"The use of Povidone Iodine nasal spray

and mouthwash during the current

COVID-19 pandemic may reduce cross

infection and protect healthcare

workers."

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

Acknowledgement:

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ABSTRACT

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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