A new study suggests that the choice of skin disinfectant affects infection risk in surgery.
Fresh findings indicate that iodine-based antiseptics decrease surgical-site infections in individuals with extremity fractures.
The study, involving nearly 8,500 participants across the US and Canada, compared the effectiveness of two commonly used alcohol-based solutions and was published in the New England Journal of Medicine.
Dr Gerard Slobogean, an Associate Professor of Orthopaedics at the University of Maryland School of Medicine, spearheaded the trial.
It revealed that an antiseptic containing iodine remarkably reduced post-surgical infections by about one-quarter compared to another frequently utilised skin antiseptic.
While the iodine-based solution showed significant benefits in patients with closed fractures, where the skin remains intact, its efficacy was not observed to the same extent in compound fractures with open wounds.
Nevertheless, the use of iodine preparation was deemed safe for patients with open fractures.
Dr Slobogean emphasised the potential impact of these findings.
He said: ‘Our results suggest that using iodine povacrylex in alcohol as a preoperative skin antiseptic could prevent surgical-site infections in thousands of patients with closed fractures each year.’
Over a million Americans undergo surgery to treat limb or pelvic fractures each year, with approximately three per cent developing surgical-site infections. The trial’s outcomes could influence the standard of care in orthopaedic surgery, clarifying the most effective antiseptic agent for preparing the skin before fracture repair procedures.
Dr Todd Jaeblon, an Associate Professor of Orthopaedics at the University of Maryland School of Medicine, hailed the study’s significance.
‘The results of this well-designed study provide some long overdue clarity to orthopaedic trauma surgeons with respect to which commonly used antiseptic skin preparation is more effective when preparing for fracture surgery.’
The trial, named PREPARE (Pragmatic Randomised Trial Evaluating Preoperative Alcohol Skin Solutions in Fractured Extremities), was jointly led by the University of Maryland School of Medicine and McMaster University of Hamilton, Ontario.
It received funding totalling $11.2 million from the Patient-Centred Outcomes Research Institute (PCORI) and additional support from the Canadian Institutes of Health Research.
Dr Mark T Gladwin, MD, the John Z. and Akiko K. Bowers Distinguished Professor and Dean at UMSOM, lauded the trial’s robust design and potential to serve as a model for future research endeavours.
The success of PREPARE underscores the collaborative efforts of researchers, clinicians, and trauma centres across North America, with over 200 individuals contributing to the investigation. This research addresses critical gaps in infection control techniques and sets a precedent for advancing evidence-based practices in orthopaedic trauma surgery.
Trauma surgeon uses chlorhexidine gluconate as skin antisepsis before surgery to repair a fractured arm. CREDIT University of Maryland School of Medicine
