Two Antiseptic Solutions Equally Effective in Preventing Postsurgical Infection

For patients who require surgery for an open fracture, both aqueous 10% povidone-iodine and aqueous 4% chlorhexidine gluconate were found to be equally effective for infection prevention, according to a recent study.

In the study, called Aqueous-PREP, the researchers aimed to compare the 2 commonly used antiseptic solutions for patients who underwent surgery involving traumatic contaminated wounds. Povidone-iodine is the preferred use in treatment, but the researchers examined the possible use of chlorhexidine skin antisepsis—frequently used in other surgical procedures.

The researchers conducted a multiple-period, cluster-randomized, crossover trial that spanned 14 hospitals located in Canada, Spain, and the United States. At the beginning of the trial, each hospital randomly received either formulation to use immediately before the surgical incision. After the procedure, the physicians alternated between the treatments every 2 months.

A total of 1638 patients participated in the study and were randomly divided into 2 cohorts. One group received treatment with povidone-iodine (n = 828) and the other was treated with chlorhexidine gluconate (n = 810).

The primary outcome of the trial was surgical site infection. Of the total number of participants, 1571 had a known primary outcome. From the total, 7% (n = 59) of the participants in the povidone-iodine group had a surgical site infection occur. Similarly, for the participants in the chlorhexidine gluconate group, 7% (n = 58) of the total participantswere found to have a surgical site infection occur.

“For patients who require surgical fixation of an open fracture, either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate can be selected for skin antisepsis on the basis of solution availability, patient contraindications, or product cost,” the researchers wrote. “These findings might also have implications for antisepsis of other traumatic wounds.”


—Jessica Ganga


PREP-IT Investigators. Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial. Lancet. Published online October 15, 2022. doi:10.1016/S0140- 6736(22)01652-X