. There is no report
of microbial resistance to hypoehloride. More studies need to be done
before clinical use is possible. Hypochloride has the additional
advantages of reducing oedema and of having no effect on granulation
?Doctor Barie: Let's explore the common concept of treating the wound
locally with a pharmacologic agent of some type, even including saline
as a pharmacologic agent. There is intraoperative lavage, which could
utilize saline or dilute povidone-iodine solution. There is the
opportunity to put topical antiseptics or antibiotics in the incision.
There is the possibility to put topical antiseptics in the wound. And
then, there is the opportunity to actually deliver medication to the
wound post-operatively as it heals. What is the science here, and does
it conform to practice?
Doctor Hau: Some old studies examined the practice of local antibiotic
instillation into wounds. Ampicillin was as effective as using
systemic antibiotics, in solution as well as in powder form.
Follow-up studies with newer agents have not been performed. There are
also no clinical studies, as far as I know, that look at the use of
antiseptics in wounds, although animal and in vitro studies suggest
that most topical antibiotics actually impair wound healing.?
Doctor Hau: An old surgical aphorism states that you shouldn't put
anything in a wound that you couldn't put in your eye.
Doctor Faist: That's right.
Doctor Fry: I don't use anything in the wound other than saline. I am
unaware of data to substantiate the position that topical drugs are
better than what one achieves with systemic perioperative prophylaxis
used appropriately, so the study of topical drugs remains of interest.
A reasonable hypothesis is that topical antisepsis will act
synergistically with antibiotic prophylaxis, and is worth testing.
Other wound dressings:
?The use of hydrogel A resulted in significantly faster and efficient
debridement, no sign of allergic reactions, significantly easier
application, a positive influence on the patients' quality of life
caused by significantly lower degree of wound pain, and apparent
cost-effectiveness of debridement.?
Read the ?In vitro evaluation of the bactericidal activity of three
wound antiseptics against biofilms of common wound pathogens?
Here?s an interesting excerpt about honey healing wounds.
I hope this is the answer you were seeking. If not, please request an
Answer Clarification, and allow me to respond, before you rate. I
will be happy to assist you further on this question, before you rate.
Preferred topical antimicrobials + post-op wound care
Wound flap + dressings + Neosporin OR Iodine
surgical wound care
Post-op wound care
topical antimicrobials + iodine + compare
compare + iodophors + bacitracin + post operative wounds
closing surgical incision + topical antimicrobials