povidone-iodine and Fever

We aimed to investigate the effect of various vaginal wash solutions on reducing risks of post-cesarean endometritis, wound infections, fever, and hospital stay duration.. Scopus, Web of Science, PubMed, and Cochrane Library were searched for randomized clinical trials that compared different vaginal wash solutions to each other or to "no vaginal cleaning"; without restriction on the age of parturients or site where trials were conducted. We analyzed this frequentist network meta-analysis using the netmeta package in R software version 4.1.2; synthesized data as mean difference or risk ratio with their 95% confidence intervals.. Our network meta-analysis included 29 RCTs with a total sample size of 9311 women undergoing CS. Regarding post-cesarean endometritis, we found that povidone-iodine had the highest significant risk reduction compared to "no vaginal cleaning" (RR = 0.08, 95% CI [0.01, 0.69]). While regarding post-cesarean reduction of wound infection, fever, and hospital stay duration, we found that chlorhexidine 4% (RR = 0.17, 95% CI [0.05, 0.65]), saline 0.9% (RR = 0.12, 95% CI [0.03; 0.48]), and saline 0.9% (MD = -1.29, 95% CI [-2.18; -0.39]), respectively, had the highest significant risk reduction compared to "no vaginal cleaning.". Vaginal wash solutions were associated with a significant reduction of post-cesarean endometritis, wound infection, fever, and hospital stay duration. Since povidone-iodine had the highest significant reduction of post-cesarean endometritis, we recommend setting povidone-iodine as the standard practice as pre cesarean vaginal wash solution; consistent practice guidelines of Enhanced Recovery After Surgery (ERAS).

Topics: Anti-Infective Agents, Local; Cesarean Section; Endometritis; Female; Fever; Humans; Network Meta-Analysis; Postoperative Complications; Povidone-Iodine; Pregnancy; Surgical Wound Infection

Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. This is an update of a Cochrane Review first published in 2010 and subsequently updated in 2012, twice in 2014, in 2017 and 2018.. To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications. We also assessed the side effects of vaginal cleansing solutions to determine adverse events associated with the intervention.. We searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (7 July 2019), and reference lists of retrieved studies.. We included randomized controlled trials (RCTs) and quasi-RCTs assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity. Cluster-RCTs were eligible for inclusion, but we did not identify any. We excluded trials that utilized vaginal preparation during labor or that did not use antibiotic surgical prophylaxis. We also excluded any trials using a cross-over design. We included trials published in abstract form only if sufficient information was present in the abstract on methods and outcomes to analyze.. At least three of the review authors independently assessed eligibility of the studies. Two review authors were assigned to extract study characteristics, quality assessments, and data from eligible studies.. We included 21 trials, reporting results for 7038 women evaluating the effects of vaginal cleansing (17 using povidone-iodine, 3 chlorhexidine, 1 benzalkonium chloride) on post-cesarean infectious morbidity. Trials used vaginal preparations administered by sponge sticks, douches, or soaked gauze wipes. The control groups were typically no vaginal preparation (17 trials) or the use of a saline vaginal preparation (4 trials). One trial did not report on any outcomes of interest. Trials were performed in 10 different countries (Saudi Arabia, Pakistan, Iran, Thailand, Turkey, USA, Egypt, UK, Kenya and India). The overall risk of bias was low for areas of attrition, reporting, and other bias. About half of the trials had low risk of selection bias, with most of the remainder rated as unclear. Due to lack of blinding, we rated performance bias as high risk in nearly one-third of the trials, low risk in one-third, and unclear in one-third. Vaginal preparation with antiseptic solution immediately before cesarean delivery probably reduces the incidence of post-cesarean endometritis from 7.1% in control groups to 3.1% in vaginal cleansing groups (average risk ratio (aRR) 0.41, 95% confidence interval (CI) 0.29 to 0.58; 20 trials, 6918 women; moderate-certainty evidence). This reduction in endometritis was seen for both iodine-based solutions and chlorhexidine-based solutions. Risks of postoperative fever and postoperative wound infection are also probably reduced by vaginal antiseptic preparation (fever: aRR 0.64, 0.50 to 0.82; 16 trials, 6163 women; and wound infection: RR 0.62, 95% CI 0.50 to 0.77; 18 trials, 6385 women; both moderate-certainty evidence). Two trials found that there may be a lower risk of a composite outcome of wound complication or endometritis in women receiving preoperative vaginal preparation (RR 0.46, 95% CI 0.26 to 0.82; 2 trials, 499 women; low-certainty evidence). No adverse effects were reported with either the povidone-iodine or chlorhexidine vaginal cleansing. Subgroup analysis suggested a greater effect with vaginal preparations for those women in labour versus those not in labour for four out of five outcomes examined (post-cesarean endometritis; postoperative fever; postoperative wound infection; composite wound complication or endometritis). This apparent difference needs to be investigated further in future trials. We did not observe any subgroup differences between women with ruptured membranes and women with intact membranes.. Vaginal preparation with povidone-iodine or chlorhexidine solution compared to saline or not cleansing immediately before cesarean delivery probably reduces the risk of post-cesarean endometritis, postoperative fever, and postoperative wound infection. Subgroup analysis found that these benefits were typically present whether iodine-based or chlorhexidine-based solutions were used and when women were in labor before the cesarean. The suggested benefit in women in labor needs further investigation in future trials. There was moderate-certainty evidence using GRADE for all reported outcomes, with downgrading decisions based on limitations in study design or imprecision. As a simple intervention, providers may consider implementing preoperative vaginal cleansing with povidone-iodine or chlorhexidine before performing cesarean deliveries. Future research on this intervention being incorporated into bundles of care plans for women receiving cesarean delivery will be needed.

Topics: Administration, Intravaginal; Anti-Infective Agents, Local; Benzalkonium Compounds; Cesarean Section; Chlorhexidine; Disinfection; Endometritis; Female; Fever; Humans; Povidone-Iodine; Pregnancy; Preoperative Care; Randomized Controlled Trials as Topic; Surgical Wound Infection

Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. This is an update of a Cochrane review first published in 2010 and subsequently updated in 2012, and twice in 2014.. To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications. We also assessed the side effects of vaginal cleansing solutions to determine adverse events associated with the intervention.. We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (10 July 2017), and reference lists of retrieved studies.. We included randomized trials and one quasi-randomized trial assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity. Cluster-randomized trials were eligible for inclusion but none were identified. We excluded trials that utilized vaginal preparation during labor or that did not use antibiotic surgical prophylaxis. We also excluded any trials using a cross-over design.. At least three of the review authors independently assessed eligibility of the studies. Two review authors were assigned to extract study characteristics, quality assessments, and data from eligible studies.. We included 11 trials reporting results for 3403 women evaluating the effects of vaginal cleansing (eight using povidone-iodine, two chlorhexidine, one benzalkonium chloride) on post-cesarean infectious morbidity. Additionally, some trials used vaginal preparations using sponge sticks, douches, or soaked gauze wipes. The control groups were typically no vaginal preparation (eight trials) or the use of a saline vaginal preparation (three trials). The risk of bias in the studies reduced our confidence in the results for endometritis outcomes.Vaginal preparation with antiseptic solution immediately before cesarean delivery probably reduces the incidence of post-cesarean endometritis from 8.7% in control groups to 3.8% in vaginal cleansing groups (average risk ratio (RR) 0.36, 95% confidence interval (CI) 0.20 to 0.63, 10 trials, 3283 women, moderate quality of evidence). Subgroup analysis could not rule out larger reductions in endometritis with antiseptics in women who were in labor or in women whose membranes had ruptured when antiseptics were used. Risks of postoperative fever and postoperative wound infection may be slightly lowered by antiseptic preparation, but the confidence intervals around the effects for both outcomes are consistent with a large reduction in risk and no difference between groups (fever: RR 0.87 (0.72 to 1.05; wound infection: RR 0.74 (95% CI 0.49 to 1.11), both moderate-quality evidence). Two trials reported a lower risk of a composite outcome of wound complication or endometritis in women receiving preoperative vaginal preparation (RR 0.46, 95% CI 0.26 to 0.82, two trials, 499 women, moderate-quality evidence). No adverse effects were reported with either the povidone-iodine or chlorhexidine vaginal cleansing.. Vaginal preparation with povidone-iodine or chlorhexidine solution compared to saline or not cleansing immediately before cesarean delivery probably reduces the risk of post-cesarean endometritis. Subgroup analysis could not rule out larger reductions in endometritis with antiseptics in women who were in labor or in women whose membranes had ruptured when antiseptics were used.The quality of the evidence using GRADE was moderate for all reported outcomes. We downgraded the outcome of post-cesarean endometritis and composite of wound complications or endometritis for risk of bias and postoperative fever and postoperative wound infections for wide CIs.As a simple, generally inexpensive intervention, providers may consider implementing preoperative vaginal cleansing with povidone-iodine or chlorhexidine before performing cesarean deliveries.

Topics: Administration, Intravaginal; Anti-Infective Agents, Local; Benzalkonium Compounds; Cesarean Section; Chlorhexidine; Disinfection; Endometritis; Female; Fever; Humans; Povidone-Iodine; Pregnancy; Preoperative Care; Randomized Controlled Trials as Topic; Surgical Wound Infection; Vagina

To evaluate the efficacy of preoperative vaginal cleansing using povidone-iodine solution 10% on rates of post cesarean section (CS) infectious morbidities (endometritis, febrile morbidity and wound infection).. This prospective randomized trial was conducted among 226 pregnant women scheduled for term elective CS. Patients were equally divided into two groups by simple randomization method. The study group had preoperative vaginal cleansing using povidone-iodine solution 10% for about 1 min, while the control group did not. All cases received the prophylactic antibiotics and the usual abdominal scrub. Adverse post CS infectious morbidities such as endometritis, febrile morbidity and wound infection were observed at the time of hospital discharge and weekly for 6 weeks postpartum.. Both groups were matched regarding the baseline patients' characteristics. Overall, post-CS infectious morbidity was significantly reduced from 20.7% in the control group to 7.5% in the intervention group. Marked significant reduction was seen in the incidence of endometritis (11.8% in the control group versus 2.8% in the intervention group). However, maternal fever and wound infection showed no significant difference between both groups.. Vaginal cleansing with povidone-iodine solution 10% prior to elective CS appears to be effective in reducing rates of post-CS infectious morbidity mainly endometritis.

Topics: Administration, Intravaginal; Adult; Anti-Infective Agents, Local; Cesarean Section; Disinfection; Endometritis; Female; Fever; Humans; Postoperative Complications; Povidone-Iodine; Pregnancy; Preoperative Care; Surgical Wound Infection; Vagina

Although oral health care has a preventive effect against ventilator-associated pneumonia (VAP), the most effective method of oral health care in this respect remains to be established. The objective of this single-center, randomized, controlled trial was to investigate the relationship between VAP and various methods of oral health care. All patients included in the study (n=142) were on mechanical ventilation with oral intubation at the intensive care unit of the Tokyo Dental College Ichikawa General Hospital. They were divided into two groups, one receiving standard oral health care (Standard group), and the other receiving oral health care using an oral moisture gel instead of water (Gel group). After removal of the intubation tube, biofilm on cuff of the tube was stained with a disclosing agent to determine the contamination level. Factors investigated included sex, age, number of remaining teeth, intubation time, fever ≥38.5°C, VAP, cuff contamination level, and time required for one oral health care session. No VAP occurred in either group during the study period. The level of cuff contamination was significantly lower in the Gel group than the Standard group, and the time required for one session of oral health care was shorter (p<0.001). Multivariate analysis revealed use of the oral moisture gel as a factor affecting cuff contamination level. Use of an oral moisture gel decreased invasion of the pharynx by bacteria and contaminants together with biofilm formation on the intubation tube cuff. These results suggest that oral health care using an oral moisture gel is effective in preventing cuff contamination.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Local; Biofilms; Coloring Agents; Critical Care; Equipment Contamination; Female; Fever; Gels; Glycerol; Humans; Image Processing, Computer-Assisted; Intubation, Intratracheal; Lubricants; Male; Middle Aged; Mouth Mucosa; Oral Hygiene; Photography; Pneumonia, Ventilator-Associated; Povidone-Iodine; Risk Factors; Time Factors; Water

The objective of the study was to determine whether vaginal preparation with povidone iodine before cesarean delivery decreased the risk of postoperative maternal morbidities.. The design of the study was a randomized, controlled trial in women undergoing cesarean delivery with subjects assigned to have a preoperative vaginal cleansing with povidone iodine or to a standard care group (no vaginal wash). The primary outcome was a composite of postoperative fever, endometritis, sepsis, readmission, wound infection, or complication.. There were 155 vaginal cleansing subjects and 145 control subjects. Overall, 9.0% developed the composite outcome, with fewer women in the cleansing group (6.5%) compared with the control group (11.7%), although the difference was not statistically significant (relative risk, 0.55; 95% confidence interval, 0.26-1.11; P = .11). Length of surgery, being in labor, and having a dilated cervix were all associated with the composite morbidity outcome.. Vaginal cleansing with povidone iodine before cesarean delivery may decrease postoperative morbidities, although the reduction is not statistically significant.

Topics: Adult; Anti-Infective Agents, Local; Cesarean Section; Endometritis; Female; Fever; Gravidity; Humans; Labor Stage, First; Labor, Obstetric; Parity; Patient Readmission; Postoperative Complications; Povidone-Iodine; Pregnancy; Preoperative Care; Sepsis; Surgical Stapling; Surgical Wound Infection; Sutures; Vagina

To compare the effectiveness between savlon solution was douching and povidone-iodine solution painting for reducing febrile morbidity after total abdominal hysterectomy.. Clinical trial.. One hundred and fifty patients at Srinagarind Hospital were scheduled for total abdominal hysterectomy (TAH). All subjects were non-randomly allocated to receive either savlon (1:1000 solutions) douching or povidone-iodine (1% solution) painting as pre-operative vaginal preparations. They also received Cefazolin 1 gm. intravenously before the operation. The principal outcome of the study was febrile morbidity.. The overall rate of febrile morbidity was 21 percent. The incidence of febrile morbidity in the savlon vs. povidone-iodine groups was 16 (12/75) and 25 (19/75) percent, respectively. No statistically significant difference was found between the two groups (p-value = 0.16). The odds ratio was 1.78 (95%CI 0.79 to 3.99) and adjusted odds ratio was 2.09(95%CI 0.86 to 5.10) CONCLUSION: The effectiveness between savlon solution douching and povidone-iodine solution painting in conjunction with a prophylactic antibiotic before TAH for reducing febrile morbidity was not significant different.

Topics: Administration, Intravaginal; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cetrimonium Compounds; Chlorhexidine; Drug Combinations; Female; Fever; Humans; Hysterectomy; Middle Aged; Povidone-Iodine; Premedication; Preoperative Care; Surgical Wound Infection; Vaginal Douching

To evaluate the effectiveness of vaginal douching with 1 per cent povidone-iodine in reducing febrile and infectious morbidities after total abdominal hysterectomy (TAH).. The authors conducted a randomized controlled trial in 300 patients undergoing elective TAH in three hospitals in Northeast Thailand: a university, a regional and a general hospital. The patients were randomly allocated to the intervention or control groups. Patients in the intervention group received pre-operative vaginal douching with 1 per cent povidone-iodine while patients in the control group did not. External evaluators not apprised of the intervention assessed febrile and infectious morbidities.. 300 patients were enrolled in the study. The incidences of febrile morbidity in patients with and without pre-operative vaginal douching were 25 and 35 per cent, respectively, though not statistically significant (risk difference -9.6%, 95% CI -19.9%, 0.8%, adjusted odds ratio 0.6, 95% CI 0.3%, 1.0%). A statistically significant difference in infectious morbidity was found between the groups (8 vs 19%, risk difference -10.0%, 95% CI -17.8%, -2.2%, adjusted odds ratio 0.4, 95% CI 0.2%, 0.9%).. Pre-operative vaginal douching with 1 per cent povidone-iodine significantly reduces infectious morbidities after TAH.

Topics: Administration, Intravaginal; Adult; Aged; Anti-Infective Agents, Local; Female; Fever; Humans; Hysterectomy; Infection Control; Infections; Middle Aged; Povidone-Iodine; Treatment Outcome; Vaginal Douching

It was shown that prophylactic use of ciprofloxacin (500 mg per os 30 min prior to and 5 days after transrectal multifocal prostatic biopsy) along with topical treatment with 40 ml 1% povidone-iodine and evacuant enema provided negative bacteriological urine analysis in 24 hours for 94.4 per cent of cases. Positive effect was registered for all patients as no urinary tract infections were demonstrated. Transitory fever over 37.5 degrees C was not registered at 67 (97.2 per cent) patients, for the rest cases no changes of the treatment regime were necessary. The results of the trial proves high bacteriological and clinical efficacy of the therapy regimes and allow to recommend its implementation at transrectal biopsy.

Topics: Administration, Topical; Anti-Infective Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacteriuria; Biopsy; Ciprofloxacin; Fever; Humans; Male; Povidone-Iodine; Prostate; Rectum; Urinary Tract Infections; Urine

Topics: Abscess; Adult; Anti-Bacterial Agents; Antifungal Agents; Aortic Aneurysm, Abdominal; Aspergillosis; Aspergillus fumigatus; Blood Vessel Prosthesis; Combined Modality Therapy; Coronary Sinus; Coronary Vessels; Debridement; Drug Therapy, Combination; Fever; Heart Valve Prosthesis; Humans; Male; Postoperative Complications; Povidone-Iodine; Prosthesis-Related Infections; Pyrimidines; Replantation; Tomography, X-Ray Computed; Triazoles; Voriconazole

Topics: Aged; Anti-Infective Agents, Local; Ceftriaxone; Erythema; Female; Fever; Humans; Minocycline; Ofloxacin; Povidone-Iodine; Rickettsia Infections; Severity of Illness Index; Treatment Outcome

Gossypiboma is derived from the Latin word gossypium, meaning cotton, and it means a postoperatively retained foreign body used in operations. Several cases of gossypiboma have been reported especially after abdominal surgery, but there has not been any reported case in plastic surgery. Mandibular contouring surgery cannot ensure a view wide enough to avoid injury to surrounding structures such as a facial artery and a retromandibular vein. In addition, many surgeons pack the sponge into the operative field to prevent bleeding, and surgeons may neglect remnant surgical materials. Recognition of gossypiboma is essential but is often considerably delayed and cause medicolegal problems. Therefore, it is important to ensure that every effort is made to prevent such occurrences. We had a chance to evaluate and treat gossypiboma, and in this paper, we want to share our experiences.. In circa 1999 to 2007, there were 3 cases diagnosed as gossypiboma after a mandible angle surgery. All patients were female, and some had signs of fever, swelling, tenderness, and purulent discharge of an oral wound. We performed a computed tomographic scan and blood test, and foreign body removal was done under general anesthesia. Intraoperatively, the diagnosis of gossypiboma was confirmed.. All symptoms were reduced or subsided after surgery. It was noted that no postoperative infection remained.. Gossypiboma must be considered when fever, unilateral swelling, tenderness, or unhealed oral wound is sustained despite an antibiotics therapy and a drainage procedure after a mandible angle surgery. In that case, a computed tomographic scan can be recommended as an effective method for detection of gossypiboma.

Topics: Adult; Anti-Infective Agents, Local; Curettage; Edema; Female; Fever; Foreign Bodies; Humans; Mandible; Middle Aged; Plastic Surgery Procedures; Povidone-Iodine; Suppuration; Surgical Sponges; Surgical Wound Dehiscence; Surgical Wound Infection; Therapeutic Irrigation; Tomography, X-Ray Computed

Our goal was to assess the safety and effectiveness of vaginal povidone-iodine gel in reducing febrile morbidity after abdominal hysterectomy.. This cohort study included 158 women treated with gel immediately before hysterectomy, after the usual surgical preparation, and 317 historic control subjects with the usual surgical preparation only, at two teaching hospitals. Febrile morbidity was assessed by a blinded review of temperature records and was analyzed by Fisher's exact test and multiple logistic regression.. Febrile morbidity occurred in 17% of gel-treated patients and 26% of controls (adjusted odds ratio 0.52, 95% confidence interval 0.31 to 0.89). In patients receiving prophylactic antibiotics the adjusted odds ratio for febrile morbidity in gel-treated patients was 0.47 (95% confidence interval 0.27 to 0.83). Prolonged fever occurred in 17% of controls and 10% of gel-treated patients (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.97).. Preoperative vaginal povidone-iodine gel is a safe and promising technique for reducing febrile morbidity after hysterectomy.

Topics: Administration, Intravaginal; Adult; Anti-Infective Agents, Local; Cohort Studies; Female; Fever; Gels; Humans; Hysterectomy; Length of Stay; Logistic Models; Middle Aged; Povidone-Iodine; Prospective Studies

A procedure to prevent silent aspiration, which results in frequent respiratory infections, was conducted on elderly bed-bound nursing home patients who suffered mainly from cerebral infarction and dementia. We cleaned the mouth with povidone iodine and kept them in a sitting position for 2 hr after each meal in order to restrict respiratory bacterial infection and to prevent aspiration of gastric juices, respectively. Patients with urinary tract infections were excluded from the present protocol. During the treatment for 103 days the number of febrile days was significantly decreased in the treated group compared with the control group, probably due to minimizing of respiratory infections.

Topics: Aged; Aged, 80 and over; Bed Rest; Eating; Female; Fever; Gastroesophageal Reflux; Homes for the Aged; Humans; Inhalation; Japan; Male; Nursing Homes; Pharynx; Pneumonia, Aspiration; Posture; Povidone-Iodine; Respiratory Tract Infections

Topics: Baths; Fever; Humans; Povidone; Povidone-Iodine