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Christy Elizabeth Benson, Kathie L Rogers, Donny W Suh; The efficacy of povidone-iodine in reducing surgical site contamination during strabismus surgery: dual application versus single application. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2594.
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To investigate the contamination rates of strabismic patients who received surgical prep using single versus dual application of povidone-iodine (PI).
A total of 104 patients (ages 7 months to 79 years) undergoing strabismus surgery were randomly divided into Groups A and B. Prior to surgery, the surgical sites for both Groups A and B were prepared by applying four drops of 5% povidone-iodine directly into the conjunctival fornices, followed by cleansing the eyelashes with cotton tips soaked with 5% PI. Next, sterile gauze pads soaked with 5% PI were used to clean the periocular skin in a circular fashion, gradually moving away from the eye. After lid speculum placement, the patients in Group B received an additional two drops of PI in the conjunctival fornices prior to surgery. Intraoperatively, the conjunctiva, sclera, needles/sutures, and lid speculum were cultured. Gram stain and cultures were obtained and quantified, and the results were used to compare the two groups.
Group A (single application PI) had a 25% contamination rate of surgical site and sutures (6 of 60 cases), as opposed to Group B (dual application of PI), which had a 10% contamination rate (11 of 44 cases). Contamination was defined as any bacterial growth on blood agar plates at two days. This difference was statistically significant with a p value of 0.03. The rate of eyelid speculum contamination was unaffected by additional applications of PI (12.5% contamination rate in both Groups A and B, p value 0.5). The additional application of PI affected the contamination rate of the conjunctival incision site the most, exhibiting a decrease from 20.5% to 5% (p value 0.02).
A second application of PI prior to surgery significantly decreased the rate of contamination of the surgical site and sutures. Dual application of PI prior to surgery did not decrease the rate of contamination of the lid speculum. Our study not only confirms PI’s continued effectiveness as a bactericidal agent, but also highlights the benefits of a second application of PI in terms of reducing bacterial contamination.
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