Large Multicenter Clinical Trial Finds that Antiseptic Containing Iodine Reduces Surgical-Site Infections in Patients with Extremity Fractures

Study results published in the New England Journal of Medicine could prevent thousands of surgical-site infections each year, researchers predict

February 2, 2024

A large multicenter clinical trial found that an antiseptic containing iodine resulted in about one-quarter fewer post-surgical infections in patients with limb fractures compared to another frequently used skin antiseptic. 

The results of the study of nearly 8,500 patients across the United States and Canada were recently published online in the New England Journal of Medicine.

The study was jointly led by University of Maryland School of Medicine, in Baltimore, and McMaster University in Hamilton, Ontario. 

Wake Forest University School of Medicine and Atrium Health Wake Forest Baptist Medical Center, in Winston-Salem, and Atrium Health Carolinas Medical Center, in Charlotte, were two of the 25 participating medical centers in the United States and Canada. 

The PREPARE (Pragmatic Randomized Trial Evaluating Preoperative Alcohol Skin Solutions in Fractured Extremities) trial – which compared the two most commonly used alcohol-based solutions, one with iodine povacrylex, and the other with chlorhexidine gluconate – may prompt changes in the type of antiseptic orthopaedic surgeons use to prepare the skin to repair fractures. Researchers saw the benefit in patients with closed, or simple fractures, where the skin remains intact, but not in compound fractures with open wounds, although they noted that using the iodine preparation was not harmful to these open-fracture patients.

“We are pleased to have collaborated on this important study that will change the way we care for fracture and trauma patients,” said Dr. Holly Pilson, associate professor of orthopaedic surgery at Wake Forest University School of Medicine and an orthopaedic trauma surgeon and the principal investigator at Atrium Health Wake Forest Baptist’s site. “We are grateful to our entire team and our colleagues at Atrium Health Carolinas Medical Center for their hard work and dedication that will help us improve outcomes for our patients.”

The study was funded with $11.2 million from the Patient-Centered Outcomes Research Institute (PCORI), with additional support from the Canadian Institutes of Health Research.

Read the full release from University of Maryland School of Medicine.