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Conventional povidone-iodine paint only technique vs. spray technique in preoperative antisepsis of anterior abdominal wall: a comparison of effectiveness and cost

Objectives To assess the effectiveness of spray technique (aqueous based solution in a reusable sprayer) and conventional paint only technique in view of reducing abdominal wall bacteria and to assess the volume of povidone-iodine used in each technique and evaluate which technique is more cost-effective. Methodology The sample included 70 patients, who had elective Gynaecological surgeries at Teaching Hospital, Kandy (2014-2015). This was a non-randomized clinical trial. In all patients, half the abdomen was prepared using the conventional technique and the other half using the new spray technique. Prepreparation and post-preparation skin swabs were taken and cultured to assess the mixed bacterial colony counts. Two output variables were measured; percentage reduction of mixed bacterial colony counts between preoperative and postoperative cultures for the two methods separately and the volume of povidone-iodine used in each method. Results The mean percentage reductions in mixed bacterial colony count in spray method: 98.78% and in the conventional paint method: 98.74%. P value for the two sample t-test was 0.963. Thus there is no significant difference between the mean percentage reductions in the mixed bacterial colony count in the two methods. The mean volume of povidone-iodine used in the spray method was 33.514ml with a corresponding P value of 0.000. Therefore the volume of povidone-iodine used in the spray method is significantly less than 50 ml that is used in the conventional method. (corresponding 95% upper bound for the CI: 34.714). Conclusion Both the conventional paint only technique and the new spray technique are equally effective in reducing abdominal wall bacteria. The volume of povidoneiodine used in the spray method is significantly less than that of the conventional method.