What is the brown stuff they put in your nose before surgery?
The brown substance applied to the inside of your nose before an operation is most commonly a povidone-iodine solution, sometimes referred to as an iodophor. Povidone-iodine (PI) is a powerful, broad-spectrum antiseptic, meaning it is effective at killing a wide range of microorganisms, including bacteria, viruses, and fungi. The characteristic brown color comes from the iodine component in the solution.
Why is nasal decolonization necessary?
The nasal passages are a primary reservoir for bacteria, particularly Staphylococcus aureus, including its antibiotic-resistant form, Methicillin-resistant Staphylococcus aureus (MRSA). In fact, up to 80% of S. aureus infections are caused by bacteria living in the patient's own nose. During a surgical procedure, these bacteria can transfer from the patient's nose to the incision site, leading to a surgical site infection (SSI). SSIs can cause significant complications, including prolonged hospital stays, delayed wound healing, increased costs, and, in severe cases, higher mortality rates. Preoperative nasal decolonization is a crucial infection control strategy that aims to eliminate or significantly reduce the bacterial load in the nose before surgery, thereby lowering the risk of SSI.
How povidone-iodine works to prevent infection
Povidone-iodine acts quickly and effectively due to its unique mechanism of action. When applied to the skin or mucous membranes, the iodine in the solution is slowly released. This elemental iodine rapidly penetrates microorganisms and oxidizes key proteins, nucleotides, and fatty acids, ultimately leading to cell death. This oxidative process provides a broad-spectrum antimicrobial effect that can begin working within 15 to 20 seconds of application and can last for several hours. Because its mechanism is oxidative, rather than targeting specific metabolic pathways, it is less prone to developing bacterial resistance compared to antibiotics.
The application process
For most patients, a healthcare provider will perform the nasal decolonization shortly before the surgery. The process is straightforward and quick, designed to be as comfortable and effective as possible.
- Prep: The patient is typically asked to lie with their head slightly elevated.
- Application: A pre-saturated swab, or a swab with an application of gel or liquid PI, is inserted into one nostril. The provider rotates the swab firmly against the inner surface of the nostril for a specified duration, typically about 15-30 seconds, to ensure thorough coverage.
- Repeat: The process is repeated with a new swab in the other nostril.
- Wait time: Patients are instructed not to blow their nose or wipe the treated area for a short period to allow the antiseptic to take effect.
Comparison of nasal decolonization agents
While povidone-iodine is a common choice, other agents are also used for nasal decolonization. The choice of agent can depend on factors such as surgical protocol, cost, and the specific bacteria being targeted.
| Feature | Povidone-Iodine (PI) | Mupirocin (Antibiotic Ointment) | Alcohol-Based Antiseptics (ABA) |
|---|---|---|---|
| Mechanism | Broad-spectrum antiseptic, kills microbes via oxidation. | Antibiotic, inhibits bacterial protein synthesis. | Alcohol-based antiseptic. |
| Speed of Action | Rapid, within seconds. | Slower action, requires several days of application. | Rapid, within seconds. |
| Application | Single application shortly before surgery. | Twice daily for 5 days pre-surgery. | Variable, can be applied multiple times per day. |
| Resistance Concerns | Low risk of developing bacterial resistance. | High potential for developing antibiotic resistance, especially with widespread use. | Low resistance concerns, but shorter duration of effect. |
| Cost | Generally more cost-effective for single, pre-operative use. | Often more expensive due to extended treatment protocol. | Can be cost-effective, depending on bulk purchase. |
| Compliance | High compliance, as administered by staff on the day of surgery. | Lower compliance, as it relies on patient self-administration at home. | Higher compliance, as often administered by staff or easy for self-application. |
Side effects and precautions
Povidone-iodine is widely regarded as safe for nasal use at the concentrations used for preoperative decolonization. The most common side effect reported is a mild, transient irritation or burning sensation in the nose, or a temporary unpleasant taste if the solution drains into the throat. In most cases, these sensations are mild and do not persist. Severe allergic reactions to povidone-iodine are extremely rare but possible. Patients with known iodine sensitivity or thyroid disorders should inform their healthcare provider before application, though true iodine allergies are rare.
Conclusion
In conclusion, the brown substance applied to the nose before surgery is povidone-iodine, a potent antiseptic used for nasal decolonization. This simple and rapid procedure is a vital component of infection control protocols, significantly reducing the bacterial load in the nasal passages and minimizing the risk of surgical site infections. Its broad-spectrum antimicrobial activity, low risk of resistance, and ease of application make it a preferred option for enhancing patient safety during surgical procedures. By targeting harmful pathogens at a major reservoir, this practice helps safeguard patient well-being and improves overall surgical outcomes. For more information on infection prevention, consult the CDC guidelines for surgical site infection prevention.
