povidone-iodine and Wounds--Penetrating

We present a case of failed conservative management of a traumatic wound sustained in a wilderness setting. The patient was initially treated with a povidone-iodine scrub, suture closure, and expectant management by 2 physicians who were paying clients on a multiday river rafting expedition. Empiric antibiotic coverage and irrigation of the dehisced wound were initiated several days after initial treatment. The patient arranged his own evacuation 8 days after injury. Hospitalization, intravenous (IV) antibiotics, and surgical debridement with wound vacuum placement led to a full recovery. This case presents several common wound care pitfalls. The sequelae to these pitfalls are more dramatic in a wilderness setting and underscore the importance of early aggressive management and considering prompt evacuation when treating wounds sustained in the wilderness.

Topics: Debridement; Humans; Leg Injuries; Male; Povidone-Iodine; Rivers; Therapeutic Irrigation; Wilderness Medicine; Wound Healing; Wounds, Penetrating

Wound cleansing is an integral part of the management of acute traumatic wounds. There is consensus that it reduces infection rates. However, the choice of cleansing agent remains controversial, especially the use of antiseptics has been questioned. This article reviews the current literature on the use of antiseptics particularly povidine iodine in traumatic wound cleansing and discusses the beneficial and harmful effects of such practice.

Topics: Acute Disease; Anti-Infective Agents, Local; Antisepsis; Clinical Trials as Topic; Drug Evaluation, Preclinical; Drug Resistance, Bacterial; Evidence-Based Medicine; Fibroblasts; Humans; Iodine; Patient Selection; Povidone-Iodine; Skin Care; Therapeutic Irrigation; Wound Healing; Wound Infection; Wounds, Penetrating

Povidone Iodine (PVI) has been used to prevent wound infection for a long time, yet the merits and effectiveness of this agent in reducing the rates of infection in simple traumatic wounds have been debated. The aim of this study is determine the effect of PVI as skin disinfectant in preventing simple traumatic wound infection after repair in emergency departments.. This study is a single-blind, randomized, controlled trial, conducted at the emergency departments of two university hospitals. In this trial, those collecting and analyzing data were unaware of the assigned treatment. Participants included ED patients with simple traumatic wounds, randomly assigned to either experiment or control groups. Wounds were similarly irrigated with normal saline in both groups. But the skin around the wounds of patients in the experiment group was cleansed by PVI solution. The patients were followed till their next ED visit for stitch removal. The presence or absence of wound infection was considered as the primary outcome and assessed by an ED physician.. In total, 444 patients were screened and included in the study. The patients were statistically similar according to their baseline characteristics. Men constituted 85% of the study participants. The highest numbers of reported wound sites belonged to head (30%), lower limbs (24%) and upper limbs (19%) accordingly. The rates of infections in the experiment and control groups were similar (p=0.231) but a significant association was observed between the rate of infections and wound location. Lower limbs (OR=9.23, p<0.0001) and upper limbs (OR=5.47, p=0.011) indicated the highest risks of wound infections among other locations.. Our study showed that using PVI in the management of traumatic wounds did not reduced rate of infections.

Topics: Adult; Anti-Infective Agents, Local; Emergency Service, Hospital; Female; Humans; Iran; Male; Povidone-Iodine; Single-Blind Method; Sodium Chloride; Treatment Outcome; Wound Healing; Wound Infection; Wounds, Penetrating

The purpose of our study was to examine which of the wound irrigants commonly used in the emergency department is the most efficacious in reducing the risk of wound infection. Five hundred thirty-one patients were randomized into three groups. All patients had their wounds irrigated using a 20-mL syringe with a 20-gauge IV catheter. Patients received irrigation with normal saline (NS), 1% povidone-iodine solution (PI), or pluronic F-68 (Shur-Clens) (SC). Treatment was assigned by month; all wounds were treated with one solution during each of the three months of the study. The wounds were closed with interrupted, simple nylon sutures. The number of wound infections was 13 (6.9%), eight (4.3%), and nine (5.6%) for groups receiving NS, PI, and SC, respectively. This was not statistically significant. We conclude that there is not a significant difference in infection rates among sutured wounds irrigated with NS, PI, or SC. The cost of NS was the lowest of the three treatments in our ED.

Topics: Administration, Topical; Adolescent; Adult; Aged; Child; Child, Preschool; Detergents; Emergency Service, Hospital; Humans; Infant; Middle Aged; Povidone; Povidone-Iodine; Sodium Chloride; Surface-Active Agents; Therapeutic Irrigation; Wound Infection; Wounds, Penetrating

It is common practice to soak acute traumatic wounds in dilute povidone-iodine solution before definitive wound cleaning and debridement. The effectiveness of soaking wounds is unknown. Using quantitative wound bacterial counts as a measure of efficacy, we compared wounds soaked in 1% povidone-iodine solution or in normal saline with wounds receiving no treatment. Adult patients were eligible for the study if they were seen in the emergency department with visibly contaminated traumatic wounds within 12 hours of injury. Patients were excluded if they refused consent, were allergic to iodine, or had taken antibiotics within five days; if the wound did not require debridement; if the wound had been previously cleaned; or if subsequent cultures were sterile. Thirty-three heavily contaminated acute traumatic wounds in 29 patients were included in the study. Wounds were randomly assigned to one of three groups. Tissue samples were taken before and after a ten-minute period of soaking in either povidone-iodine or saline; controls were covered with gauze during the ten-minute period. The mean bacterial count per gram of tissue decreased 6.4 x 10(5) (standard deviation, 1.68 x 10(6)) after no soak, increased 3.39 x 10(7) (1.05 x 10(8)) after saline soak, and decreased 9.19 x 10(6) (1.72 x 10(7)) after povidone-iodine soak. Wounds with counts of less than 10(5) bacteria/g tissue are unlikely to become infected. Multiple regression analysis was used to analyze the changes in bacterial count after treatment as a function of experimental group and initial bacterial count. There was no significant difference between the control and povidone-iodine groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Topical; Adult; Colony Count, Microbial; Emergency Service, Hospital; Humans; Povidone; Povidone-Iodine; Random Allocation; Risk Factors; Sodium Chloride; Wound Infection; Wounds, Penetrating

Primary closure of the contaminated wound using a closed suction catheter and antibiotic or povidone-iodine irrigation is cost-effective and convenient alternative to standard open wound care with delayed primary closure. Antibiotic irrigation appeared more effective than povidone-iodine in this study, but the total number of patients studied was too small to be statistically significant.

Topics: Abdominal Injuries; Adult; Anti-Bacterial Agents; Catheterization; Catheters, Indwelling; Colon; Humans; Povidone-Iodine; Prospective Studies; Therapeutic Irrigation; Wound Infection; Wounds, Penetrating

The management of penetrating abdominal trauma has evolved considerably over the last 30 years. The goal of any algorithm for penetrating abdominal trauma should be to identify injuries requiring surgical repair and avoid unnecessary laparotomy with its associated morbidity. We describe a case where the infusion of povidone-iodine (Videne) and air into the wound uncovered the peritoneal breach clinically and guided the radiologist to the site of the internal injury. This case report raises an intriguing possible role for povidone-iodine and air to be used both for wound toilet and to aid identification of occult wound tracks on computed tomography imaging. We advocate the routine use of wound irrigation with a mixture of povidone-iodine and air as described, in a select group of patients, as an adjunct to diagnosis before abdominal computed tomography scanning.

Topics: Abdominal Injuries; Adult; Humans; Male; Povidone-Iodine; Spleen; Therapeutic Irrigation; Tomography, X-Ray Computed; Wounds, Penetrating

Shiunko is a traditional botanic formula (ointment) which is used clinically for the treatment of wounded skin caused by cuts, abrasions, frost or burn. The aim of this study was to evaluate the effect of Shiunko on epithelization of wounded skin. Experimental cutting wounds on the back skin of Sprague-Dawley rats were induced. Different bacterial inoculations (Pseudomonus aeruginosa and Staphylococcus aureus) and treatment (Shiunko, Povidone-iodine and saline) were arranged herein. The incidences of infection and the speed of epithelization were evaluated. We observed that the incidences of wound infection following Pseudomonas aeruginosa inoculation were lower on both the Shiunko-treated group (0%, p < 0.01) and Povidine-iodine-treated group (5%, p < 0.05), than the saline-treated group (40%). The Shiunko-treated group reported higher percentages of complete epithelization not only on the sterilized wounds (100%) but also on the contaminated wounds (90%) when compared to the saline-treated group (60% sterilized wounds, 40% and 50% contaminated wounds) on day 7 (p < 0.01). Povidone-iodine did not promote epithelization of wounded skin, whereas Shiunko did.

Topics: Animals; Anti-Infective Agents, Local; Drugs, Chinese Herbal; Male; Medicine, Kampo; Microbial Sensitivity Tests; Ointments; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections; Rats; Rats, Sprague-Dawley; Skin; Staphylococcal Skin Infections; Staphylococcus aureus; Wound Healing; Wound Infection; Wounds, Penetrating

Owing to similarities between human immunodeficiency virus and feline retroviruses, the feline model was chosen for the study to investigate the efficacy of timely topical treatment of accidental human immunodeficiency virus infection in the operating room. Cats were subcutaneously inoculated with either feline leukemia virus or feline immunodeficiency virus. An effort was made to neutralize the virus in loco either by infiltration of the inoculation site with povidone-iodine or with monoclonal antibodies, or by cauterization and excision. The animals were periodically monitored for feline leukemia virus antigens or for feline immunodeficiency virus antibodies. The results indicated that in the feline model, the development of generalized virus infection may be prevented by local measures if applied immediately.

Topics: Animals; Cats; Equipment Contamination; Female; Intraoperative Complications; Male; Postoperative Complications; Povidone-Iodine; Retroviridae Infections; Surgical Instruments; Wounds, Penetrating

Topics: Drug Industry; Humans; Povidone-Iodine; Wounds, Penetrating

Topics: Adult; Corneal Injuries; Drug Packaging; Female; Humans; Keratoconjunctivitis Sicca; Ophthalmic Solutions; Povidone; Povidone-Iodine; Wounds, Penetrating