Deby Evans

Deb Evans is the MVC Site Engagement Manager.

In a follow-up to last week’s blog post, we received an inquiry about the use of povidone-iodine nasal swabs to reduce the colonization of Staphylococcus Aureus (S. aureus) in those undergoing joint replacement surgery. Upon research and liaising with The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), some studies support use of the povidone-iodine alternative. Furthermore, we learned that hospitals in Michigan are using povidone-iodine as a treatment option to reduce colonization of S. aureus and thus surgical site infections (SSI).

The first study compared nasal mupirocin ointment applied twice daily for five days leading up to surgery versus two doses of povidone-iodine solution within two hours of surgical incision. Both treatment options were used in conjunction with chlorhexidine. Researchers measured the incidence of deep SSI within three months after surgery. Results were favorable in the povidone-iodine group compared to the mupirocin group and it was concluded nasal povidone-iodine solution may be considered a viable alternative to mupirocin in reducing SSIs.

A second study compared the use of an off-the-shelf povidone-iodine solution versus a specifically manufactured povidone-iodine skin and nasal antiseptic, with saline as a placebo. For each method baseline cultures were taken immediately preoperatively. Following this, both nostrils were treated twice using four applicators for two minutes each time. After four hours the right nostril was re-cultured, while the left nostril was re-cultured at 24 hours. The results showed that the specifically manufactured treatment provided more significant decolonization after the four-hour time period. However, no significant differences were noted among the three groups within the 24-hour time frame. The authors concluded that a single application of the specifically manufactured povidone-iodine skin and nasal antiseptic might be more clinically effective in eliminating S. aureus and decolonization than off-the-shelf povidone-iodine products. Using this method may also help reduce costs while maintaining an effective reduction in SSI.

A third study, undertaken in China, demonstrated a successful reduction in colonization of S. aureus in patients treated with povidone-iodine. This alternative was studied due to the unavailability of mupirocin in China. The authors wanted to assess the prevalence of methicillin-resistant and methicillin-sensitive S. aureus (MRSA & MSSA) in Chinese hospitals and to determine the success of S. aureus decolonization. Screening of the eligible patients took place within twenty-four hours of admission and those who tested positive were treated. The treatment consisted of twice a day 5% povidone-iodine nasal swabs applied to both nostrils for five days prior to surgery. Patients were then retested on the day of surgery to determine the extent of decolonization. The results showed 100% eradication of MRSA and a 94% eradication rate for MSSA.

Overall, more hospitals may want to consider using povidone-iodine nasal swabs as part of their treatment protocol for joint replacement. The studies have shown that this treatment alternative can be just as effective at decolonizing S. Aureus, which helps reduce the risk of SSI and all the costs associated with these and readmission. Povidone-iodine nasal swabs are more readily available world-wide and are a cheaper alternative to mupirocin, further making it an ideal treatment protocol. In addition, using these swabs does not carry the risk of resistance that wide-spread use of mupirocin does, this will enable facilities to continue use of the mupirocin alternative for those patients unable to use povidone-iodine.

If you have any questions, please do not hesitate to contact the MVC Coordinating Center, Deb Evans (debevans@med.umich.edu) or Abeer Yassine (abeery@med.umich.edu)  or directly comment on this article. We welcome your comments and feedback.