Every year, millions of patients around the world suffer from infections after undergoing surgery. According to the WHO, around 10% of trauma patients with an open fracture develop an infection. Reducing the risk of infection in these cases is a global health priority, especially for countries with limited access to infection prevention measures.
Currently, to prepare the area that will be surgically intervened, the health staff applies iodine o chlorhexidine (an alcohol-based solution), the two most commonly used antiseptic solutions. While this second solution is the most recommended option for some specialties such as general surgery or gynecology, there was no scientific evidence as to which was the optimal antiseptic to use specifically in patients who are to undergo surgery for an open fracture, as explained by traumatologist and researcher at Parc Taulí Francesc Marcano.
Reducing the risk of infection is a global health priority, especially in countries with limited access to prevention measures
"There are studies done in different specialties on the use of both antiseptic solutions and, for the most part, chlorhexidine is the most cited option. However, in traumatology we were transferring results from other specialties, however this extrapolation it is not suitable", explains Marcano. "Infections in the field of traumatology can be more complicated to detect than in other specialties, and this can lead to long-term complications in the consolidation of fractures."
There was no scientific evidence on the optimal antiseptic to use in patients undergoing fracture surgery
An international study to determine which is the best option
Faced with this situation, an international group of researchers has studied which is the best antiseptic solution with which to prepare the skin before an open fracture operation. The specific objective has been to compare the effectiveness of iodine against a solution with chlorhexidine, both aqueous-based.
The study has been led by the Universities of Maryland (United States) and McMaster (Canada), -world reference institution in traumatology-, and has had the participation of Francesc Marcano and Laia Martínez-Carreres from Locomotor System Research Group from Parc Taulí Research and Innovation Institute (I3PT), and the nurse from Parc Taulí Matsuyama Sanz, in charge of leading the study in Europe. Likewise, it has also been carried out at Vall d'Hebron University Hospital and in 10 other institutions in the USA and Canada. The research has had the participation of 1.700 patients, an extraordinary number with regard to studies in traumatology, according to Marcano.
The results, which have been published in the prestigious magazine The Lancet, have shown that the incidence of infections in open fractures is the same in the two groups and, therefore, it can be stated that both antiseptic solutions are equally good.
The results, published in 'The Lancet', have shown that both antiseptic solutions are equally good
A very relevant answer for countries with scarce resources
The implications of the results of this study are particularly relevant to countries with limited access to resources and with logistical difficulties. "This flexibility is particularly important when you cannot have both solutions". In the case of these health systems "the results potentially justify the acquisition of a single product for these populations if necessary".
As I3PT researcher Francesc Marcano points out, in certain areas there is more availability of iodine and you can acquire at a better price. “Considering this aspect, it is very important to note that the two solutions are equally effective in the case of open fractures".
PREP-IT Researchers. Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial. Lancet. 2022 Oct 15;400(10360):1334-1344. doi: 10.1016/S0140-6736(22)01652-X. PMID: 36244384. https://pubmed.ncbi.nlm.nih.gov/36244384/
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