Canadian Journal of Anesthesia

, Volume 51, Issue 9, pp 932–936 | Cite as

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

  • Junichi Ogata
  • Kouichiro Minami
  • Hiroshi Miyamoto
  • Takafumi Horishita
  • Midori Ogawa
  • Takeyoshi Sata
  • Hatsumi Taniguchi
Cardiothoracic Anesthesia, Respiration and Airway



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.


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.


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.


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


Endotracheal Intubation Tracheal Tube Bacterial Colonization Povidone Selective Digestive Decontamination 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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



La pneumonie nosocomiale est une complication encore fréquente à la suite d’une intubation endotrachéale. Nous avons vérifié le transport des bactéries à l’intérieur de la trachée pendant l’intubation endotrachéale et évaluons les effets du gargarisme avec povidone iodé sur la contamination bactérienne de la pointe du tube d’intubation.


Les patients du groupe de gargarisme ont utilisé 25 mL de povidone iodé (2,5 mg· mL−1). Les patients témoins se sont gargarisés avec 25 mL d’eau du robinet. Avant l’intubation trachéale, les microorganismes ont été prélevés sur la paroi postérieure du pharynx au moyen de coton-tiges stériles. Après l’anesthésie, tous les patients ont été extubés et les bactéries de la pointe du tube trachéal ont été prélevées et mises en culture.


Avant l’intubation orotrachéale, on a détecté des bactéries sur les parois postérieures du pharynx chez les 19 patients témoins. Ce groupe comprenait cinq patients avec staphylocoque aureus résistant à la méthicilline (SARM) dans la cavité nasale avant l’opération. Le SARM a aussi été détecté dans le pharynx de quatre patients. Il y avait une colonisation bactérienne chez les 19 patients qui ont utilisé le mélange povidone iodé. On a retrouvé le SARM dans la cavité nasale de quatre patients, mais non dans le pharynx. Tous les patients témoins présentaient une colonisation bactérienne à la pointe du tube après l’extubation. De plus, le SARM a été détecté chez deux des quatre patients. Par contre, la povidone iodé a éliminé les bactéries en général et les colonies de SARM dans le pharynx avant l’intubation et à la pointe du tube après l’extubation.


Le gargarisme avec povidone iodé avant l’intubation orale réduit le transport bactérien dans la trachée.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1990–May 1999, issued June 1999. Am J Infect Control 1999; 27: 520–32.CrossRefGoogle Scholar
  2. 2.
    Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study; EPIC International Advisory Committee. JAMA 1995; 274: 639–44.CrossRefPubMedGoogle Scholar
  3. 3.
    Vincent JL. Nosocomial infections in adult intensivecare units. Lancet 2003; 361: 2068–77.CrossRefPubMedGoogle Scholar
  4. 4.
    Hoffken G, Niederman MS. Nosocomial pneumonia. The importance of a de-escalating strategy for antibiotic treatment of pneumonia in the ICU. Chest 2002; 122: 2183–96.CrossRefPubMedGoogle Scholar
  5. 5.
    Appelgren P, Hellstrom I, Weitzberg E, Soderlund V, Bindslev L, Ransjo U. Risk factors for nosocomial intensive care infection: a long-term prospective analysis. Acta Anaesthesiol Scand 2001; 45: 710–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Tejada Artigas A, Bello Dronda S, Chacon Valles E, et al. Risk factors for nosocomial pneumonia in critically ill trauma patients. Crit Care Med 2001; 29: 304–9.CrossRefGoogle Scholar
  7. 7.
    Levine SA, Niederman MS. The impact of tracheal intubation on host defenses and risks for nosocomial pneumonia. Clin Chest Med 1991; 12: 523–43.PubMedGoogle Scholar
  8. 8.
    Kotani N, Lin CY, Wang JS, et al. Loss of alveolar macrophages during anesthesia and operation in humans. Anesth Analg 1995; 81: 1255–62.PubMedGoogle Scholar
  9. 9.
    Smulders K, van der Hoeven H, Weers-Pothoff I, Vandenbroucke-Grauls C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest 2002; 121: 858–62.CrossRefPubMedGoogle Scholar
  10. 10.
    Valles J, Artigas A, Rello J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995; 122: 179–86.CrossRefPubMedGoogle Scholar
  11. 11.
    Dennesen P, van der Ven A, Vlasveld M, et al. Inadequate salivary flow and poor oral mucosal status in intubated intensive care unit patients. Crit Care Med 2003; 31: 781–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Shiraishi T, Nakagawa Y. Evaluation of the bactericidal activity of povidone-iodine and commercially available gargle preparations. Dermatology 2002; 204(Suppl 1): 37–41.CrossRefPubMedGoogle Scholar
  13. 13.
    Kawana R, Nagasawa S, Endo T, Fukuroi Y, Takahashi Y. Strategy of control of nosocomial infections: application of disinfectants such as povidone-iodine. Dermatology 2002; 204(Suppl 1): 28–31.CrossRefPubMedGoogle Scholar
  14. 14.
    Nagatake T, Ahmed K, Oishi K. Prevention of respiratory infections by povidone-iodine gargle. Dermatology 2002; 204(Suppl 1): 32–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Murakami K, Minamide W, Wada K, Nakamura E, Teraoka H, Watanabe S. Identification of methicillinresistant strains of staphylococci by polymerase chain reaction. J Clin Microbiol 1991; 29: 2240–4.PubMedCentralPubMedGoogle Scholar
  16. 16.
    Reimer K, Wichelhaus TA, Schafer V, et al. Antimicrobial effectiveness of povidone-iodine and consequences for new application areas. Dermatology 2002; 204(Suppl 1): 114–20.CrossRefPubMedGoogle Scholar
  17. 17.
    Fuursted K, Hjort A, Knudsen L. Evaluation of bactericidal activity and lag of regrowth (postantibiotic effect) of five antiseptics on nine bacterial pathogens. J Antimicrob Chemother 1997; 40: 221–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Kollef MH, Skubas NJ, Sundt TM. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest 1999; 116: 1339–46.CrossRefPubMedGoogle Scholar
  19. 19.
    Selective Decontamination of the Digestive Tract Trialists Collaborative Group. Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract. BMJ 1993; 307: 525–32.CrossRefGoogle Scholar
  20. 20.
    Vandenbroucke-Grauls CM, Vandenbroucke JP. Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit. Lancet 1991; 338: 859–62.CrossRefPubMedGoogle Scholar
  21. 21.
    Niedner R. Cytotoxicity and sensitization of povidoneiodine and other frequently used anti-infective agents. Dermatology 1997; 195(Suppl 2): 89–92.CrossRefPubMedGoogle Scholar
  22. 22.
    Kozuka T. Patch testing to exclude allergic contact dermatitis caused by povidone-iodine. Dermatology 2002; 204(Suppl 1): 96–8.CrossRefPubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Junichi Ogata
    • 1
  • Kouichiro Minami
    • 1
  • Hiroshi Miyamoto
    • 2
  • Takafumi Horishita
    • 1
  • Midori Ogawa
    • 2
  • Takeyoshi Sata
    • 1
  • Hatsumi Taniguchi
    • 2
  1. 1.Department of AnesthesiologyUniversity of Occupational and Environmental Health School of MedicineFukuokaJapan
  2. 2.Department of MicrobiologyUniversity of Occupational and Environmental Health School of MedicineFukuokaJapan

Personalised recommendations