Iodine povacrylex outperforms chlorhexidine in skin antisepsis alcohol solution study

Editor's Note

A recent study shows show skin antisepsis with iodine povacrylex in alcohol could result in fewer surgical-site infections among patients with closed extremity fractures than antisepsis with chlorhexidine gluconate in alcohol. Published February 1 in the New England Journal of Medicine, the study shows similar results between the two solutions in patients with open fractures. 

Previous studies comparing the two solutions as skin antisepsis before surgical repair of a fractured limb have had conflicting results. In this case, researchers conducted a cluster-randomized, crossover trial at 25 US and Canadian hospitals. Each hospital received a random assignment 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), then alternated interventions every 2 months.

Among 6,785 patients with closed fractures, surgical-site infection occurred in 77 (2.4%) in the iodine group and in 108 (3.3%) in the chlorhexidine group. Among the 1,700 patients with open fractures, surgical-site infection occurred in 54 (6.5%) in the iodine group and in 60 (7.3%) in the chlorhexidine group. The frequencies of unplanned reoperation, 1-year outcomes, and serious adverse events were similar in the two groups.