The Role of Iodine Nasal Swabs in Preoperative Decolonisation

Preventing surgical site infections (SSIs) remains a key priority across healthcare systems, with growing attention being paid to the role of preoperative decolonisation, especially in high-risk procedures involving prosthetic implants. Among the most promising, practical interventions is the use of povidone-iodine nasal swabs, an effective alternative to mupirocin for reducing Staphylococcus aureus colonisation in the nasal passage.

Why Nasal Decolonisation Matters

Nasal colonisation with Staphylococcus aureus is a well-established risk factor for postoperative infections. Carriers are two to nine times more likely to develop SSIs than non-carriers (Bode et al., 2010). Targeted decolonisation can therefore play a meaningful role in infection prevention strategies, particularly for orthopaedic, cardiovascular, and neurosurgical procedures.

Iodine-Based Swabs: A Practical and Effective Approach

Povidone-iodine nasal antiseptics are gaining traction as a fast-acting, broad-spectrum alternative to topical antibiotics. Applied preoperatively, they are typically well-tolerated, easy to administer, and do not require multi-day dosing. Unlike mupirocin, they carry no risk of resistance development.

Several studies have demonstrated that intranasal povidone-iodine is at least as effective as mupirocin in reducing S. aureus colonisation and associated infection rates. In environments where rapid implementation is needed, such as emergency surgeries or streamlined elective pre-op workflows, iodine swabs offer a compelling option.

New Zealand's Infection Prevention Context

In New Zealand, the Health Quality & Safety Commission has successfully driven improvements in SSI prevention through initiatives like the Surgical Site Infection Improvement (SSII) Programme. As hospitals continue to refine local protocols, iodine-based nasal swabs present an opportunity to expand decolonisation without adding workflow burden.

References

Bode, L. G., Kluytmans, J. A., Wertheim, H. F., Bogaers, D., Vandenbroucke-Grauls, C. M., Roosendaal, R., ... & Vos, M. C. (2010). Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. New England Journal of Medicine, 362(1), 9–17. https://doi.org/10.1056/NEJMoa0808939

Phillips, M., Rosenberg, A., Shopsin, B., Cuff, G., Skeete, F., Foti, J., ... & Kreiswirth, B. N. (2014). Preventing surgical site infections: a randomized, open-label trial of nasal mupirocin ointment and nasal povidone iodine solution. Infection Control & Hospital Epidemiology, 35(7), 826–832. https://doi.org/10.1086/676872

Health Quality & Safety Commission New Zealand. (2019). Surgical site infection improvement programme: national report 2018. https://www.hqsc.govt.nz/resources/resource-library/ssi-national-report-2018/

Lalani, T., Liu, J., Zembower, T. R., Trick, W. E., & Hayden, M. K. (2021). Effectiveness of povidone-iodine nasal decolonization against Staphylococcus aureus and methicillin-resistant Staphylococcus aureus: a review. Antimicrobial Agents and Chemotherapy, 65(3), e02291-20. https://doi.org/10.1128/AAC.02291-20