New Orleans, LA – LSU Health New Orleans School of Orthopedics participated in a study comparing two antiseptic aqueous solutions to reduce 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 site infection. operative. Findings suggesting that healthcare practitioners can choose either aqueous antiseptic solution when treating open fractures based on solution availability, patient contraindications, or product cost are published in The Lancetavailable here.
Robert Zura, MD, professor and chief of orthopedics, and Jessica Rivera, MD, PhD, associate professor of orthopedics, at LSU Health New Orleans School of Medicine, are also co-authors of the article.
“I am proud of the contributions of Dr. Rivera and LSU Health New Orleans to this landmark study published in such a prestigious journal,” says Dr. Zura.
The authors point to WHO estimates of the 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 approximately 10% of open fractures developing surgical site infections. Orthopedic surgical procedures have the highest infection rate, exceeding 20% for severe open fractures of the shaft of the tibia.
Previous reviews of trials in general surgery, obstetrics, and gynecology have suggested the superiority of chlorhexidine over iodine. The multi-period, cluster-randomised, Aqueous-PREP
The crossover trial included 14 hospitals in Canada, Spain and the United States and 1,638 adults who underwent surgery for an open limb fracture. It found that the risks of surgical site infection or unplanned fracture-related reoperations did not differ between patients assigned to receive skin antisepsis with 10% aqueous povidone or 4% aqueous chlorhexidine gluconate. . The authors wrote, “Our results contrast with the superiority of chlorhexidine over alcohol that has been demonstrated in clean or clean and contaminated surgery.”
The authors note that their findings may be particularly relevant for low- and middle-income countries, where both antiseptic solutions may not be readily available or procure both.
products is unnecessarily expensive.
They conclude: “Our results are not only relevant for the management of open fractures, but could also be applicable to the surgical treatment of other traumatic wounds.”
This study was funded by the United States Department of Defense, the Canadian Institutes of Health Research, McMaster University Surgical Associates and the PSI Foundation.
LSU New Orleans Health Sciences Center educates Louisiana healthcare professionals. The state’s flagship health sciences university, LSU Health New Orleans, includes a medical school with campuses in Baton Rouge and Lafayette, the only dental school in the state, the only public health school Louisiana Public and Allied Health, Nursing, and Graduate Schools. Studies. LSU Health New Orleans faculty care for patients at public and private hospitals and clinics across the region. At the forefront of bioscience research in a number of fields on the world stage, the LSU Health New Orleans research enterprise generates jobs and enormous economic impact. LSU Health New Orleans faculty have made life-saving discoveries and continue to work to prevent, advance treatment, or cure disease. To learn more, visit http://www.lsuhsc.edu, http://www.twitter.com/LSUHealthNOWhere http://www.facebook.com/LSUHSC.
# # #
Randomized controlled/clinical trial
The title of the article
Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multi-period, cluster-randomised crossover trial
Publication date of articles
Oct 14, 2022
Conflict of Interest Statement
GPS reports site payments and principal investigator support for this manuscript from the U.S. Department of Defense and the editorial or executive board of the Journal of Orthopedic Trauma, and is a board or committee member of the Orthopedic Trauma Association , apart from the submitted work. SS reports payments made to the institution by the US Department of Defense, Medical Services, and McMaster Surgical Associates for this manuscript. JLW reports a stipend from the PREP-IT study for submitted work, support to attend site orientation visits and the PCORI conference, and attendance on a data security oversight board or council advisory to METRC, the Johns Hopkins Bloomberg School of Public Health, and the University of Maryland Institutional Review Board. ADH reports a grant (contract number W81XWH-17-1-0702) to its institution from the US Department of Defense for this manuscript. WO reports AO North America’s payment for an educational event, patient attorney’s fees, and expert opinion, AO International’s U.S. Task Force Commission, and is a member of the Board of Directors or the Southeastern Fracture Consortium committee, apart from the submitted work. SJW reports grants from AO North America, consulting fees for implant development from Synthes, and payments or honoraria for educational events from Smith and Nephew and Stryker Globus, outside of submitted work. JLG reports payments to their institution for the effort and support of the coordinator for PCORI and McMaster University study activities for this manuscript. The SNP reports a grant for study unrelated to this work from the Orthopedic Trauma Association and an honorarium for work unrelated to this manuscript from Skeletal Dynamics. RVO reports support for this manuscript from the US Department of Defense, funding from the Department of Defense regarding orthopedic surgery and infection (TOBRA, VANCO, OXYGEN grants), as well as PCORI regarding venous thromboembolism, royalties from Lincotek, Stryker’s consulting fees, and Imagen stock options, outside of the submitted work. MJP reports consultation fees for orthopedics on their tibial nail project, outside of the submitted work. JL reports Stryker royalties or licenses, Stryker consulting fees, and the chair of the Orthopedic Trauma Association’s public relations committee, AONATEC, outside of submitted work. MTM reports consulting fees from Stryker, ITS, and Acumed, board of directors of the Orthopedic Trauma Association and associate editor of the Journal of Orthopedic Trauma, outside of submitted work. MM reports payments to his institution from the U.S. Department of Defense, U.S. patents for implants using ultrasonic backscatter to detect the electrical impedance of tissues, and for a quantitative tool using impedance spectroscopy to monitor wound healing. fractures, participation in the classification committee chair for the Orthopedic Trauma Association, and an investment in an exchange-traded fund, outside of submitted work. NNO reports support for this manuscript to its institution at the US Department of Defense. GJDR reports research payments made to his institution by the AO Foundation, royalty payments unrelated to the manuscript or Wright-Tornier research, travel and meeting expenses from the AO Foundation, several patents held unrelated to the manuscript or research of Intellectual Ventures, a member of the Board of Advisors of the American Academy of Orthopedic Surgeons and a minority shareholder of Mergenet Medical and the Orthopedic Implant Company, outside of the submitted work. RDZ reports consulting fees from Bioventus, Osteocentric, and Stryker, payment for being a Bioventus consultant speaker, and is a board member of the Kuntsher Society, outside of submitted work. JTP reports grants or contracts from AO North America for the Young Investigator Research Development Award, guest speaker for AO Trauma North America Internet Live Series: Orthopedic Trauma Journal Club Session (topic: femoral neck), and support to attend meetings or travel from AO North America for the Young Investigator Research Development Award, outside of submitted work. DM reports a stipend from the PREP-IT study for submitted work and support to attend the PCORI conference twice. ILG reports research grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institutes of Health and the Department of Defense Peer Reviewed Orthopedic Research Program Clinical Translational Research Award, consulting and teaching fees from Stryker, payments instruction from AO North America and support for attendance at Institutional CME meetings, outside of submitted work. JCR reports grants from the United States Department of Defense and board or committee member of the Limb Lengthening and Reconstruction Society, Orthopedic Research Society, and American Academy of Orthopedic Surgery, apart from submitted work. PJD reports a grant from Abbott Diagnostics, Roche Diagnostics, and Siemens, consulting fees from Trimedic, payment or fees for presentations from Bayer and Roche, a member of the advisory boards of Bayer and Quidel Canada, and receipt of monitoring devices from CloudDX and Philips Healthcare, outside of the submitted work. MB reports payments made to the institution for this manuscript by the Canadian Institutes of Health Research, U.S. Department of Defense, McMaster University Surgical Associates, and Physician Services, payments made to his institution by the National Institutes of Health and the Michael G DeGroote Institute for Pain Research and Care, and is a member of the Advisory Board of the International Society for Orthopedic Surgery and Trauma, outside of submitted work. All other authors declare no competing interests.
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of press releases posted on EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.