Recommendation
On the basis of this review, the authors believe that the topical application of PVP-I is safe and may help to reduce the viral load, and the potential aerosolization, of SARS-CoV-2. Until confirmatory studies are conducted, our institutional consensus is to dilute commonly available PVP-I (typically 10%) 1:3 with saline to achieve a 2.5% concentration and bulb syringe the solution into the oral/nasal cavity, after intubation, but immediately prior to head and neck procedures that require instrumentation of the upper airway mucosa during the COVID-19 pandemic. We leave the solution in for approximately 1 minute before irrigating with saline and suctioning it out to reduce residual absorption and limit tissue staining. This procedure is applied to both COVID-19 positive adult patients and to patients with unknown status unless they have a contraindication to topical iodine (allergy/anaphylaxis, labile thyroid disease, contact dermatitis, pregnancy/nursing, active radioiodine therapy). This concentration is ten times the lowest PVP-I concentration found to be effective in-vitro to eliminate related coronaviruses but still likely a safe concentration for one-time use based upon past studies described. Due to a paucity of supporting literature, no recommendation can be made for the use of chlorhexidine-based rinses.