Optimal Antiseptic for Preoperative Skin Preparation in Orthopedic Surgeries
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Reviewed & translated by Dat Tien Nguyen, B.A, ScM.
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Posted on March 20th, 2024
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There exists uncertainty regarding the optimal antiseptic for preoperative skin preparation in orthopedic surgeries aimed at correcting fractures. Commonly utilized agents include alcohol, chlorhexidine, and iodophor. However, variations among facilities exist in terms of concentrations, compositions, and solution types of these antiseptic agents. Consequently, a study was undertaken to ascertain the most effective antiseptic for preventing surgical site infections.
The study was conducted across medical facilities in Canada and the United States and involved 6785 patients admitted for surgery to address closed lower-limb fractures and closed pelvic fractures, along with 1700 patients with open upper-limb and lower-limb fractures. Post-surgery, patients received a short-course antibiotic regimen lasting between 1 and 2 days. Within both fracture groups, patients were randomly allocated to receive either preoperative preparation with 0.7% iodine povacrylex in 74% isopropyl alcohol or 2% chlorhexidine gluconate in 70% isopropyl alcohol. Stratification measures were implemented to ensure equal representation across experimental groups concerning fracture location, soft-tissue injuries, and body mass index, among other variables.
Following a 90-day monitoring period, findings indicated that prepping the surgical site for closed fractures with 0.7% iodine povacrylex in 74% isopropyl alcohol resulted in a 26% decrease in infection risk compared to the application of 2% chlorhexidine gluconate in 70% isopropyl alcohol. However, no notable difference in the surgical-site infection risk was observed among patients requiring surgery for open fractures. Researchers speculated that the ineffectiveness in open-fracture patients might stem from iodophor activity attenuation due to saline irrigation and the diverse bacterial population potentially encountered at the open-fracture site.
The study was conducted across medical facilities in Canada and the United States and involved 6785 patients admitted for surgery to address closed lower-limb fractures and closed pelvic fractures, along with 1700 patients with open upper-limb and lower-limb fractures. Post-surgery, patients received a short-course antibiotic regimen lasting between 1 and 2 days. Within both fracture groups, patients were randomly allocated to receive either preoperative preparation with 0.7% iodine povacrylex in 74% isopropyl alcohol or 2% chlorhexidine gluconate in 70% isopropyl alcohol. Stratification measures were implemented to ensure equal representation across experimental groups concerning fracture location, soft-tissue injuries, and body mass index, among other variables.
Following a 90-day monitoring period, findings indicated that prepping the surgical site for closed fractures with 0.7% iodine povacrylex in 74% isopropyl alcohol resulted in a 26% decrease in infection risk compared to the application of 2% chlorhexidine gluconate in 70% isopropyl alcohol. However, no notable difference in the surgical-site infection risk was observed among patients requiring surgery for open fractures. Researchers speculated that the ineffectiveness in open-fracture patients might stem from iodophor activity attenuation due to saline irrigation and the diverse bacterial population potentially encountered at the open-fracture site.