TABLE 2.

Summary of clinical studies investigating preoperative decolonization with intranasal or topical PVP-I for the prevention of SSIs^a

Treatment and reference	Study design	Patient population	No. of patients	Intervention	S. aureus colonization and SSI rateb
Intranasal PVP-I					Postoperative nasal colonization
Rezapoor et al. (68)	Randomized, placebo controlled	Orthopedic surgery	34	SNP of 5% PVP-I	7 (21), P = 0.003, vs saline
			29	Off-the-shelf 10% PVP-I	15 (52)
			32	Saline (placebo)	19 (59)
					SSI rate
Bebko et al. (71)	Retrospective	Orthopedic surgery	365	Intranasal 5% PVP-I (morning of surgery) + 2% CHG wash + 0.12% oral rinse (night before and morning of surgery) versus historical control.	4 (1.1), P = 0.02 vs historical control
			344	Historical control (before introduction of decontamination protocol).	13 (3.8)
Urias et al. (75)	Retrospective	Orthopedic surgery	962	Nasal painting with PVP-I skin and nasal antiseptic + CHG washcloth bath/CHG solution shower.	2 (0.2)
			930	CHG washcloth bath/CHG solution shower.	10 (1.1)
Phillips et al. (22)	Prospective, open label, randomized	Orthopedic surgery	842	Two 30-s applications of 5% PVP-I solution into each nostril within 2 h of surgical incision + topical 2% CHG wipes.	6 (NA), P = 0.1 vs mupirocin
			855	2% mupirocin ointment twice daily for the 5 days prior to surgery + topical 2% CHG wipes.	14 (NA)
Torres et al. (74)	Retrospective	Orthopedic surgery	1,004	Universal treatment: two 30-s applications of 5% PVP-I solution into each nostril ∼1 h prior to surgical incision + CHG baths for 5 days before surgery + a topical CHG wipe preoperatively applied to the leg.	8 (0.8)
			849	Screening and treatment of MRSA-positive patients: intranasal mupirocin twice daily for 5 days prior to surgical incision + CHG baths for 5 days prior to surgical incision + a topical CHG wipe preoperatively applied to the leg.	6 (0.8)
Topical PVP-I					Preoperative skin colonization
Veiga et al. (69)	Prospective, randomized, controlled	Plastic surgery	57	Shower with liquid detergent–based 10% PVP-I 2 h before surgery.	1, P = 0.0019 vs control
			57	Control (no special instructions for showering were implemented before surgery).	12
					SSI rate
Ghobrial et al. (72)	Prospective database analysis	Spinal neurosurgery	3,185	7.5% PVP-I	33 (1.036), P = 0.728 vs CHG/IPA
			3,774	2% CHG and 70% IPA	36 (0.954)
Raja et al. (73)	Retrospective	Cardiac surgery	738	Skin preparation with 10% PVP-I in 30% industrial methylated spirit	NA (3.8), P = 0.14
			738	Skin preparation with 2% CHG in 70% IPA	NA (3.3)

^aCHG, chlorhexidine; PVP-I, povidone iodine; SNP, skin and nasal preparation; SSI, surgical site infection; IPA, isopropyl alcohol/isopropanol.

^bColonization is expressed as the number of patients with a positive culture result (numbers in parentheses indicate % of patients); the SSI rate is expressed number (%).