Single-dose intranasal 10% povidone-iodine for perioperative nasal decolonization of Staphylococcus spp.: a randomized, open label, placebo-controlled trial
In brief
One dose of nasal povidone-iodine cleared MRSA in 47% by 3 hours
In a randomized trial of 179 adults having outpatient surgery, a single preoperative dose of 10% povidone-iodine cleared nasal MRSA by 3 hours in 47% of participants with positive baseline cultures, versus 2.9% with saline. Irritation was mild and uncommon; fewer surgical infections occurred with povidone-iodine, but infection outcomes were exploratory and need larger studies.
- Journal
- The Journal of hospital infection (Q1)
- Published
- 22 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- D Grech, S Abreu, C Campbell, J Varriano, V Dhruva, G Tewfik, et al.
- PMID
- 42772691
- DOI
- 10.1016/j.jhin.2026.09.018
Why clinicians should know about it
- Picked for Microbiology (medical) (paper of the day, 24 September 2026): Rapid intranasal povidone-iodine eradication of MRSA
Abstract
BACKGROUND: Preoperative nasal colonization with Staphylococcus aureus (including MRSA) increases surgical site infection (SSI) risk. Mupirocin requires a 5-day regimen and faces resistance concerns. We evaluated whether a single preoperative intranasal application of 10% povidone-iodine (PI) suppresses nasal staphylococcal burden. METHODS: In a prospective, open label randomized, placebo-controlled trial at a single academic hospital, adults undergoing outpatient surgery were randomized to intranasal 10% PI or sterile saline. Nasal swabs were obtained at baseline and at 1, 2, and 3 hours after surgical start following study-agent application. The primary endpoint was reduction in nasal staphylococcal burden in the enrolled cohort. Organism-specific analyses among participants with positive baseline cultures were performed as supportive analyses. Secondary endpoints included SSIs at 7 and 30 days, and tolerability. RESULTS: Of 192 enrolled, 179 were analyzed (88 PI; 91 saline). At 3 hours, eradication favored PI versus saline: 33.0% vs 10.6% (S. aureus), 47.0% vs 2.9% (MRSA), and 24.0% vs 0.0% (S. epidermidis). Median reduction in log10 enumeration per mL from baseline to 3 hours was greater with PI than saline across S. aureus, MRSA, and S. epidermidis (all p < .001). PI was well tolerated (2/88 [2.1%] minor irritation; no serious adverse events). Thirty-day SSIs were infrequent and were considered exploratory: 1/88 (1.1%) with PI vs 6/91 (6.6%) with saline. CONCLUSIONS: Single-dose intranasal 10% PI administered preoperatively rapidly suppresses nasal staphylococcal carriage with excellent tolerability. Clinical outcomes, including SSIs, were exploratory. Larger studies are needed to determine whether this microbiologic suppression translates into reduced postoperative infection risk.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.