Povidone-Iodine Spray Technique Versus Traditional Scrub-Paint Technique for Preoperative Abdominal Wall Preparation

Dr. Michael D. Moen

Advocate Lutheran General Hospital

Park Ridge, Illinois

Objective:   To compare povidone-iodine spray and traditional scrub-paint techniques in reducing abdominal wall bacteria during preoperative preparation.

Methods:   60 patients scheduled to undergo vaginal surgery were recruited for study.  Prior to preparation, a blood agar plate was directly applied to the abdominal skin just above the umbilicus to obtain a control count of skin bacteria.  One half of the abdomen was prepared with a traditional 5 minute iodophor soap scrub and paint technique.  The other half of the abdomen was prepared with povidone-iodine spray which required 30-45 seconds to apply.  Plates were obtained after 1 and 3 minutes on the spray side and after the 5 minute preparation on the scrub-paint side.  The plates were incubated at 37 degrees Celsius for 48 hours and colony counts were performed.  For data analysis, multiple pairwise comparisons (scrub vs. 1 minute after spray; scrub vs. 3 minutes after  spray; and 1 vs. 3 minutes after spray) were performed using the Wilcoxon signed ranks test.  A p-value of 0.05 was considered statistically significant in all analyses.

Results:  Bacterial growth was confirmed on all control plates with the vast majority containing over 100 colonies.  The mean number of colonies for spray after 1 minute, spray after 3 minutes, and after 5 minute scrub were 1.83 +/- 3.16, 0.40 +/- 1.15 and 0.87 +/- 2.97 respectively.  Both the spray after 3 minutes and 5 minute scrub techniques were statistically more effective than the spray after 1 minute at reducing bacterial counts.  There was no statistically significant difference between the spray after 3 minutes and 5 minute scrub techniques.

Conclusion:   Povidone-iodine applied as a spray and left to dry for 3 minutes may be as effective as the traditional 5 minute scrub-paint technique in reducing abdominal wall bacteria prior to abdominal surgery.  Because the use of spray is potentially easier, quicker and less costly, further clinical evaluation should be performed to determine if it is an appropriate alternative to traditional scrub-paint techniques for abdominal preparation.