The free iodine is the bactericidal component, and its levels are dependent on the concentration of the povidone–iodine solution. Iodine is complexed by polyvinylpyrrolidone and iodide through a hydrogen bond between the two pyrroles (5), but a small amount of free iodine is constantly released and remains in dynamic equilibrium with the complex. Povidone–iodine is an example of an iodophor, a complex of iodine and a solubilising carrier, which acts as a reservoir of ‘free’ active iodine (3). This evidence suggests that the use of povidone–iodine as an agent of choice is dependent on the clinical need but is also likely to be influenced by personal preference. Although there is a distinct lack of well‐designed, randomised controlled trials evaluating antiseptic efficacy, selection should be based on the next best available evidence. ![]() This article reviews the studies that have assessed the efficacy of povidone–iodine in hand disinfection and skin preparation and its use as an antiseptic irrigant. In the clinical environment, there is no general agreement regarding the ‘best’ antiseptic and the practice varies widely. The resultant broad spectrum of antimicrobial activity is well documented and its efficacy, particularly in relation to resistant micro‐organisms such as methicillin‐resistant Staphylococcus aureus, has been shown. However, the use of solutions (tincture) of iodine has been replaced by the widespread use of povidone–iodine, a water‐soluble compound, which is a combination of molecular iodine and polyvinylpyrrolidone. ![]() ![]() Iodine and its antibacterial properties have been used for the prevention or management of wound infections for over 150 years.
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