Evening Povidone-Iodine Scrub Followed By Intra-Operative Paint Versus Conventional Paint-And-Drape In Elective Abdominal Surgery: A Two-Year Cross-Sectional Study On Surgical-Site Infection And Recovery Outcomes

Abstract

Background:  Surgical-site infection (SSI) remains a leading cause of preventable postoperative morbidity worldwide. Pre-incisional antisepsis with povidone–iodine (Betadine®) is endorsed by major guidelines, yet the optimal timing and combination of scrub and paint steps is still debated.

Methods: We performed an analytical cross-sectional study (April 2023 – March 2025) involving 90 adults scheduled for elective open hernia repair or open cholecystectomy at S.N. Medical College, Agra. Participants received either (i) Betadine® scrub the preceding evening followed by Betadine® paint on the operating-table, or (ii) conventional Savlon®/spirit paint-and-drape immediately before incision. Primary outcome was SSI within 30 days; secondary outcomes included wound discharge, fever, wound dehiscence, preparation time, and length of stay.
Results: Forty patients underwent Betadine scrub + paint and 50 received conventional paint. Baseline age, sex and procedure type were comparable (p > 0.05). SSI occurred in 1 / 40 (2.5 %) Betadine cases versus 8 / 50 (16 %) conventional cases (p = 0.034). Median preparation time was 17 min (IQR 15–19) with Betadine versus 21 min (IQR 18–24) with conventional (p = 0.012). Mean postoperative stay was 3.3 ± 1.5 days for Betadine and 4.2 ± 2.1 days for conventional (p = 0.005). Pus discharge mirrored SSI rates, and adverse skin reactions were rare in both groups.

Conclusion: A simple protocol of evening Betadine scrub followed by intra-operative Betadine paint significantly lowers SSI risk, shortens skin-prep time, and facilitates earlier discharge when compared with conventional paint-and-drape alone. These findings support incorporation of a two-step povidone–iodine regimen into institutional SSI-prevention bundles, particularly for clean elective abdominal surgery.