Skin disinfectant choice impacts surgery infection risk

Antisepsis importance in extremity fracture surgery.

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The solution surgeons use to clean a patient’s skin before surgery affects the risk of infection, says a study by McMaster University and the University of Maryland School of Medicine. In the PREPARE trial with 8,500 participants across 25 hospitals, using iodine povacrylex in alcohol reduced surgical site infections for closed fracture surgeries.

Published in The New England Journal of Medicine, these findings could prompt hospitals to consider using this solution for fracture surgeries, benefiting thousands of patients annually.

Sheila Sprague, co-principal investigator of the trial and an associate professor in the Department of Surgery at McMaster, said, “This trial represents a highly successful collaboration between McMaster University, the University of Maryland School of Medicine, and 25 trauma centers across Canada, and the United States.”

In the trial, 6,785 patients with closed fractures and 1,700 with open fractures underwent surgery. Closed fractures have intact skin, while open fractures have a higher infection risk due to exposed wounds.

Comparing common antiseptics, patients with closed fractures using iodine povacrylex in alcohol had fewer infections than those using chlorhexidine gluconate in alcohol. For open fractures, infection risks were similar with both antiseptics. The study highlights the importance of the skin disinfectant choice in reducing post-operative infections, especially for closed fractures.

Gerard Slobogean, co-principal investigator of the trial and an orthopedic trauma surgeon at the University of Maryland’s R Adams Cowley Shock Trauma Center, said, “Although some guidelines favor antisepsis with chlorhexidine gluconate over an iodophor, all recommendations have recognized a lack of consensus concerning the most effective agent.

The study underscores the critical role of skin disinfectant choice in influencing infection risks during surgical procedures. The results suggest that iodine povacrylex in alcohol may be a more practical option for reducing post-operative infections, particularly in surgeries for closed fractures. This insight could prompt hospitals to revise their policies to enhance patient outcomes in fracture surgeries.

Journal reference:

  1. The PREP-IT Investigators.Skin Antisepsis before Surgical Fixation of Extremity Fractures. The New England Journal of Medicine. DOI: 10.1056/NEJMoa2307679.

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