title: Gargling with povidone-iodine reduces the transport of bacteria during oral intubation.
abstract: OBJECTIVE
  Nosocomial pneumonia remains a common complication in patients undergoing endotracheal intubation. This study examined the transport of bacteria into the trachea during endotracheal intubation, and evaluated the effects of gargling with povidone-iodine on bacterial contamination of the tip of the intubation tube.
  
  
  METHODS
  In the gargling group, patients gargled with 25 mL of povidone-iodine (2.5 mg.mL(-1)). In the control group, patients gargled with 25 mL of tap water. Before tracheal intubation, microorganisms were obtained from the posterior wall of the patient's pharynx using sterile cotton swabs. After anesthesia, all patients were extubated and bacteria contaminating the tip of the tracheal tube were sampled and cultured.
  
  
  RESULTS
  Before orotracheal intubation, all 19 patients who gargled with tap water (control group) had bacterial colonization on the posterior walls of the pharynx. This group included five patients who had methicillin-resistant staphylococcus aureus (MRSA) in their nasal cavity preoperatively and MRSA was also detected in the pharynx of four patients. Bacterial colonization was observed in all 19 patients who gargled with povidone-iodine (gargling group) and four patients carried MRSA in their nasal cavity, although no MRSA was detected in the pharynx. In the control group, all the patients had bacterial colonization at the tip of the tube after extubation. Additionally, MRSA was detected in two of the four patients. In the gargling group, povidone-iodine eradicated general bacteria and MRSA colonies in the pharynx before intubation and at the tip of the tube after extubation.
  
  
  CONCLUSIONS
  Gargling with povidone-iodine before oral intubation reduces the transport of bacteria into the trachea.
authors.affiliation: Department of Anesthesiology, University of Occupational and Environmental Health School of Medicine, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, Fukuoka 807-8555, Japan. kminami@med.uoeh-u.ac.jp
authors.forename: Junichi
authors.initials: J
authors.lastname: Ogata
authors.forename: Kouichiro
authors.initials: K
authors.lastname: Minami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyamoto
authors.forename: Takafumi
authors.initials: T
authors.lastname: Horishita
authors.forename: Midori
authors.initials: M
authors.lastname: Ogawa
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Sata
authors.forename: Hatsumi
authors.initials: H
authors.lastname: Taniguchi
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects* / Q000254:growth & development; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000517:prevention & control; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage / Q000627:therapeutic use*; D009296:Nasal Cavity / Q000382:microbiology; D010614:Pharynx / Q000382:microbiology*; D011014:Pneumonia / Q000517:prevention & control; D011206:Povidone-Iodine / Q000008:administration & dosage / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects / Q000254:growth & development; D014132:Trachea / Q000382:microbiology
chemical_list: D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; D011206:Povidone-Iodine