Povidone-iodine and abdominal hysterectomy

      To the Editors:

      The use of intravaginal povidone-iodine gel as reported by Eason et al. (Eason EL, Sampalis JS, Hemmings R, Joseph L. Povidone-iodine gel vaginal antisepsis for abdominal hysterectomy. Am J Obstet Gynecol 1997; 176: 1011-6) demonstrates a useful antiinfective technique. We have been using a somewhat similar but easier technique for the past 26 years. In our procedures we complete a standard abdominal preparation and use a single dose of preoperative cefazolin (2.0 gm) but do not “prep” the vagina. On opening the vagina at the time of hysterectomy, we place a sponge, dripping with povidone-iodine liquid, on top of the cuff and then push the sponge (an opened 4 × 4 gauze) in the vagina, complete the surgery, close the abdomen, and remove the sponge from the vagina before the patient leaves the operating room. Although I do not have comparative statistics, I can state that my own infection rate over this time period is <5%. The only real difference with our procedure is not taking the time to place the patient in the lithotomy position and taking the time to “prep” the vagina.