Iodine povacrylex tied to fewer surgical-site infections than chlorhexidine gluconate in closed extremity fractures: study

Skin antisepsis with iodine povacrylex in alcohol resulted in fewer surgical-site infections than with chlorhexidine gluconate in alcohol in closed extremity fractures: study

Studies evaluating surgical-site infection have had conflicting results with respect to the use of alcohol solutions containing iodine povacrylex or chlorhexidine gluconate as skin antisepsis before surgery to repair a fractured limb (i.e., an extremity fracture).

In a cluster-randomized, crossover trial at 25 hospitals in the United States and Canada, the authors randomly assigned hospitals to use a solution of 0.7% iodine povacrylex in 74% isopropyl alcohol (iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (chlorhexidine group) as preoperative antisepsis for surgical procedures to repair extremity fractures. Every 2 months, the hospitals alternated interventions. Separate populations of patients with either open or closed fractures were enrolled and included in the analysis. The primary outcome was surgical-site infection, which included superficial incisional infection within 30 days or deep incisional or organ-space infection within 90 days. The secondary outcome was unplanned reoperation for fracture-healing complications.

The study has been published in ‘The new england journal of medicine’

Key findings of the study were:

• A total of 6785 patients with a closed fracture and 1700 patients with an open fracture were included in the trial.

• In the closed-fracture population, surgical-site infection occurred in 77 patients (2.4%) in the iodine group and in 108 patients (3.3%) in the chlorhexidine group (odds ratio, 0.74; 95% confidence interval [CI],

• 0.55 to 1.00; P = 0.049).

• In the open-fracture population, surgical-site infection occurred in 54 patients (6.5%) in the iodine group and in 60 patients (7.3%) in the chlorhexidine group (odd ratio, 0.86; 95% CI, 0.58 to 1.27; P = 0.45).

• The frequencies of unplanned reoperation, 1-year outcomes, and serious adverse events were similar in the two groups.

The authors concluded that – ‘Among patients with closed extremity fractures, skin antisepsis with iodine povacrylex in alcohol resulted in fewer surgical-site infections than antisepsis with chlorhexidine gluconate in alcohol. In patients with open fractures, the results were similar in the two groups. Nevertheless, the possibility that patients will have an allergic reaction to an ingredient in either solution means that hospitals will need to continue to stock both interventions.’

Further reading:

Skin Antisepsis before Surgical Fixation of Extremity Fractures

Sprague and Slobogean et al

N Engl J Med 2024;390:409-20.

DOI: 10.1056/NEJMoa2307679