Why Do Surgeons Use Iodine?

October 13, 2021

At some point in our lives we’ve gotten a cut, scrape or wound which was immediately cleaned up with either soap and water or iodine – sometimes even both. This power combo ensures that the affected area is disinfected thoroughly before the medication is applied. Pretty much a staple item in many first aid kits, iodine can easily be found in pharmacies, superstores, and online retailers. They are sold per bottle or as sometimes part of a wound disinfectant set.

Iodine usage is however not limited to home or personal use. This powerful germ fighting disinfectant is a standard sight in the medical industry and is one of the preferred solutions that are being used in operating rooms. So what exactly is iodine and why is it being used a lot in medical and healthcare settings.

What is iodine?

Iodine or more specifically recognized in the medical industry as Povidone-iodine and as iodopovidone is a disinfectant and antiseptic solution that is used before surgery as well as after one. It works as a hand disinfectant for surgeons, health workers, and for the skin of the individual requiring medical attention.

Available in liquid and powder form, iodine is used to treat minor wounds as well. In some cases, it is possible for a person to suffer some side effects from iodine application such as skin swelling and irritation. When applied on larger injuries it can cause high blood sodium levels, kidney issues, and metabolic acidosis.

A quick look into the history of iodine

The chemical element known as iodine was initially discovered in 1811 by Bernard Courtois. Early on, it was widely accepted that the chemical was great at preventing skin infections or treating an existing one. Furthermore, it worked really well in treating minor cuts and wounds. Since then, iodine is highly recognized as a multipurpose bactericide, at the same time it remains to be effective in fighting against viruses, yeast infections, fungi, molds, protozoans, and even molds. However, with its many benefits came a few drawbacks, but these issues were eventually overcome when PVP-I was discovered.

PVP-I or povidone iodine (a complex form of iodine) was first discovered in the fifties. Back then, tests were conducted by the Toxicology Laboratories in Philadelphia – said tests were conducted on microorganisms (in vitro). The study showed how well PVP- iodine’s antibacterial properties were not as toxic on the test subjects (mice) compared to iodine tincture. Further tests were eventually conducted on human subjects and the clinical trial results displayed the superiority of PVP- from other formulations. Thanks to its antiseptic and disinfectant functions, WHO has included it on the List of Essential Medicines. Sold over the counter under various brand names, one example is Betadine – this reddish brown compound is a must-have in everyone’s medicine cabinet.

Iodine for surgical skin preparation

There’s a reason why surgeons prefer using iodine-based solutions in the operating room. Unlike other antiseptics, iodine does a great job of infiltrating the cell walls of countless microbes that could possibly bring in an infection in the incision area. Using an iodine antiseptic in surgical skin preparation has multiple benefits to both the surgeons and the patients. These are as follows:

Efficacy – Compared to other disinfectants and antiseptics, iodine has been proven to be the most effective against a large number of microbial infections that can occur in surgeries. Some examples of these organisms include tubercle bacillus and MRSA.

Economical – Not only is iodine capable of reducing site infection incidents in the operating room, it is also known as one of the most cost-effective options for skin prep.

Reliable and dependable in the surgical industry – Proven to be one of the most durable surgical choices for skin preparation in a surgical environment, products that contain iodine can withstand even wet environments in the operating room.

Systemic absorption at lower risk – With the use of iodine in the medical field, (particularly in surgical settings) the chances of individuals experiencing systemic absorption is very low. Similarly, the risk of contracting iodine toxicosis is almost impossible.

No bacterial defense build-up – Most surgical antiseptics have a tendency of developing resistance, according to studies this is not the case with antiseptics that contain iodine. Because iodine is more dependable, it allows for repeated usage.

Why using iodine is better than alcohol

Whenever someone gets a wound or a scratch, they often reach for isopropyl alcohol. After all, this disinfectant solution has often been marketed as capable of killing 99.9% of bacteria. Though isopropyl alcohol can be found in many medical or healthcare settings, more often than not, most doctors, nurses, and surgeons are quick to reach for iodine instead.

Countless studies conducted on the efficacy of alcohol versus iodine have actually yielded equal results. Both solutions are in reality uniformly effective in disinfecting. However, there are some minor differences to each product. These minor variations have in no doubt been the primary reason why one is more favored by the other.

Isopropyl alcohol has been known to kill microbes fast with no residual activity to be found. Typically, facilities use alcohol to disinfect medical equipment and tools. Even TV doctors and nurses can be seen using isopropyl alcohol to clean up a scalpel, medical-grade scissors, and many more surgical devices. Scenarios involving the need to remove a bullet or perform emergency surgeries show individuals in search of high percentage isopropyl alcohol or even drinking liquor in order to disinfect makeshift medical implements. On the downside, isopropyl alcohol must be kept away from mucus and has been known to cause damage to corneas, nerves, and irritate the skin. It’s also extremely flammable, thus it must be handled with care and kept away from open flames.

On the other hand, iodine can be used on mucous membranes and have no ill effects when used on the eyes. Though it does cause skin irritation, it causes fewer adverse effects when applied. Because it can eliminate microbial organisms really fast, iodine is commonly used by surgeons to scrub in or as an antiseptic during operating procedures. However, unlike isopropyl alcohol that is colorless and evaporates easily, iodine has a reddish brown tincture that leaves a harmless stain on the skin and even on clothes.

Essentially, surgeons prefer using iodine in the O.R to go directly on the skin whereas isopropyl alcohol is widely favored to sterilize tools and to sanitize surfaces. There are of course many instances of both being used in surgical procedures with results that are just as effective when just one chemical is utilized.

How common are surgical site infections?

Defined as infections that occur up to a month post-surgery or even a year after, for patients who have undergone implants, surgical site infections (SSI) can affect the incision area or the tissue found within the tissues operated on.

SSI is mostly infections that occur superficially which makes treating it much easier. However, when the infection goes beneath the skin and penetrates tissues, implanted devices, and organs – this type of infection is serious and deadlier.

The Center for Disease Control and Prevention has three varying surgical site infection categories. These are infections that are superficial, deep incisional, and body parts or organ infections.

Risks involved in a patient acquiring SSI during a procedure can vastly depend on the procedure, as well as the patient’s existing medical conditions. Numerous studies have determined the primary patient and procedure-associated components that could lead to surgical site infections. Some patient factors that could potentially result in SSI include age, diabetes, malnutrition, and coexisting infections like TB or HIV.

Other possible factors are external and can be caused by the length of the procedure, overall quality of the skin prep done prior to the operation, the skill of the surgeon, improper sterilization of surgical implements, and the operating theater condition. For this reason, it cannot be stressed how the usage of iodine and even isopropyl alcohol is crucial.

Disinfecting with iodine inside and outside the medical arena

Thousands of people undergo surgery worldwide. These procedures can range from the run of the mill surgeries like tonsil removal to major operations like organ transplants. Pre-operative skin preparation is an important step that medical workers must adhere to. Similarly, proper prep of the skin surrounding the site of the surgery must be of the highest priority for the staff designated to the operating theater, especially since it’s extremely cost-efficient and extremely simple to execute. And to top it off, prepping with antiseptics like iodine is an easy way to prevent infection.

No matter how minor or severe a wound is, treating it begins with disinfectant. Store-bought iodine can be a great starting point to ensure that no infections would occur. Granted that the chemical iodine does leave a brownish-red tincture, this minor staining is a mere inconvenience that is outweighed by the many benefits that this solution can provide. If medical facilities and surgeons rely on the amazing qualities of iodine, there is no reason for the average person not to have a bottle or two on hand.