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Background: Triclosan (Irgasan), an antibacterial active against staphylococci and coliform bacteria, has been formulated for use as a handwash. There has been only one previous report of the use of the glove juice test to determine the immediate, residual, and cumulative effects of a 1% triclosan-based handwash product. There have been no previous studies on the use of 1% triclosan combined with povidone-iodine (PI) in a handwash product. Methods: The glove juice technique was used to document and compare the immediate, 3-hour residual, and 5-day cumulative effects on the mean log 10 bacterial counts of 1% triclosan—based handwash product and 1% triclosan with 5% PI. A standardized surgical handwashing technique was used before sample collection. These results and the identity and type of the aerobic bacteria cultured from the samples were compared with the results of standardized washing and glove juice sampling with 4% weight/volume chlorhexidine gluconate (CHG), 7.5% PI, and a nonantimicrobial liquid soap. Results: All five tested products showed significant log 10 reduction from baseline on day 1, hour 0 ( p 10 bacterial count when 7.5% PI, 4% CHG, and 1% triclosan with 5% PI were compared with each other immediately after washing ( p > 0.05). There was a significant difference between 1% triclosan and the liquid soap when they were each compared with 4% CHG, 7.5% PI, and 1% triclosan with 5% PI. There was no statistically significant difference between the 1% triclosan product and the liquid soap ( p > 0.20). All products were effective at reducing the immediate bacterial count from the baseline level. All formulations except the liquid soap showed significant cumulative effect ( p p > 0.05). Both products differed significantly ( p p Conclusions: Triclosan combined with PI resulted in the prevention of bacterial regrowth at 3 hours such as occurred when PI alone was used. Triclosan-containing products have a small cumulative effect, although not as great as that produced by CHG. The triclosan-based products did not appear to select for gram-negative bacterial overgrowth, although the study period may have been too short to detect such an effect.

The effective period of action of topical and systemic antibiotics is significantly greater in contaminated wounds closed primarily than in wounds undergoing a delayed closure. The beneficial effects of antibioties were apparent in the primarily closed wounds for forty-eight hours. When treatment of open contaminated wounds was delayed for three hours or more, antibiotics had no apparent therapeutic value. The ineffectiveness of antibiotics in open wounds was attributed to a rapidly developing fibrin coagulum which may limit the drug's access to the organism. The therapeutic potential of antibiotics in contaminated open wounds was enhanced by swabbing the wound with a gauze sponge at the time of administration of the drug. Utilizing this adjunct, the limited period of systemic and topical antibiotic action in contaminated wounds undergoing delayed closure was prolonged. The responses of the primarily closed contaminated wounds to this combination of therapies were less impressive since antibiotics alone were found to be effective in contaminated wound treatment. Hypotheses proposed to explain the therapeutic value of scrubbing as an adjunct to antibiotic treatment were that scrubbing mechanically cleansed the wound by removing the bacteria and/or disrupted the coagulum covering the contaminated wound, allowing the drug more intimate contact with the bacteria.

To avoid the mental and physical trauma of preoperative shaving of the genital area prior to vasectomy 50 men who underwent vasectomy were given small amounts of Betadine surgical scrub to use as a washing material in their genital area for 2-4 days prior to surgery with a washing the morning of surgery. At the time of operation there was no clipping or shaving of the operative field only a warm Betadine scrub without a nail brush. No infection was reported in any of the 50 patients. There was enlargement of the testicle in 2 patients possibly due to sitting up too soon. Neither was considered as caused by the surgical technique.

Human immunodeficiency virus (HIV), the etiological agent of the acquired immunodeficiency syndrome (AIDS), was treated with either Betadine® (povidone-iodine) Solution or Betadine Surgical Scrub®. HIV inactivation was analyzed using the viral reverse transcriptase assay or by observing the cytopathic effect produced in HIV-infected, H-9, T-cell cultures. The minimum effective Betadine dose was 0.25% for complete inactivation of HIV that was treated for various time intervals (immediate vortex to ten minutes). The titer of HIV stocks used in these experiments (105 TCID50per mL) was greater than amounts generally detected in clinical specimens. Our results provide a rationale for the use of povidone-iodine as a topical antiseptic against HIV in the clinic or laboratory.

To the Editor.— In a Letter to the Editor, Schuster et al 1 suggested that iodophors such as povidone-iodine (Betadine) can "reasonably" be expected to inactivate human immunodeficiency virus (HIV), also known as human T-cell lymphotrophic virus type III. The authors urged that compounds such as iodophors, which are "used almost universally for personal and patient disinfection," be evaluated for eradication of HIV before turning attention to ionizing radiation and other agents. In response to Schuster and colleagues as well as to many other infection control practitioners who have shown a continuing and extensive interest in this topic, we supported an in vitro study that evaluated the use of Betadine solution (10% povidone-iodine) and Betadine surgical scrub (7.5% povidone-iodine) in the inactivation of HIV. The study was conducted in the Infectious Disease Unit of Massachusetts General Hospital, Boston, by Robert T. Schooley, MD, and associates and was recently completed. (The

The purpose of this study was to assess the therapeutic potential of Betadine and pHisoHex surgical scrub solutions in contaminated wounds. The results of this study demonstrate that these surgical scrub solutions were harmful to the wound and had no therapeutic value. The deleterious effects of these scrub solutions appeared to be the result of their detergent content. The antiseptic agents contained in these scrub solutions exerted a favorable influence on the contaminated wound but their beneficial effects did not eliminate the harmful influences of the detergent.