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Four Letters Re: In Praise of Betadine

Hello Jim,
A. Woofer should be commended for his excellent article on Betadine. An excellent way to use/carry Betadine in a small personal first aid kit is Betadine swab sticks. There are normally used for skin prep before minor surgical procedures. Take care, - Jeff in Ohio

Jim,
I’m writing to take exception with the author’s affinity for using Betadine in open wounds to “prevent infection.” While the liberal application of Betadine was relatively standard practice in the Emergency Medicine community when I started practicing 20 years ago, recent studies have changed this practice considerably.

As the author himself points out, “It kills everything”. While this may be the desired effect against microorganisms Betadine is also cytotoxic, meaning it kills healthy cells of the patient as well. Studies have shown that this delays healing, increases scar formation and may lead to chronic wound formation – wounds that never close or heal. Other studies comparing Betadine with wound cleaning detergents (Shur-cleanse) or tap water or sterile water overwhelmingly conclude that tap water is the best agent for wound cleaning. While this may sound far fetched it has changed the way many Emergency Departments (including my own) treat wounds. A couple of good references for anyone interested in this subject would be:

Durani P, Leaper D: Povidone-iodine: use in hand disinfection, skin preparation and antiseptic irrigation. Int Wound J 5:376, 2008
Moscati RM et al: A multicenter comparison of tap water versus sterile saline for wound irrigation. Acad Emerg Med 14:404, 2007

You can find these journals available to the public at any medical school library.

Additionally, the author briefly mentions irrigation using a pin-hole in a plastic bag filled with irrigating solution. This too has been studied recently, along with other field expedient irrigation methods, and the conclusions are that you cannot get enough pressure using this method to dislodge debris from a wound. It requires 15psi for irrigation to have the desired effect. These pressures are best achieved in the field setting using a standard syringe and flexible IV catheter along with copious amounts of clean water.

I commend the author for teaching first aid techniques to lay people. I do this myself and know first hand the amount of work involved in preparing and presenting quality training. We owe it to our students to incorporate (into our teaching and our practice) the latest changes in the field so that what we teach is better than what we ourselves were taught years ago. - PA Matt

Sir:
Readers should be reminded: Don't confuse Betadine solution with Betadine soap. Both are available, but the soap should not be used to purify water. Betadine solution can be used as stated in the article. Please note these soaps and solutions should not be used on persons having a history of anaphylactic reaction to iodine or shellfish. Hibicleans (Chlorhexidine), manufactured by Regent, can be used for wound cleansing instead. Hibicleans is not as broad spectrum as Betadine solution, but is the standard substitute. - Mike in Tennessee

James Wesley:
Just finished reading the information from Woofer on betadine for wounds. About a week ago, my spouse took a tumble and fell about three feet into some planter boxes filled with dirt. He had some big belly scratches and a nasty arm gash. He was covered in dirt. Immediately had him shower with soap and water to get rid of the dirt and then I poured betadine on the wounds, bandaged up the big gash, and took him to the Emergency Room (ER). Apparently, these days the family physicians no longer want their patients to come to the office for such things like they used to do. As the ER physician told us, "this is new medicine and the doctor's office wants to churn through patients and suturing takes time." It was debatable about the arm gash being sutured or not but instead the ER physician cleaned some and then used wound glue to close it. The ER did nothing to my wound cleaning job for the belly scratches. Guess I must have done as good a job as the ER physician would have done. (Husband got his first tetanus vaccine with diphtheria. We don't like vaccines but these were some pretty nasty dirt filled wounds. I told the ER doctor that I was worried about both tetanus and 'flesh eating disease". She responded that tetanus and 'flesh eating disease' are the same thing. It sure doesn't appear to me to be the same bacterium but maybe one of your readers would know?) Within a day the belly wounds were healing very, very nicely. I think the the arm gash will leave a dented scar but it too is healing up pretty nicely. It has been many, many years since I had a first aid class. Looks like I did the right things.

I had planned to use the Thanksgiving weekend to get my first aid supplies organized so that I could pull out a container for wound treatments, one for colds, etc. Instead, I was running from one location to another to pull things together. Also, I had only been focusing on the wounds as the visible impact and a possible concussion but didn't think of possible broken bones nor internal injuries.

What would I have have done differently? I wish had had my supplies readily available instead of my hunting for my supplies for wound treatments. I wish I had taken the refresher first aid, advanced first aid, and the wilderness training program. And, wish I had done a better overall accounting of the situation to ask about broken bones or think of possible internal organ injuries. Finally, I have several first aid books but again I would not have been able to locate them easily and I would have had to read through them instead of as, Woofer, pointed out being very familiar with the written materials.

I was prepared for a modest crisis but would have been ill prepared for a major crisis simply because I was not and am not well organized. Some things are here; other things are there -- and in a crisis one doesn't want to be running here and there gathering things together. Regards, - Still Getting Ready

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