Summary of findings for povidone-iodine irrigation to prevent surgical site infection
| Study | Year | Country | Level | Study design | Population | PA | Definition of infection | Intervention | Comparison | Outcome(+/−)* | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, yr | Surgical procedure | ||||||||||
| Surgery in general | |||||||||||
| Sindelar and Mason (3), (4) | 1977; 1979 | United States | II | RCT | 9–80 | Included general and urologic procedures (n = 500) | Y | Pus from incision site within 12 wk after surgery along with bacteria recovered from wound culture | 10% povidone-iodine irrigation (n = 242) | Saline irrigation (n = 258) | + |
| Singh et al (7) | 1988 | India | II | Prospective comparative study | NA | Various clean or contaminated operations (n = 90) | N | NA | 5% povidone-iodine irrigation (n = 30) | 5% povidone-iodine irrigation + 5 mg/mL of metronidazole (n = 30) | − |
| Sterile normal saline irrigation (n = 30) | − | ||||||||||
| General surgery | |||||||||||
| Barr (8) | 1978 | United States | II | Prospective comparative study | NA | Gastrointestinal | N | NA | Betadine lavage (n = 35) | No lavage (n = 60) | + |
| Sindelar and Mason (9) | 1979 | United States | II | RCT | Laparotomy (n = 168) | Y | Abscess formation | 1% povidone-iodine irrigation | Saline irrigation | + | |
| de Jong et al (10) | 1982 | The Netherlands | II | RCT | ≥ 5 | Intra-abdominal or inguinal hernia operations | N | Discharge from wound within 4 wk after surgery or a positive culture of fluid from wound | 1% povidone-iodine irrigation (n = 154) | No irrigation (n = 142) | − |
| 10% povidone-iodine irrigation (n = 149) | No irrigation (n = 137) | − | |||||||||
| Tighe et al (11) | 1982 | Ireland | II | RCT | 3.5–74 | Appendectomy (n = 131) | Y | Presence of pus with or without probing | 1% Betadine irrigation (n = 49) | Sterile water irrigation (n = 31) | − |
| No irrigation (n = 51) | − | ||||||||||
| Rogers et al (12) | 1983 | United States | II | RCT | Mean 60.2 | General surgery (n = 187) | Y | Pus from wound within 1 mo of surgery | 10% povidone-iodine (1% available iodine) irrigation (n = 86) | Normal saline irrigation (n = 101) | − |
| Johnson et al (13) | 1985 | United Kingdom | II | RCT | Intervention group: mean 68.3 (range 48–86) Comparison group: mean 67.2 (range 52–80) | Abdomino–perineal excision of the rectum for carcinoma or proctectomy for carcinoma (n = 56) | N | Purulent wound discharge or wound discharge with bacteria cultured | 1% povidone-iodine irrigation (n = 28) | Sterile normal saline irrigation (n = 28) | + |
| Parker et al (14) | 1985 | United Kingdom | II | RCT | Intervention group: mean 69 Comparison group: mean 68 | Major resection for large bowel carcinoma (n = 45) | Y | Pus discharging from wound | 10% aqueous povidone-iodine irrigation (n = 22) | Water irrigation (n = 23) | + |
| Sindelar et al (15) | 1985 | United States | II | RCT | Intervention group: mean 51.5 (range 19–75) Comparison group: mean 51.7 (range 20–69) Overall: mean 51.4 (range 19–75) | intra-abdominal (n = 75) | Y | NA | 1% povidone-iodine (0.1% available iodine) irrigation (n = 37) | Saline irrigation (n = 38) | + |
| Cardiovascular surgery | |||||||||||
| Angelini et al (16) | 1990 | United Kingdom | II | Prospective comparative study | Intervention group: mean 61 Comparison group: mean 58 | Early repeat sternotomy for postoperative hemorrhage (n = 43) | Y | Presence of purulent discharge along with a positive culture for bacteria | Aqueous povidone-iodine irrigation (n = 22) | No irrigation (n = 21) | + |
| Ko et al (17) | 1992 | United States | I | Single-blind RCT | NA | Cardiopulmon-ary bypass surgery with sternotomy incision (n = 1980) | Y | Unusual pain, fever, tenderness, induration, drainage or erythema | Povidone-iodine (0.5% in NaCl) irrigation (n = 990) | Saline (0.9% in NaCl) irrigation (n = 990) | − |
| Orthopedic surgery | |||||||||||
| Cheng et al (18) | 2005 | Taiwan | I | Single-blind RCT | intervention group: mean 64 Comparison group: mean 61 | Spinal surgery (n = 414) | Y | Unusual pain, fever, tenderness, induration, drainage or erythema | 0.35% povidone-iodine irrigation (n = 208) | Normal saline irrigation (n = 206) | + |
| Chang et al (19) | 2006 | Taiwan | I | Single-blind RCT | Intervention group: mean 67.1 (range 20–82) Comparison group mean 65.4 (range 22–89) | Primary instrumental lumbosacral posterolateral fusion due to degenerative spinal disorder with segmental instability (n = 244) | Y | NA | 0.35% povidone-iodine irrigation (n = 120) | Normal saline irrigation (n = 124) | + |
| Urologic surgery | |||||||||||
| Richter et al (20) | 1991 | Israel | II | Prospective comparative study | mean 64 (range 55–90) | Open prostatectomy (n = 156) | Y | Redness, swelling, pus with a positive culture | NA | No irrigation (n = 76) | + |
PA = prophylactic antibiotics; Y = yes; N = no; RCT = randomized controlled trial; NA = not available; NaCl = sodium chloride;
↵* + = intervention was significantly more effective than comparison; − = intervention was not significantly more effective than comparison.