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Gargling with povidone-iodine reduces the transport of bacteria during oral intubation

[Le gargarisme avec un mélange de povidone-iode réduit le transport bactérien pendant l’intubation orale]

Junichi Ogata, MD^*, Kouichiro Minami, MD PhD^*, Hiroshi Miyamoto, MD PhD, Takafumi Horishita, MD PhD^*, Midori Ogawa, PhD, Takeyoshi Sata, MD PhD^* and Hatsumi Taniguchi, PhD

^* From the Departments of Anesthesiology, and
Microbiology, University of Occupational and Environmental Health School of Medicine, Fukuoka, Japan.

Address correspondence to: Dr. Kouichiro Minami, Department of Anesthesiology, University of Occupational and Environmental Health School of Medicine, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, Fukuoka 807-8555, Japan. Phone: +81-93-691-7265; Fax: +81-93-601-2910; E-mail: kminami{at}med.uoeh-u.ac.jp

Purpose: 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.

Conclusion: Gargling with povidone-iodine before oral intubation reduces the transport of bacteria into the trachea.

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