Research findings show that using iodine-povidone in alcohol instead of chlorhexidine gluconate before surgery is associated with fewer site infections in closed, but not open, extremity fractures.
These results could lead to many hospitals considering a change in guidelines for the use of iodine-povidone in alcohol during fracture surgeries, as it reduces site infections in closed fractures without harm to patients with open fractures, said study author Sheila Sprague, MD, an associate professor of surgery at McMaster University in Hamilton, Ontario, Canada, as reported by Medscape.
A cluster-randomized crossover study in 25 hospitals in Canada and the United States found that in the iodine group, 2.4% of patients with closed fractures experienced site infections, compared to 3.3% in the chlorhexidine group. The number of postoperative wound infections was similar in both groups for open fractures: 6.5% in the iodine group and 7.3% in the chlorhexidine group.
Due to the high number of fracture surgeries performed annually in North America, the use of iodine-povidone in alcohol as preoperative skin antisepsis has the potential to prevent site infection in thousands of patients with closed fractures each year, according to Sprague. These findings could lead to significant changes in clinical practice.
The study was published online on February 1 in the New England Journal of Medicine.
The researchers noted that previous studies on site infections before fracture repair surgeries delivered conflicting results. In their multicenter study, the two most common approaches in Canada and the United States for closed and open fractures were compared.
The study included 6,785 patients with closed fractures and 1,700 patients with open fractures. The primary outcome was a site infection, and the secondary outcome was an unplanned reoperation due to fracture-related complications.
Authors of an accompanying editorial stressed the need for further studies to continue reducing the risk of postoperative wound infections. They suggested that a deeper understanding of individual patient microbiomes may lead to tailored interventions to further reduce infection risk.
Funding for the study was provided by the Patient-Centered Outcomes Research Institute and the Canadian Institutes of Health Research. Sprague and Tamber disclosed no conflicts of interest, and Rogers and Wenzel are editors of the New England Journal of Medicine.