June 22, 2024

Surgeons’ choice of skin disinfectant impacts infection risk, reveals study conducted in Canada and the United States

The type of skin disinfectant used by surgeons before surgery can affect the risk of surgical site infection, according to a recent study conducted by McMaster University and the University of Maryland School of Medicine. The research, part of the PREPARE trial, involved nearly 8,500 participants across 25 hospitals in Canada and the United States. The study found that the use of iodine povacrylex in alcohol to disinfect a patient’s skin could significantly reduce the risk of surgical site infection in patients undergoing surgery for a closed fracture.

The findings of the study, which have been published in The New England Journal of Medicine, are expected to prompt hospitals to consider a shift in policy towards using iodine povacrylex in alcohol for fracture surgeries. “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. This multi-center approach allowed us to quickly and efficiently address an important clinical research question that will lead to the prevention of thousands of infections each year,” said Sheila Sprague, co-principal investigator of the trial and associate professor in the Department of Surgery at McMaster.

The trial included 6,785 patients with closed lower extremity or pelvic fractures and 1,700 patients with open fractures. Closed fractures occur when the bone is broken but the skin remains intact, while open fractures have a higher risk of infection due to the exposure of the wound and bone to environmental bacteria before surgery. The researchers compared two commonly-used antiseptic products in the United States and Canada.

The results showed that patients with closed fractures who received 0.7% iodine povacrylex in 74% isopropyl alcohol for skin disinfection experienced fewer post-operative surgical site infections compared to those who received 2% chlorhexidine gluconate in 70% isopropyl alcohol. However, in patients with open fractures, the risk of infection was similar regardless of the type of antiseptic used.

The findings of this trial highlight the potential benefits of using iodine povacrylex in alcohol as a preoperative skin disinfectant for patients with closed fractures. “Although some guidelines favor antisepsis with chlorhexidine gluconate over an iodophor, all recommendations have recognized a lack of consensus with respect to the most effective agent. Our results suggest that the use of iodine povacrylex in alcohol as preoperative skin disinfection could prevent surgical-site infection in thousands of patients with closed fractures each year,” said Gerard Slobogean, co-principal investigator of the trial and an orthopedic trauma surgeon at the University of Maryland.

The study also highlighted the importance of patient involvement in the research process. Jeffrey Wells, a patient partner and member of the trial’s executive committee, emphasized the significance of including the voice of trauma patients in the design, implementation, and dissemination of the trial.

The authors of the study noted that this randomized controlled trial is significantly larger than previous trials, allowing for the detection of important differences in infection rates. While the trial focused on fracture surgery patients, the researchers believe that the findings may also have relevance for other surgical disciplines.

1. Source: Coherent Market Insights, Public sources, Desk research
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