"The use of Povidone Iodine nasal spray
and mouthwash during the current
COVID-19 pandemic may reduce cross
infection and protect healthcare
J Kirk-Bayley MRCP FRCA EDIC FFICM
Consultant Intensivist & Anaesthetist,
Royal Surrey County Hospital
VS Sunkaraneni LLM FRCS (2009)
Consultant Rhinologist, Royal Surrey County Hospital
SJ Challacombe, PhD, FRCPath, FDSRCS, FMedSci, DSc(h.c), FKC
Martin Rushton Professor of Oral Medicine, King’s College London
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In late 2019 a novel coronavirus, SARS-CoV-2 causing
Coronavirus disease 2019 (COVID-19) appeared in
Wuhan China, and on 11th March 2020 the World
Health Organisation declared it to have developed
pandemic status. In early SARS-CoV-2 infection,
viral titres of greater than 107/mL in saliva and nasal
mucous can be found; minimisation of these titres
should help to reduce cross infection. Povidone-
iodine (PVP-I) disinfectant has better anti-viral activity
than other antiseptics and has already been proven
to be an extremely effective virucide in vitro against
severe acute respiratory syndrome and Middle East
respiratory syndrome coronaviruses (SARS-CoV and
MERS-CoV). Its in vivo virucidal activity is unknown,
but it retains its antimicrobial activity against bacteria
in vivo intraorally and one application can reduce
oral microbial flora for greater than 3 hours.
PVP-I disinfectant has been shown to be safe when administered to the nasal cavity and as a mouthwash. We propose a protocolised intra-nasal and oral application of PVP-I for both patients and their attendant healthcare workers (HCWs) during the current COVID-19 pandemic to help limit the spread of SARS-CoV-2 from patients to healthcare workers and vice versa. The aim is to reduce the viral ‘load’ in two of the key areas from where droplets and aerosols containing the virus are expectorated (the lower respiratory tract being the other). The aim of use in HCWs is to destroy virus that has entered the upper aerodigestive tract before it has the opportunity to infect the host.
We suggest the protocol is considered for routine use during the care of COVID-19 patients, particularly before any procedure that involves the upper aerodigestive tract, including intubation, nasal and oral procedures, endoscopy and bronchoscopy. We suggest it should be considered when such procedures are carried out in all patients during the pandemic regardless of COVID-19 status, due to the reported significant rates of asymptomatic infection
The total iodine exposure proposed is well within previously recorded safe limits in those without contraindications to its use. The intervention is inexpensive, low risk and potentially easy to deploy at scale globally.
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