Iodinated skin disinfectants

Skin disinfection." Reduction of germ counts prior to punctures or surgical procedures is desirable if the risk of wound infection is to be minimized. Useful agents include alcohols (1- and 2-propanol ethanol 60-90% iodine-re-leasing agents like polyvinylpyrrolidone [povidone, PVPj-iodine as a depot form of the active principle iodine, instead of iodine tincture), cationic surfactants, Liillmann, Color Atlas of Pharmacology <... 

Iodine Iodine is a volatile purple-black solid with a beautiful metallic sheen. As the least reactive halogen, iodine is safe to handle and is widely used as a skin disinfectant. It was first prepared in 1811 from seaweed ash, but commercially useful deposits of the iodine-containing minerals lautarite (CaIC>3) and dietzeite [7 Ca( 103)2 8 CaCr04] were subsequently found in Chile. Iodine is used in the preparation of numerous organic compounds, including dyes and pharmaceutical agents, but there is no one single use of major importance. 

Skin disinfection with iodine also caused goiter and hypothyroidism in five of 30 newborns under intensive care (69). Antiseptics containing iodine should be avoided not only during pregnancy and delivery but also after the delivery during breastfeeding. 

The activity of povidone-iodine in preoperative skin disinfection in adults is well proven. 

Povidone-iodine is appropriate for skin disinfection before an incision, a puncture, with use of intravenous or arterial catheters, and for the prophylaxis of iatrogenic Clostridia infections. 

Povidone-iodine used for skin disinfection before skin puncture blood was taken altered serum concentrations of potassium, phosphate, and uric acid. 

The need of skin disinfectants before injection is controversial.110 It is generally thought that the use of antiseptics may be ineffective and unnecessary.111112 Aseptic conditions are required for the use of catheters to minimize the infection. Povidone iodine and chlorhexidine are commonly used for the catheters. 

Skin disinfection before insertion of peripheral infusion catheters is standard practice. Ethanol 70% has been compared with 2% iodine dissolved in 70% ethanol in a prospective, randomized trial in 109 patients who were given infusions of prednisone and theophylline (2). Phlebitis occurred six times in the ethanol group and 12 times in the iodine group. The relative risk reduction of 53% failed to reach significance, but the power of the study was only 0.55, so there was a 45% chance of missing a true difference. As vast numbers of catheters are inserted each year, a small difference in phlebitis rate could save many patients discomfort. 

I AUemand D, Gruters A, Beyer P, Weber B. Iodine in contrast agents and skin disinfectants is the major cause for hypothyroidism in premature infants during intensive care. Horm Res 1987 28(l) 42-9. 

For all intrapartum and postpartum uses of iodine, there are effective alternatives and this is evidenced in Scotland s neonatal units, which have been largely free of excess iodine exposure from skin disinfectants and iodinated contrast media since the mid-1980s. 

Topical Application Substances with a saturated solution of potassium iodine are used for topical application to skin or mucosal surfaces. IIH has been repeatedly mentioned in case reports, when iodine-containing disinfections were applied to open wounds or for intraperitoneal lavage (Mumenthaler and Aeberhard, 1982 Share and Frey, 1980). 

MS Marr, B Saggers. A skin disinfectant. Povidone-iodine (Betadine). Nurs Times 60 758-759, 1964. 

Products used for the hand and skin disinfection ought to increase their bactericidal (vegetative phases), fungicidal, and virucidal efficacies. They should deliver their effects more rapidly, and they should exert no toxic effects on the skin. Disinfectant solutions used for the hygienic handrub mainly consist of alcohols (II, 1.), halogens (II, 21.2.), phenolics (II, 7.), or PVP-iodine (II, 21.2.12.), and are frequently combined with other ingredients. Products used for the surgical handrub mainly consist of alcohols, such as ethanol 80%, isopropanol 70%, n-propanol 60%i, or mixtures of those. 

Endocrine Hypothyroidism and altered metabolism of thyroid hormones have been reported as adverse events in neonates and children, resulting from the use of antiseptics containing povidone-iodine [SED-15, 1896 SEDA-30, 279 SEDA-31, 411 SEDA-32, 440]. Because of concerns about possible iodine excess, chlorhexidine-based antiseptics have replaced povidone-iodine in some clinical settings. However, this may not be advantageous for infants and children who are receiving total parenteral nutrition (TPN) as iodine is not routinely added to TPN solutions. Previously, iodine deficiency was considered unlikely in patients receiving TPN, because of adsorption from iodine-containing skin disinfectants and other adventitious sources [67 68 ]. 

Povidone—iodine is a brown, water-soluble powder containing approximately 10% iodine. However, the amount of free iodine, which is responsible for the antimicrobial activity, is low in a concentrated solution, but is released as the solution is diluted (41). Concentrated solutions have actually been contaminated with bacteria (42). For use as an antiseptic, povidine—iodine is diluted with water or alcohol to a concentration of 1% iodine. Detergents are added if it is used as a surgical scmb. lodophors are important as broad-spectmm antiseptics for the skin, although they do not have the persistent action of some other antiseptics. They are also used as disinfectants for clinical thermometers that have been used by tuberculous patients, for surface disinfection of tables, etc, and for clean equipment in hospitals, food plants, and dairies, much as chlorine disinfectants are used. 

Of the four halogens, iodine is the weakest oxidizing agent. Tincture of iodine, a 10% solution of I2 in alcohol, is sometimes used as an antiseptic. Hospitals most often use a product called povidone-iodine, a quite powerful iodine-containing antiseptic and disinfectant, which can be diluted with water to the desired strength. These applications of molecular iodine should not delude you into thinking that the solid is harmless. On the contrary, if I2(s) is allowed to remain in contact with your skin, it can cause painful bums that are slow to heal. 

Consider using organic complexes like iodophors and povidone-iodine that get trapped in surfactant micelles and release iodine as a disinfectant upon dilution, for products that contact human skin. 

Mucosal disinfection Germ counts can be reduced by PVP iodine or chlor-hexidine (contact time 2 min), although not as effectively as on skin. 

Frosting is reached more quickly with a brush than with a donble cotton bud, unless greater pressure is applied. Brashes should be used once only or disinfected with povidone-iodine. Single-use brushes are preferable would you like to treat your skin with a brush that has already been nsed on acres of nnknown skin ... 

Are you old enough to remember tincture of iodine Before the introduction of antibacterial ointments and sprays for the treatment of minor cuts and burns, tincture of iodine, a mixture of iodine and alcohol, was a common disinfectant for the skin. The pure iodine used to make this solution consists of diatomic molecules, I2, whose mutual attractions are strong enough to form a solid at room temperature. Because the only bond within the I2 molecule is the nonpolar 1-1 bond, we do not expect normal dipole-dipole attractions between iodine molecules. Why, then, do they attract each other strongly ... 

National Formulary for Children, 2005). Povidone-iodine should be avoided in pregnancy for skin and vaginal disinfection, and also during breast-feeding. It is contraindicated for preterm infants under 32 weeks gestation for infants whose body weight is under 1.5 kg or for regular use in neonates (Weber et al., 1998 Linder et ai, 1997 British National Formulary for Children, 2005). 

PVP-I is used frequently in various fields as a broad-spectrum topical disinfectant for bacteria, funguses, viruses and protozoa. It is a powder containing 10% iodine (Figures 96.1 and 96.2). The available iodine content in the preparation varies from 0.05 to 1%. PVP-I solutions used for disinfection of the skin or wounds have a 1% iodine content. 

---