Study finds antisepsis agents interchangeable in reducing infection risk in open fracture surgeries (Iodine as good as chlorhexidine)

Medical Xpress / Louisiana State University / The Lancet ^ | Oct. 14, 2022 | Robert Zura, MD et al

[ConservativeMind]

Orthopaedics faculty participated in a study comparing two antisepsis aqueous solutions in reducing the risk of infection in patients requiring surgery for open fractures. In the largest known randomized-controlled trial, the research team found that contrary to current international recommendations, chlorhexidine gluconate was not superior to povidone-iodine in an alcohol or aqueous solution in preventing surgical site infection.

The results suggesting health care practitioners can select either aqueous-based antisepsis solution when treating open fractures on the basis of solution availability, patient contraindications, or product cost are published in The Lancet.

The authors highlight WHO estimates of millions of patients worldwide each year who have surgical site infections. The inherent risk of using fracture fixation in a contaminated or dirty wound is realized in about 10% of open fractures developing surgical site infections. Orthopaedic surgical procedures have the highest infection rate, greater than 20% for severe open tibia shaft fractures.

Previous reviews of general surgery, obstetrics and gynecology trials suggested the superiority of chlorhexidine over iodine. The Aqueous-PREP multiple-period, cluster-randomized, crossover trial included 14 hospitals in Canada, Spain and the United States and 1,638 adults who underwent surgery for an open extremity fracture.

It found that the odds of surgical site infection or unplanned fracture-related reoperations did not differ between patients assigned to receive skin antisepsis with aqueous 10% povidone or aqueous 4% chlorhexidine gluconate. The authors wrote that their "findings contrast the superiority of chlorhexidine in alcohol that has been shown in clean or clean-contaminated surgery."

The authors note their findings could have particular relevance to low- and middle-income countries, where both antiseptic solutions might not be readily available.

They conclude that their "findings are not only relevant to the management of open fractures but might also be applicable to the surgical treatment of other traumatic wounds."

[ConservativeMind]

I’ll take the iodine, because we need it and the body can adjust to a large dose.

[ConservativeMind]

The “Take Charge Of Your Health” Ping List
This high volume ping list is for health articles and studies which describe something you or your doctor, when informed, may be able to immediately implement for your benefit.

Email me to get on either the “Common/Top Issues” (20 - 25% fewer pings) or “Everything” list.

[Deaf Smith]

Iodine (monkey blood) used to be a common component of first aid kits.

[Liaison]

I’ll take the iodine, but the wife is allergic. It’s nice to have an alternative when needed.

[Sparky1776]

I use it on an amputation site on my right foot and a problem toe on my left on a fairly regular basis, sometimes daily for the past three years. So far so good.