Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection
September 21st, 2015
Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.
The overall goal of this procedure is to reduce infectious complications following prostate needle biopsy by pretreating the rectal vault and perianal area using a povidone iodine slurry. Ultimately, microbial culture data from the rectal vault and monitoring of clinical infections demonstrates that the preparation reduces bacterial counts and infections following prostate biopsy. We first came up with the idea for this method based upon observations that infectious complications following prostate needle biopsy we're increasing despite patients taking adequate antibiotic prophylaxis.
The main advantage of our technique versus other methods, such as targeted antibiotic prophylaxis, is that our method can be used in every biopsy patient without the need of culture processes and adjustment of antibiotic regimens. To prepare the patient, ask him to lie down on the examination table on his side with his knees flexed to his chest before proceeding. Take a moment to review the documentation on the patient, the procedure, and the indication once everything is confirmed.
If the patient has elected for anesthesia, proceed by having the anesthesia service. Give the patient an intravenous injection of sedative. Next, prepare for the examination by putting on examination gloves.
Now lubricate the rectal vault and perform a rectal examination to investigate the areas of the prostate, which will be focused on by the trans rectal ultrasonography. To make the working povidone iodine solution first, pour 15 milliliters of stock, 10%povidone iodine solution into a sterile container. Then add five milliliters of 1%lidocaine gel to this basin, and mix them together with a cotton applicator for 15 seconds to create a slurry, thus completing the PIRP.
Next, open up a four centimeter square sterile gauze and soak it in the povidone iodine slurry. Then insert the gauze into the rectal vault. Only a small tail of gauze should be left emanating from the anus.
After two minutes, remove and discard the gauze. Next, use a disposable gynecologic swab to paint the perianal area with A-P-I-R-P solution. Once finished, dispose of this swab, then soak a fresh gynecologic swab in the povidone iodine slurry and insert it into the rectal vault approximately three centimeters into the anus.
Paint the anterior rectal wall with this swab. An essential component of this operation is painting the anterior rectal vault with the povidone iodine preparation, because this is the mucosal surface that's penetrated by the needle biopsy probe. To maximize the exposure of the rectal mucosa to the PIRP, repeat this process at least three times.
Keep using the same swab to paint the back wall of the rectal vault repeatedly. Very importantly, proceed with letting the PIRP solution dry for two to three minutes so its spec to recital effects, can have their full effect. Then proceed with the standard TRANSRECTAL ultra sonography and biopsy.
This PIRP technique has been in practice since January of 2012 on 165 patients. Thus far, only one patient has experienced an infectious complication in the form of systemic sepsis. A patient population undergoing T-R-U-S-P-M-B, which only received oral antibiotic therapy serves as a control population.
22 of the 515 patients in this cohort experienced an infection. 17 of the infections were in the urinary tract, and five experienced clinical sepsis defined by a fever with a positive blood culture.Overall. Integration of the PIRP technique into clinical practice was associated with a significant reduction in post biopsy infections.
Rectal cultures were performed in the 165 patients before and after PIRP to document changes in rectal vault microorganism colony count attributable to the treatment overall, a very significant 97.2%reduction in microorganism colonies was noted after PIRP administration. After watching this video, you should have a good understanding of the optimal means to prepare the rectal vault with the povidone iodine preparation prior to biopsy. Don't forget that povidone iodine can elicit an allergic reaction in patients with shellfish or iodine allergies, and should be avoided in use in these patients.
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Overview
This article presents a protocol aimed at reducing infections following transrectal ultrasound guided prostate needle biopsy (TRUS PNB). The method involves pretreating the rectal vault and perianal area with a povidone iodine slurry to decrease bacterial counts and subsequent infections.
Key Study Components
Area of Science
- Urology
- Infection Control
- Medical Procedures
Background
- Infectious complications after prostate needle biopsy have been rising.
- Standard antibiotic prophylaxis has not been sufficient in preventing infections.
- The proposed method is simple and cost-effective.
- It does not require culture processes or adjustments in antibiotic regimens.
Purpose of Study
- To reduce infectious complications following prostate needle biopsy.
- To evaluate the effectiveness of a povidone iodine slurry in preparation.
- To provide a universal method applicable to all biopsy patients.
Methods Used
- Patients lie on their side with knees flexed to chest.
- Rectal vault and perianal area are pretreated with povidone iodine slurry.
- Microbial culture data is collected from the rectal vault.
- Clinical infections are monitored post-procedure.
Main Results
- The preparation significantly reduces bacterial counts.
- Infection rates following biopsy are lower with this method.
- Patients do not require tailored antibiotic regimens.
- The technique is straightforward and can be implemented widely.
Conclusions
- Povidone iodine slurry is effective in reducing infections post-biopsy.
- This method is a viable alternative to traditional antibiotic prophylaxis.
- Further studies may validate its widespread adoption in clinical practice.
Frequently Asked Questions
Executive Industry Relevance
Infectious complications following transrectal ultrasound-guided prostate needle biopsy (TRUS PNB) remain a significant challenge in urological practice, particularly due to rising quinolone-resistant organisms. A povidone iodine rectal preparation (PIRP) offers a simple, reproducible, and cost-effective method to reduce rectal microbial burden and subsequent infections without additional systemic antibiotic exposure. This approach supports infection control strategies in outpatient urological procedures and aligns with antimicrobial stewardship goals by minimizing unnecessary antibiotic use.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Enables evaluation of antimicrobial agents for topical prophylaxis in mucosal infection models.
- Operational Value: Provides a standardized method to assess microbial reduction in the rectal vault pre- and post-intervention.
Screening & Assay Development
- Scientific Value: Facilitates development and validation of quantitative microbial culture assays from rectal swabs.
- Operational Value: Supports high-throughput screening of antiseptic formulations for mucosal infection prevention.
Translational & Preclinical Research
- Scientific Value: Offers a translatable model for assessing topical antimicrobial efficacy in human mucosal tissues.
- Operational Value: Enables preclinical evaluation of infection risk reduction strategies prior to clinical adoption.
Pipeline & Workflow Integration
The PIRP technique integrates into the pre-procedural workflow of TRUS PNB, serving as a preventive step to reduce infectious complications before biopsy sampling.
- Discovery Biology: Supports hypothesis testing regarding mucosal microbial translocation and infection mechanisms during biopsy.
- Screening: Enables assay readiness for quantifying microbial colony counts in rectal vault specimens.
- Analytics: Generates quantitative microbial culture data to compare pre- and post-treatment bacterial loads.
- Translational Research: Connects bench-level antimicrobial activity to clinical infection outcomes in urological procedures.
- Enterprise Reuse: Represents a reusable infection control platform adaptable to other trans mucosal procedures.
Operational & Enterprise Impact
- Scientific Value: Provides mechanistic insight into microbial burden reduction and infection prevention.
- Operational Value: Delivers a simple, reproducible, and scalable method using readily available materials.
- Strategic Value: Reduces procedure-related infections, decreasing clinical burden and healthcare costs.
- Portfolio Impact: Supports risk-adjusted decision-making in urological device and procedure development.
Implementation Considerations
- Requires training in aseptic technique and proper mucosal application.
- Necessitates access to sterile gauze, povidone iodine solution, lidocaine jelly, and gynecologic swabs.
- Demands standardization across clinical staff to ensure consistent slurry preparation and application timing.
- Requires patient screening for iodine or shellfish allergy prior to use.
- Limited to mucosal pretreatment; does not replace systemic antibiotics in high-risk patients.
