Is polysporin and triple antibiotic ointment the same?

Iodine versus Bacitracin or any antibiotic

• In a post op wound care setting, when do surgeons, nurses or staff use an Iodine based topical(or Iodophor) versus Bacitracin (or any antibiotic ointment - eg Polysporin or Neomycin) on a wound? Which is better in fighting bacteria, infection, etc. and under which circumstances? Responses should be based on practical real life use, not just theoretical.

• Answer:

  Hello Jaleva, It appears, from what I have found that iodine based products are used as a cleaning solution, preoperatively. (I have typically seen iodine used as a scrub before surgery and not used post-op on all wounds). If a patient is a diabetic, or immunocompromised, a surgeon is more likely to use an antiseptic topical solution/ointment. In situations where iodine is used post op, it is used as a cleaning solution ? a topical ointment may be applied afterwards, as iodine is inactivated by wound serous fluid. Iodophors may be used when a wound has become infected, to clean and help debride a wound. It depends on the type of wound/surgery and surgeon?s choice however as to what anti-microbials are used, if at all, immediately following surgery. Some surgeons prefer no topicals, to prevent resistance. Some patients have an iodine allergy or sensitivity, and according to at least one source, absorbed iodine caused metabolic acidosis, renal failure and death. http://www.worldwidewounds.com/2004/february/Cooper/Topical-Antimicrobial-Agents.html ?Benefits from the use of topical antimicrobial products can be split into two classifications: ? Interruption of infection in invasive situations due to the transfer of resident bacteria into wounds, incisions, injection sites or damaged skin. ? Interruption of disease transmission in non-invasive situations to others and oneself due to the acquisition of transient bacteria and their transfer to a point of entry into the host, and to oneself due to skin infections from one?s own resident skin flora. ?Interruption of infection in invasive situations due to the transfer of resident bacteria into wounds, incisions, injection sites or damaged skin Studies examining clinical endpoints that support the benefits of using topical antimicrobial products in invasive procedures are summarized below. ?Surgery ? Clinical studies have shown the benefit of using topical antimicrobial products to control the resident flora on surgeons? hands and at the site of incision in many different types of surgery including: intrathoracic procedures (Hughes et al. 1966; Klovekorn et al. 1985), gynecological surgery (Beaton undated), neurological procedures (Jackson 1972), intraperitonial procedures (Gruer et al. 1984; Brown et al. 1984), vascular surgery (Grinbaum et al. 1995; Denton 1991), and general or elective surgery (Georgiade et al.)? ?Furthermore, it is important to remember that topical antimicrobial products are used as part of an overall hygiene regimen and should not serve as the only means of infection control.? http://www.cleaning101.com/antibacterial/SDA-CTFA%20FDA%20petition-8.27.01-SECTION%202-benefits.pdf ?Though antisepsis as a method of prevention of post-operative wound sepsis has been in use for nearly a century, no agreement exists as to the best method for the preparation of the patients' skin and the surgeons' hands. A large amount of research done in the recent years has thrown doubt on many of the traditional concepts. It has been shown that the mere application of an antiseptic on the operation site will cause a 99% reduction in the colony counts of organisms on the skin and that this reduction persists for two hours or more[2]. Dineen[3] has shown that a five minute scrub is as effective as a ten minute one in effectively reducing the number of microorganisms on the hands. However, in a recent survey of 113 hospitals in the United Kingdom it is seen that the time for antiseptic application varied from between less than one minute to more than ten minutes[4]. It is difficult to opine as to the optimal contact time needed to get a relatively germ free operation site. The position is complicated by the fact that 20% or more cutaneous organisms reside in the deeper layers of the skin and are beyond the reach of antiseptics applied to the surface[5]. It has also been shown that even after effective decontamination of the skin surface, regrowth of organisms occurs from the deeper layers of the skin and that the numbers of skin organisms approached the control levels with passage of time[6]. More disturbingly, the action of vigorous scrubbing may in fact release these organisms onto the surface, thus negating the very concept of skin degerming.? http://www.jpgmonline.com/article.asp?issn=0022-3859;year=1993;volume=39;issue=3;spage=134;epage=6;aulast=Shirahatti ?The postoperative period usually does not contribute greatly to the risk of surgical wound infections. Nevertheless, wounds can become contaminated and later become infected if they are touched by contaminated hands or objects after the operation, especially if the wound is left open or if a drain is used. Until wound edges are sealed and the wound is healing (about 24 hours after the operation for most wounds), wounds are covered with sterile dressings to reduce the risk of such contamination. A transparent, semipermeable membrane dressing has been developed for use on wounds because the dressing does not need to be removed for the wound to be observed; the effect of use of this dressing on wound infection rates is unknown.? ?Prophylactic Antimicrobials 1. Parenteral antimicrobial prophylaxis is recommended for operations that 1) are associated with a high risk of infection or 2) are not frequently associated with infection but, if infection occurs, are associated with severe or life-threatening consequences, for example, cardiovascular and orthopedic operations involving implantable devices. Category I? http://aepo-xdv-www.epo.cdc.gov/wonder/prevguid/p0000420/p0000420.asp ?The most common cause of wound sepsis is Staphylococcus aureus (Cooper and Lawrence 1996b) and Beta-haemolytic streptococci (Lancefield group A). Treatment of these infections is empirical, partly because the bacteriology of ulcers with extensive surrounding cellulitis is similar to that of chronic non-infected ulcers (Grey 1998). Lawrence (1993a) reports that Group A streptococcus is so pathogenic it almost inevitably leads to infection. Potentially pathogenic bacteria commonly found in wounds are mostly aerobic (Cooper and Lawrence 1996b). This is supported by Lawrence (1993a) who recorded the percentage incidence of bacteria in 58 venous ulcers. A review of leg ulcer bacteriology concluded that although streptococcal invasion was unlikely to initiate ulceration, it resulted in ulcer deterioration or delayed healing (Hayes 1997). http://www.nursing-standard.co.uk/archives/ns/vol15-30/vol15w30p5058.pdf ?A significant reduction in the incidence of coagulase negative staphylococci related peritonitis was achieved by treating patient skin with a CHG detergent followed by 70% ethanol or the use of povidone?iodine with or without a subsequent alcohol rinse? ?A significant decrease in the number of post-operative infections among patients with groin incisions was affected by using repeated shower-baths with 4% CHG prior to standard surgical preparations (Brandberg et al. 1981). With repeated use (3-8 times), the number of infections decreased from 17.5% to 8% in the group using Hibiscrub versus the control group (local washing only).? http://www.cleaning101.com/antibacterial/2001%20SDA-CTFA%20Submission-AppdxA.pdf ?Mechanism of action. Povidone iodine acts by destroying microbial protein and DNA. Spectrum of antimicrobial activity. This drug has excellent in vitro antimicrobial activity but is inactivated by wound exudate. Clinical use. Povidone iodine has not been proved useful as a topical antimicrobial treatment for burn patients.? http://www.medbc.com/annals/review/vol_13/num_4/text/vol13n4p216.htm ?A commonly used antimicrobial agent is povidone-iodine (Betadine®), a complex of iodine, the bactericidal component, with polyvinylpyrrolidone (povidone), a synthetic polymer.1 The most common commercial form is a 10% solution in water yielding 1% available iodine.1 Povidone-iodine is available as a surgical scrub or skin cleanser with a detergent base (0.75% available iodine) or in other forms.? ?The safety of a wound care treatment may be determined by whether the treatment retards the progress of the wound through the stages of healing (inflammatory, proliferative/reepithelializing, and remodeling). The efficacy of a wound care treatment (eg, povidone-iodine) can be judged in vitro by its ability to kill microorganisms and in vivo by whether it decreases the rate or severity of wound infection. The task of evaluating the choice of povidone-iodine solution for treatment of wounds, especially the chronic wounds most often seen in physical therapy practice, is made complex by two factors.? ?Wounds may be irrigated or soaked once or repeatedly with povidone-iodine solution. Povidone-iodine solution also can be applied for longer periods as part of the dressing. There are no studies comparing the effects of these methods. Povidone-iodine solution also may be used at full strength (10%) or diluted to any desired concentration prior to use. Research results should be interpreted based on the specifics of the application used. Recent positions taken by two federal agencies?the Food and Drug Administration (FDA) and the Agency for Health Care Policy and Research (AHCPR)?have implications for the use of povidone-iodine solution in wound treatment. The FDA has approved povidone-iodine for use in nonprescription first-aid antiseptic products.2 Use of the term "first aid" implies that povidone-iodine can be used for short-term treatment (approximately 1 week) and on relatively superficial and acute wounds. In assessing the evidence regarding use of povidone-iodine, the FDA report states: Controlled studies on wound healing were conducted in animals and humans and involved various types of dermal wounds.... Both superficial and deeper wounds were studied with a contralateral control.... Results showed that there were no statistically significant differences in mean healing times between any of the treatment groups and their controls. In addition, microscopic analysis showed no differences in wound healing in the groups studied. These pathological and histological studies did not indicate any deleterious effect of povidone-iodine on wound healing. However, there was also no evidence demonstrating that povidone-iodine might aid wound healing.2 The FDA has issued no position statement on povidone-iodine use for prolonged periods or in treating chronic wounds. ?Rodeheaver et al23 inoculated experimental wounds in guinea pigs with 102 to 107 organisms of S aureus. Ten minutes later, the wounds were irrigated with either povidone-iodine solution (10%) or normal saline. Four days after treatment, the authors found no difference between the two groups in the number of viable bacteria present in the wounds or in the number of wounds with visible purulent exudate. When the same experiment was conducted using povidone-iodine surgical scrub, the wounds treated with povidone-iodine had higher rates of infection than those treated with saline. Wounds contaminated with 103 organisms showed 60% infection when treated with povidone-iodine versus 0% with saline. Inoculation with 104 organisms produced 90% infection when treated with povidone-iodine versus 0% with saline. With 105 organisms, wounds treated with povidone-iodine were 100% infected versus 15% for saline controls.? Please read the entire article, as I?m unable to post more than this due to copyright restrictions. http://www.ptjournal.org/FEB98/burks.cfm Iodophor ======== ?Iodophors penetrate the cell wall with oxidation of the contents and free iodine substitution. There is a fast reaction time and intermediate persistence. Iodophors rapidly neutralize in the presence of organic matter. It has excellent activity against Gram-positive organisms and good activity against Gram-negative and TB organisms, fungi and viruses. It is a skin irritant and can be absorbed through the skin. Iodophors contain both iodine and a carrier. This combination provides a reservoir for the iodine. This reservoir determines the iodine available while the amount of iodine in solution indicates the free iodine. The activity of iodophors is dependent on the concentration of this free iodine.25 The FDA TFM has tentatively classified iodophors in 5 to 10 percent concentration as Category I, a safe and effective agent.26? http://www.infectioncontroltoday.com/articles/3b1topics.html ?These experiments provide evidence that 1% povidone-iodine, 3% hydrogen peroxide, 0.5% sodium hypochlorite, and 0.25% acetic acid are unsuitable for use in wound care. This sequence of experiments could be used to identify bactericidal, noncytotoxic agents prior to their clinical use.? http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3970664&dopt=Citation ?Povidone iodine is available commercially in several formulations (solution, cream, ointment, dry spray or dressings). There is extensive in vitro evidence of the efficacy of PVP-I as a cidal agent, from varying methodology [15], [40],[41], [42]. In one study it was shown that PVP-I lethally damaged >99% cells within 10 seconds of exposure, and as little as 2.36 ×105 atoms of iodine were required to kill one bacterial cell[39]. Activity at low concentration is affected by the presence of organic matter, but not all in vitro tests incorporate this factor into their design. Clinically, PVP-I has application not only in the management of wounds, but as a skin antiseptic prior to surgery, and in the disinfection of inert surfaces [43]. Whereas its efficacy as a skin disinfectant is undisputed, numerous publications describe the use of iodine in cleansing wounds, and as a topical agent to prevent or treat localised wound infections, but controversy surrounds its safety and efficacy[44]. Since 1994 PVP-I has been approved by the US Food and Drugs Administration for the 'first aid' treatment of small, acute wounds, but it was not recommended for use with pressure ulcers by the US Department of Health & Human Services.? Page 3 of this article contains a chart comparing the benefits of iodine 3%, chlorhexidine, iodophor, and other antiseptics. http://www.reproline.jhu.edu/english/4morerh/4ip/IP_manual/06_Antisepsis.pdf ?Both chlorhexidine gluconate and iodophors have broad spectra of antimicrobial activity. In some comparisons of the two antiseptics, chlorhexidine gluconate achieved greater reduction in skin microflora than did povidone-iodine and also had greater residual activity after a single application. Further, chlorhexidine gluconate is not inactivated by blood or serum Proteins. Iodophors may be inactivated by blood or serum proteins, but exert a bacteriostatic effect as long as they are present on the skin. a. Protect an incision closed primarily with a sterile dressing for 24-48 hours postoperatively. Also ensure that the dressing remains dry and that it is not removed bathing.\315\ \316\ Category IA b. No recommendation on whether or not to cover an incision closed primarily beyond 48 hours, nor on the appropriate time to shower/bathe with an uncovered incision. Unresolved Issue c. Wash hands with an antiseptic agent before and after dressing changes, or any contact with the surgical site. Category IA d. For incisions left open postoperatively, no recommendation for dressing changes using a sterile technique vs. clean technique. Unresolved Issue e. Educate the patient and family using a coordinated team approach on how to perform proper incision care, identify signs and symptoms of infection, and where to report any signs and symptoms of infection. Category II? Topical Antimicrobials ?Antibacterial ointments including bacitracin, Polysporin, and Bactroban are routinely used for wound care after dermatologic surgery to reduce infections and to provide a moist healing environment. However, some patients develop allergic contact dermatitis.? ?Comment: White petrolatum appears to be a safe and much less costly alternative to bacitracin ointment. There seems to be no significant increase in wound infections with petrolatum, and the risk of allergic contact dermatitis is eliminated. Bacitracin selects for Gram-negative organisms, which can cause infections that may require more expensive antibiotics to treat than S. aureus infections. The use of antibacterial ointments is so universal that many more studies like this one will be needed to convince dermatologists to switch to petrolatum for routine postoperative wound care.? http://dermatology.jwatch.org/cgi/content/full/1996/1101/1 Topical antibiotic ointments such as Bacitacin and Polysporin are very often used in minor wounds. http://www.abramsderm.com/downloads/Woundcare_PostOp.pdf In dermatological surgery:?Cleanse the wound or suture line twice daily with soap and water. Use a cotton-tipped swab (Q-tip) to remove any dried blood or crust. Pat dry gently. Apply a thin layer of Bacitracin or Polysporin ointment over the wound and cover with a new Telfa pad (non-stick dressing) or bandage. Avoid using ointments containing neomycin (Neosporin) because they may cause redness or itching in some people. The first day the wound may be tender and bleed slightly or seep a small amount of clear fluid. Two days after surgery you may shower and allow the wound to get wet, but do not let the forceful stream of the shower hit the wound directly. Always remove a wet bandage promptly and replace with a dry bandage applied over a layer of antibiotic ointment.? http://www.dermwestconn.com/instructions/wound_care.html ?Currently, a number of topical agents are available to assist in microbial control of the burn wound, including silver sulfadiazine, mefenide acetate, 0.5% silver nitrate, bacitracin/polymyxin B, mupirocin, and Mycostatin. No single agent is totally effective and each has advantages and disadvantages. Almost all agents will affect wound healing and increase metabolic rate. Silver sulfadiazine (e.g. Silvadene or SSD) is the most commonly used topical antimicrobial agent in burns. Mafenide acetate 11.2% cream (e.g. Sulfamylon) is one of the oldest effective topical antimicrobial agents.? http://www.totalburncare.com/orientation_postburn_infection.htm ?Topical antimicrobial agents usually have a non-specific mode of action and therefore the opportunity for unwanted patient effects exist, but there is a lesser chance of the development of resistance in microbial species. The development of antiseptic resistance, however, has already been noted with chlorhexidine, and it has been linked to antibiotic resistance [14]. Misuse and abuse of antiseptics must, therefore, be avoided, and additional antimicrobial therapies will always be needed. Tea tree oil has already been assessed for in vitro[97] and in vivo[98] activity, and antimicrobial peptides isolated from amphibian skin offer promise in treating infections[99].? http://www.worldwidewounds.com/2004/february/Cooper/Topical-Antimicrobial-Agents.html ?There are topical agents that are less harmful to epidermal cells in culture and can be successfully used immediately prior to surgery? Epicel. 1. Amphotercin B 2. Cefoperazone 3. Ciprofloxacin 4. Gentamicin sulfate 5. Neomycin sulfate 6. Nystatin (Mycostatin®) 7. Polymyxin B sulfate 8. Tobramycin sulfate 9. Vancomycin hydrochloride 10. Polymyxin B sulfate & bacitracin zinc (Polysporin?, Bibiotic) 11. Polymyxin B sulfate, bacitracin zinc & neomycin sulfate (Triple Anitbiotic) ?Prep the wound surface with a scrub that is not detrimental to Epicel??(povidone iodine, poloxamer 188, or acetic acid) then thoroughly rinse with sterile normal saline.? In this situation, provodine iodine is used before applying Epicel autograft, along with a triple antibiotic ointment. http://www.genzymebiosurgery.com/pdfs/epicel_concepts_for_care.pdf ?Goldman utilizes an anti-aerobic agent and an anti-anaerobic agent as well, to best eliminate gram-positive, gram-negative and anaerobic pathogens.? ?Even if topical antibiotics are included in the therapy, they will be Bacitracin or Neosporin, which are both offered over the counter. "Review of the literature feels that all it does is set the patient up for MRSA because you're treating a broad spectrum of bugs that are sitting on the wound," Gill says. "But unless they're there in sufficient quantities to actually cause infection, you're just giving antibiotics for no good reason. The other thing is, patients oftentimes develop an allergy to long-term use with Neosporin or Bacitracin because of the vehicle they're mixed in--(like) petroleum jelly."? http://www.infectioncontroltoday.com/articles/331topics.html ?Petroleum-based antimicrobial ointments such as bacitracin and/or polymyxin B are clear on application, painless, and allow for easy wound observation. These agents are commonly used for treatment of facial burns, graft sites, healing donor sites, and small partial-thickness burns. Povidone iodine ointment has a broad antimicrobial activity, including bacteria, fungi, and some viral forms. Mupirocin (e.g. Bactroban) has improved activity against gram positive bacteria, especially methillin resistant Staph. aureus (MRSA) and selected enteric bacteria. Gentamicin ointment will select for resistant organisms and diminish effectiveness of its parenteral form, but may be useful in selected cases.? http://www.totalburncare.com/orientation_postburn_infection.htm ?Bacitracin Most clinical use of bacitracin is in the prophylaxis of Gram-positive bacteria infection in open areas. The addition of neomycin and polymyxin B expands the antimicrobial action to Gram-negative bacteria. A physiological pH. A freshly prepared 0.1% NaOCl solution decontaminates skin colonized with S. aureus, C. albicans, and P. aeruginosa within 10, 20, and 30 min, respectively. There is no report of microbial resistance to hypoehloride. More studies need to be done before clinical use is possible. Hypochloride has the additional advantages of reducing oedema and of having no effect on granulation and epithelialization.? http://www.medbc.com/annals/review/vol_13/num_4/text/vol13n4p216.htm ?Doctor Barie: Let's explore the common concept of treating the wound locally with a pharmacologic agent of some type, even including saline as a pharmacologic agent. There is intraoperative lavage, which could utilize saline or dilute povidone-iodine solution. There is the opportunity to put topical antiseptics or antibiotics in the incision. There is the possibility to put topical antiseptics in the wound. And then, there is the opportunity to actually deliver medication to the wound post-operatively as it heals. What is the science here, and does it conform to practice? Doctor Hau: Some old studies examined the practice of local antibiotic instillation into wounds. Ampicillin was as effective as using systemic antibiotics,[8] in solution as well as in powder form. Follow-up studies with newer agents have not been performed. There are also no clinical studies, as far as I know, that look at the use of antiseptics in wounds, although animal and in vitro studies suggest that most topical antibiotics actually impair wound healing.? Doctor Hau: An old surgical aphorism states that you shouldn't put anything in a wound that you couldn't put in your eye. Doctor Faist: That's right. Doctor Fry: I don't use anything in the wound other than saline. I am unaware of data to substantiate the position that topical drugs are better than what one achieves with systemic perioperative prophylaxis used appropriately, so the study of topical drugs remains of interest. A reasonable hypothesis is that topical antisepsis will act synergistically with antibiotic prophylaxis, and is worth testing. http://www.medscape.com/viewarticle/452244 Other wound dressings: ====================== ?The use of hydrogel A resulted in significantly faster and efficient debridement, no sign of allergic reactions, significantly easier application, a positive influence on the patients' quality of life caused by significantly lower degree of wound pain, and apparent cost-effectiveness of debridement.? Read the ?In vitro evaluation of the bactericidal activity of three wound antiseptics against biofilms of common wound pathogens? http://www.hmpcommunications.com/OWM/displayArticle.cfm?articleID=article352 Here?s an interesting excerpt about honey healing wounds. http://taylorandfrancis.metapress.com/(uarurw45ttmu2s55dwrn3crz)/app/home/contribution.asp?referrer=parent&backto=issue,18,32;journal,115,120;linkingpublicationresults,1:101945,1 I hope this is the answer you were seeking. If not, please request an Answer Clarification, and allow me to respond, before you rate. I will be happy to assist you further on this question, before you rate. Sincerely, Crabcakes Search Terms ============ Preferred topical antimicrobials + post-op wound care Wound flap + dressings + Neosporin OR Iodine surgical wound care Post-op wound care topical antimicrobials + iodine + compare compare + iodophors + bacitracin + post operative wounds closing surgical incision + topical antimicrobials