Topical Povidone Iodine Inhibits Bacterial Growth in the Oral Cavity of Patients on Mechanical Ventilation

A Randomized Controlled Study

Shoma Tsuda; Sakiko Soutome; Saki Hayashida; Madoka Funahara; Souichi Yanamoto; Masahiro Umeda


BMC Oral Health. 2020;20(62) 

In This Article


Ventilator-associated pneumonia (VAP) is an airway infection developing more than 48 h after intubation that affects 8–28% of patients requiring mechanical ventilation. VAP is a major complication in the intensive care unit that has been reported to contribute to higher mortality rates and longer hospital stays.[1–4]

There are several risk factors for VAP, and some prevention strategies have been explored. One of the main causes of VAP is thought to be the aspiration of oral bacteria. The US Institute for Healthcare Improvement (IHI) recommends a preventive intervention called the IHI Ventilator Bundle, which consists of 1) elevation of the head of the bed, 2) daily sedation vacations and assessment of readiness to extubate, 3) peptic ulcer disease prophylaxis, 4) deep vein thrombosis prophylaxis, and 5) daily oral care with 0.12% chlorhexidine.[5] However, despite its effectiveness in preventing VAP, 0.12% chlorhexidine is not approved for mucosal application in Japan. Therefore, oral care is not included in the Japanese Society of Intensive Care Medicine (JSICM) VAP Bundle.[6]

As an alternative to 0.12% chlorhexidine, povidone iodine has been used widely to disinfect the mucous membranes in Japan. However, it is not generally used to prevent VAP. According to the meta-analysis by Labeau et al.[7] on prevention of VAP by oral antiseptics, a significant reduction was observed in patients receiving chlorhexidine, while in those receiving povidone iodine the efficacy on preventing VAP was unclear because of fewer number of studies. The aims of this randomized controlled study were to investigate if topical povidone iodine (i) inhibits bacterial growth and (ii) disrupts the balance of the oral microbiota in the oral cavity of patients undergoing mechanical ventilation.