povidone-iodine and Emergencies

Topics: Emergencies; Humans; Povidone; Povidone-Iodine; Wound Infection

An open randomised comparative study was conducted in patients presenting with a hand injury requiring a surgical operation, in order to compare the efficacy of topical application of rifamycin SV with that of iodinated polyvidone dermal solution, in terms of the quality and rate of healing evaluated by the clinician, 268 patients were included in the study and 223 of them participated in the analysis of the results. Analysis of the results demonstrated the following conclusions: signs of infection developed in 8 patients in the rifamycin SV group (7%) and in 20 patients in the iodinated polyvidone group (18.5%). This difference was significant (p = 0.011) in favour of rifamycin SV. The rate of healing was considered to be rapid in 10% of patients in the rifamycin SV group and in 4% of patients in the iodinated polyvidone group. It was considered to be slow in 14% of the subjects in the rifamycin SV group and in 21% of those in the iodinated polyvidone group. This difference was also significant in favour of the rifamycin SV group (p = 0.038). In terms of local tolerance, 32 patients equally distributed between the two treatment groups developed signs of cutaneous intolerance.

Topics: Administration, Topical; Adolescent; Adult; Aged; Child; Child, Preschool; Emergencies; Female; Hand Injuries; Humans; Infant; Infant, Newborn; Male; Middle Aged; Povidone; Povidone-Iodine; Random Allocation; Rifamycins; Surgical Wound Infection; Wound Healing

A prospective, randomized study of 500 consecutive emergency department patients with traumatic lacerations requiring sutures was performed comparing use of topical 1% povidone-iodine (Betadine) and scrubbing with wound management by irrigation with normal saline without scrubbing. A 60-second wound irrigation and scrub with a 1% povidone-iodine solution was the only difference in treatment between the two groups. Data relating to risk factors such as age; degree of contamination; type of closure; ethanol intoxication; mechanism of injury; and bone, joint, or tendon involvement were analyzed. Wounds were classified as clean, infected, or purulent at follow-up examination. One hundred five patients were lost to follow-up. Of the 395 remaining patients, 122 were contacted by phone and were classified based on their description of the wound; 273 were classified at reexamination in the ED. Of 201 povidone-iodine group wounds, 11 became infected; two of them (5.4%) were purulent. Of 194 control wounds, 30 became infected, of which 12 (15.46%) were purulent (P less than .01). These data suggest that use of a topical 1% povidone-iodine solution in traumatic lacerations prior to suturing reduces the incidence of wound infections.

Topics: Adult; Emergencies; Humans; Povidone; Povidone-Iodine; Prospective Studies; Random Allocation; Sodium Chloride; Sutures; Wound Infection; Wounds and Injuries

Single doses of clindamycin hydrochloride and gentamicin sulfate given preoperatively, combined with intraoperative topical application of povidone-iodine were given to patients with perforated or gangrenous appendicitis. The incidence of wound sepsis was reduced from 36% to 5%; severe infections were reduced from 25% to 0% when compared with a control untreated group of patients. When used alone, povidone-iodine had little effect in these patients. No toxic effects of the antibiotics or antiseptic were recorded nor were any resistant strains of pathogenic organisms grown from cultures.

Topics: Administration, Topical; Adolescent; Adult; Appendectomy; Appendicitis; Clindamycin; Clinical Trials as Topic; Drug Therapy, Combination; Emergencies; Gentamicins; Humans; Intraoperative Care; Middle Aged; Povidone; Povidone-Iodine; Premedication; Surgical Wound Infection

The effects of intrarectal metronidazole and intraincisional povidone iodine on sepsis after emergency appendicectomy were compared in a double-blind randomised controlled trial in 496 patients. Wound sepsis occurred in 12.3% of metronidazole-treated patients compared with 24% in the povidone-iodine group and 23.5% in an untreated control group. The metronidazole-treated patients left hospital approximately 2 days earlier than patients in the other two groups. They returned to work sooner and receiver fewer visits from the district nursing service. A short six-dose course of metronidazole significantly reduces the wound-infection rate in patients over the age of 12 undergoing emergency appendicectomy. If the clinical and economic benefits of metronidazole shown by this study are confirmed, the drug should be considered for routine use in emergency appendicectomy.

Topics: Appendectomy; Clinical Trials as Topic; Costs and Cost Analysis; Double-Blind Method; Emergencies; Humans; Length of Stay; Metronidazole; Povidone; Povidone-Iodine; Random Allocation; Surgical Wound Infection

Restorative proctocolectomy with ileopouch-anal anastomosis (IPAA) is the treatment of choice for intractable or complicated ulcerative colitis(UC). Elderly patients often present with acute colitis requiring emergent subtotal colectomy(SC). Frail patients are at risk of developing septic complications related to the closed rectosigmoidal stump, often requiring formation of a second stoma to be reversed at the time of completion proctectomy. This carries nuisance to such exhausted patients. We propose a simple and inexpensive trick to avoid the need for creating a mucous fistula.. IPAA was performed as a 3-stage procedure in emergency settings. The rectosigmoidal stump was closed and placed subcutaneously; skin was closed over it. After SC, if patients showed signs of stump-related pelvic sepsis, a lavage of the rectal stump with povidone iodine solution and with saline was carried out as a rescue treatment aiming to avoid the need of opening the rectal stump to drain sepsis.. Thirty-five patients underwent SC for UC between 1987 and 2012. The skin was closed over the closed stump in the 20. Seven patients out of these 20 experienced early stump-related septic complication. In five cases, we were able to avoid opening of the rectal stump, and a second stoma was unnecessary. After opening the closed stump in the remaining ones, a prompt improving of symptoms was observed.. Rectal washout was well tolerated and avoided a second stoma in five out of seven patients, with better quality of life and body perception after IPAA surgery. This is relevant when dealing with geriatric patients, needing to completely recover before undergoing completion proctectomy.

Topics: Anti-Infective Agents, Local; Colectomy; Colitis, Ulcerative; Emergencies; Humans; Ileostomy; Laparoscopy; Povidone-Iodine; Sodium Chloride; Surgical Wound Infection; Therapeutic Irrigation; Treatment Outcome

We present the cases of three patients with skin blisters following carbon monoxide (CO) poisoning. Their blisters appeared to be related to the severity of the poisoning (HbCO levels of more than 40%). Two of the three patients died despite aggressive initial 100% surface oxygen followed by hyperbaric oxygen therapy. The pathophysiology of this type of blister remains unresolved. It could result from pressure necrosis alone or from a combination of pressure necrosis and direct CO inhibition of tissue oxidative enzymes. Although skin involvement as a result of CO poisoning is less frequently reported today than in the past (perhaps because of misidentified burns or because of more aggressive resuscitation and treatment protocols), the physician should recognize that such blisters may signal severe CO poisoning.

Topics: Adolescent; Aged; Blister; Burns, Chemical; Carbon Monoxide Poisoning; Carboxyhemoglobin; Emergencies; Female; Hemoglobins; Humans; Male; Middle Aged; Oxygen; Povidone-Iodine; Resuscitation