title: Dual application versus single application of povidone-iodine in reducing surgical site contamination during strabismus surgery.
abstract: OBJECTIVE
  To investigate the contamination rates in patients undergoing strabismus surgery who received a single versus a dual application of povidone-iodine.
  
  
  METHODS
  Patients undergoing strabismus surgery were divided into two groups of approximately equal size. Prior to surgery, the surgical sites for both groups were prepared by applying 4 drops of povidone-iodine 5% directly into the conjunctival fornices, after which the eyelashes were cleaned with cotton tips soaked with povidone-iodine 5%. Sterile gauze pads soaked with povidone-iodine 5% were used to clean the periocular skin. After lid speculum placement, the patients in the dual application group received an additional 2 drops of povidone-iodine in the conjunctival fornices. Intraoperatively, the conjunctiva, sclera, needles/sutures, and lid speculum were cultured. Gram stain and cultures were obtained and quantified. Contamination was defined as any bacterial growth on blood agar plates at 2 days.
  
  
  RESULTS
  A total of 104 patients (aged 7 months to 79 years) were included. The single application group had a 25% contamination rate of surgical site and sutures; the dual application group, a 10% contamination rate. This difference was statistically significant (P = 0.03). The rate of eyelid speculum contamination was unaffected by additional applications (12.5% contamination rate in both groups [P = 0.5]). The additional application of povidone-iodine affected the contamination rate of the conjunctival incision site the most, with a decrease from 20.5% to 5% (P = 0.02).
  
  
  CONCLUSIONS
  In our study cohort a second application of povidone-iodine significantly decreased the rate of contamination of the surgical site and sutures. It did not affect contamination of the lid speculum.
authors.affiliation: The Wolfe Eye Clinic, Truhlsen Eye Center, The University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: christy.benson@unmc.edu.
authors.forename: Christy E
authors.initials: CE
authors.lastname: Benson
authors.affiliation: The Wolfe Eye Clinic, Truhlsen Eye Center, The University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Kathy L
authors.initials: KL
authors.lastname: Rogers
authors.affiliation: The Wolfe Eye Clinic, Truhlsen Eye Center, The University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Donny W
authors.initials: DW
authors.lastname: Suh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D015169:Colony Count, Microbial; D009877:Endophthalmitis / Q000382:microbiology / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D011206:Povidone-Iodine / Q000008:administration & dosage*; D013285:Strabismus / Q000601:surgery*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine