A Randomised Controlled Trial Comparing Spray Versus Paint Application of Iodine Skin Antisepsis in Head and Neck Surgery

BACKGROUND: It is unknown whether the method of application of povidone iodine solution for skin antisepsis affects its efficacy. The primary aim of this study was to compare the efficacy of spray-on aqueous povidone iodine solution in preventing surgical site infection in patients undergoing open head and neck surgery versus the standard paint-on application of the same agent. The secondary objective was to assess if the use of spray-on antiseptic solution reduced time in the operating room in complex head and neck surgery. METHODS: This was a prospective, double-blinded, noninferiority randomised controlled trial. The intervention arm received spray-on application of 10% aqueous povidone iodine solution after induction of general anaesthesia. Those in the control arm underwent standard skin preparation by painted application of the same agent. Participants were reviewed on Days 7 and 30 postoperatively to identify postoperative surgical site infection. RESULTS: Four-hundred and forty adult patients undergoing open head and neck surgery were recruited. After withdrawals, 432 participants were included, with 210 patients in the intervention arm (spray) and 222 in the control arm (paint). The overall rate of surgical site infection was 6.5%. There was no significant difference in the rate of surgical site infection between the groups receiving spray-on versus painted povidone iodine solution (5.7% and 7.2%, respectively, p = 0.66). For patients undergoing free flap surgery, the mean time in the operating room was 12.9 min less in the spray-on arm; however, this was not statistically significant (95% CI -42.7 to 68.4 min, p = 0.65). CONCLUSIONS: Spray-on skin preparation with povidone iodine solution before open head and neck surgery appears to be as effective as traditional paint-on application in preventing surgical site infection in the first 30 days following surgery.