title: Foaming Betadine Spray as a potential agent for non-labor-intensive preoperative surgical site preparation.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) report published in 2009 shows that there were about 16,000 cases of surgical site infection (SSI) following ~ 850,000 operative procedures making SSI one of the most predominant infection amongst nosocomial infections. Preoperative skin preparation is a standard procedure utilized to prevent SSIs thereby improving patient outcomes and controlling associated healthcare costs. Multiple techniques/ products have been used for pre-operative skin preparation, like 2 step scrubbing and painting, 2 step scrubbing and drying, and 1 step painting with a drying time. However, currently used products require strict, time consuming and labor-intensive protocols that involve repeated mechanical scrubbing. It can be speculated that a product requiring a more facile protocol will increase compliance, thus promoting a reduction in SSIs. Hence, the antimicrobial efficacy of a spray-on foaming formulation containing Betadine (povidone-iodine aerosol foam) that can be administered with minimum effort is compared to that of an existing formulation/technique (Wet Skin Scrub).
  
  
  METHODS
  In vitro antimicrobial activities of (a) 5% Betadine delivered in aerosolized foam, (b) Wet Skin Scrub Prep Tray and (c) liquid Betadine are tested against three clinically representative microorganisms (S. aureus, S. epidermidis and P. aeruginosa,) on two surfaces (agar-gel on petri-dish and porcine skin). The log reduction/growth of the bacteria in each case is noted and ANOVA statistical analysis is used to establish the effectiveness of the antimicrobial agents, and compare their relative efficacies.
  
  
  RESULTS
  With agar gel as the substrate, no growth of bacteria is observed for all the three formulations. With porcine skin as the substrate, the spray-on foam's performance was not statistically different from that of the Wet Skin Scrub Prep technique for the microorganisms tested.
  
  
  CONCLUSIONS
  The povidone-iodine aerosolized foam could potentially serve as a non-labor intensive antimicrobial agent for surgical site preparation.
authors.affiliation: Department of Bioengineering, University of Missouri, 252 Agricultural Engineering Building, Columbia, MO, 65211, USA. rkzfb@mail.missouri.edu.
authors.forename: Roli
authors.initials: R
authors.lastname: Kargupta
authors.affiliation: Department of Bioengineering, University of Missouri, 252 Agricultural Engineering Building, Columbia, MO, 65211, USA. gjhz7c@mail.missouri.edu.
authors.forename: Garret J
authors.initials: GJ
authors.lastname: Hull
authors.affiliation: Department of Surgery, University Hospital, Columbia, MO, USA. krood7@gmail.com.
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Rood
authors.affiliation: Department of Surgery, University Hospital, Columbia, MO, USA. jgallowa@ITS.JNJ.com.
authors.forename: James
authors.initials: J
authors.lastname: Galloway
authors.affiliation: Department of Bioengineering, University of Missouri, 252 Agricultural Engineering Building, Columbia, MO, 65211, USA. cfm145@gmail.com.
authors.forename: Clinton F
authors.initials: CF
authors.lastname: Matthews
authors.affiliation: Department of Surgery, University Hospital, Columbia, MO, USA. Dale.Paul@NavicentHealth.org.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Dale
authors.affiliation: Department of Bioengineering, University of Missouri, 252 Agricultural Engineering Building, Columbia, MO, 65211, USA. senguptas@missouri.edu.
authors.forename: Shramik
authors.initials: S
authors.lastname: Sengupta
mesh_terms: D000818:Animals; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D004202:Disinfectants / Q000494:pharmacology*; D004203:Disinfection / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D011206:Povidone-Iodine / Q000737:chemistry / Q000494:pharmacology*; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods*; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012867:Skin / Q000187:drug effects / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects; D013212:Staphylococcus epidermidis / Q000187:drug effects; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D013552:Swine
chemical_list: D004202:Disinfectants; D011206:Povidone-Iodine