Study in vitro and in vivo on the synergy between iodophor-impregnated incision drapes and antisepsis with 2% chlorhexidine-70% isopropanol or 10% iodine povidone

Background: If the previous antisepsis is done with povidone iodine (PVP-I), iodophore-impregnated incision drapes (Ioban2) will not diminish surgical site infection (SSI).  Could they do so if antisepsis were done with chlorhexidine 2% in isopropanol 70% (ClxIPA) instead?

Methods:  1) In vitro: Assessment of the synergistic effect of ClxIPA-Ioban2 by antiseptogram of eich microorganisms. On other dishes, PVP-I (or sterile distilled water as a control) were used, instead of ClxIPA. 2) In vivo: The cutaneous microbiota from the back of the second phalange of the 2nd -5th fingers of both hands of volunteers were studied. Then antisepsis was carried out on both hands with ClxIPA and, on the non-dominant hand, a band of Ioban2 was wrapped around the sampling surface. Two hours later, the microbiota was collected from both hands into a solution with culture medium and an antiseptic inhibitor. The log10-reduction of the before-after microbiota for each volunteer, was compared with him/herself. A similar process was done with PVP-I or distilled water (control).

Results In vitro, a significant increase in inhibition halos were obtained when using Ioban2 together these two antiseptics. In vivo, Ioban2 helped both antiseptics to reduce microbial colonization 2 hours after antisepsis. Moreover, the antimicrobial efficacy, in both experiments, was significantly higher with ClxIPA than with PVP-I (with or without Ioban2).

Conclusion:-Ioban2 increases significantly the antimicrobial efficacy of ClxIPA, in vitro and in vivo. Presurgical antisepsis with ClxIPA + Ioban2 could decrease the SSI, but it must be verified by controlled studies.