To reduce transmission for the front-line health care provider, use of a prophylactic nasal spray and oral mouthrinse may be a useful approach. Povidone-iodine (PVP-I) is a widely available broad-spectrum antiseptic with potent antiviral, antibacterial and antifungal activity. It is commonly used in clinical settings for skin disinfection before and after surgery. In vitro studies support its use against COVID-19, MERS-CoV, H1N1 influenza and rotavirus with good efficacy. It has been shown to be an effective therapy when used as a mouthwash or intranasally. In addition, 0.2% PVP-I solution has been shown to be safe when administered intranasally and as a mouth-rinse.

The American Dental Association has published guidelines for minimizing transmission of COVID-19, which includes the use of a preoperative 0.2% PVP-I mouthwash. The aim is to reduce the viral “load” from key areas from where virus-containing droplets are aerosolized. Researchers have reported significantly reduced viral load lasting for up to four hours following intranasal and mouth-rinse.

A 1% PVP-I solution is usually available in preoperative areas and could be diluted with saline (1 cc of PVP-I with 20 cc of saline for an approximate 0.2% solution). Patients would be asked to gargle for 30 seconds before expectorating into a basin. Additionally, a buffered saline solution containing 0.2% PVP-I could be administered intranasally before an aerosolizing event like dental procedure or intubation