Antisepsis Agents Are Interchangeable in Reducing Open Fracture Infection Risks

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antisepsis

Two antisepsis aqueous solutions were compared by the orthopaedic faculty at LSU Health New Orleans to study whether they reduce the risk of infection in patients requiring surgery for open fractures. It was one of the largest known randomized trials and it revealed that the current international recommendations are contradictory. Chlorhexidine gluconate did not show superiority to povidone-iodine in alcohol and aqueous solution to prevent infection of surgical sites.

The results of the study published in The Lancet suggested that healthcare workers can choose either of the two aqueous-based antisepsis solutions during the treatment of open fractures. It can be based on the availability of solutions, product cost, or patient contraindications.

Rober Zura MD and Jessica Rivera MD, Ph.D., are also co-authors of the paper.

I am proud of Dr Rivera’s and LSU Health New Orleans’ contributions to this landmark study published in such a prestigious journal

Rober Zura MD

The authors highlighted that according to WHO, millions of patients suffer from surgical site infections across the globe. However, only 10% of the time it is noted that fracture fixation on a dirty or contaminated wound comes with inherent risks in open fractures. Eventually leading to the development of surgical site infections. Additionally, orthopaedic surgical interventions have the highest rate of infections. Furthermore, it is more than 20% for severe open tibia shaft fractures.

Which Antisepsis Aqueous Solution is Superior?

Previous general surgery reviews claim through obstetrics and gynaecology trials that chlorohexidine is superior to iodine. The studies conducted are based on Aqueous-PREP multiple-period cluster-randomized, crossover trial. Furthermore, it included fourteen hospitals in Canada, Unites States, and Spain with 1,683 adults who underwent open extremity fracture surgery.

Moreover, the trial revealed that the odds of unplanned fracture-related reoperations and surgical site infection were the same for patients whether they received skin antisepsis with aqueous 10% povidone or aqueous 4% chlorhexidine gluconate.

The authors wrote,

findings contrast the superiority of chlorhexidine in alcohol that has been shown in clean or clean-contaminated surgery

However, they also noted that their findings may have relevance to low- or middle-income countries. The reason is that both antisepsis solutions might not be available and must not be cost-efficient.

The authors further concluded,

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

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