Ten years experience with povidone-iodine in heart surgery

Ten years experience with povidone-iodine (PVP-I) (10%) ('Beta-isodona') in 7566 patients undergoing open-heart operations in the German Heart Centre, Munich, is reported. Povidone-iodine was used pre-, intra- and postoperatively for skin and wound disinfection according to a regime introduced more than 10 years ago and retained unchanged until today. The incidence of minor, superficial wound healing defects was 5%, whereas severe, deep sternal or retrosternal infections occurred in 0.5% of all patients. Superficial infections are no risk to the patient and can be treated successfully with local application of PVP-I. Deep infections, however, are associated with a mortality of about 40% despite the use of antibiotics and continuous wound irrigation with PVP-I (0.5%). Many factors contribute to the risk of these infections and only meticulous observation of aseptic and surgical technique, the prophylactic and therapeutic use of highly effective antibiotics, as well as the exclusion of sources of exogenous bacteria, can further reduce the incidence of these complications.